AIDS mortality, "race or color", and social inequality in a context of universal access to highly active antiretroviral therapy (HAART) in Brazil, 1999-2004

Highly active antiretroviral therapy (HAART) has led to a substantial increase in the survival of people living with AIDS, despite heterogeneities among individuals from different socioeconomic strata. The present paper analyzes AIDS deaths in Brazil during a period in which HAART became a key treatment regimen, exploring the hypothesis that "race or color" defines one dimension of socioeconomic inequality in Brazil. AIDS mortality, stratified by gender and "race or color", was calculated using data from the National Mortality System. The rates were highest among individuals classified as "black" and lower among those classified as "mixed-race", with a continuous increase among the later from 1999 to 2004 for men and women. Among individuals classified as "white", mortality rates remained stable among men, but not women. Median age at death among "mixed-race" individuals was lower for both men and women. Differential trends according to gender and "race or color" were highlighted by the present study, indicating the pressing need to further explore the underlying factors that might explain different mortality rates in a context of universal access

Distribuição social da AIDS no Brasil, segundo participação no mercado de trabalho, ocupação e status sócio-econômico dos casos de 1987 a 1998

Estudou-se a evolução temporal da epidemia de AIDS no Brasil, tendo a ocupação como variável identificadora da condição sócio-econômica dos casos. Todos os casos de AIDS de 20 a 49 anos de idade, diagnosticados entre 1987-1998, foram incluídos. Analisou-se a evolução temporal das taxas de incidência de AIDS, por sexo, categoria ocupacional e quintos da Escala de Status Sócio-econômico (ESO), além da proporção de casos segundo os quintos da ESO por categoria de exposição. Entre os homens, as taxas de incidência aumentaram, no 1: período, em praticamente todas as categorias ocupacionais, e reduziram entre aquelas classificadas como "não manuais", no 2: período. Entre as mulheres, observou-se incremento anual em quase todas as categorias ocupacionais, de 1987 a 1998. Os maiores aumentos relativos foram observados nos quintos da ESO de menor status sócio-econômico, para ambos os sexos. A categoria de exposição "UDI" foi a que apresentou o pior status sócio-econômico, em ambos os sexos, e a categoria "homo/bissexual" o status mais elevado, entre os homens. A análise evidenciou a progressiva mudança no gradiente social da epidemia de AIDS, com maior velocidade de disseminação nas populações de menor status sócio-econômico

Correction: Modeling HIV Vaccines in Brazil: Assessing the Impact of a Future HIV Vaccine on Reducing New Infections, Mortality and Number of People Receiving ARV

The AIDS epidemic in Brazil remains concentrated in populations with high vulnerability to HIV infection, and the development of an HIV vaccine could make an important contribution to prevention. This study modeled the HIV epidemic and estimated the potential impact of an HIV vaccine on the number of new infections, deaths due to AIDS and the number of people receiving ARV treatment, under various scenarios.The historical HIV prevalence was modeled using Spectrum and projections were made from 2010 to 2050 to study the impact of an HIV vaccine with 40% to 70% efficacy, and 80% coverage of adult population, specific groups such as MSM, IDU, commercial sex workers and their partners, and 15 year olds. The possibility of disinhibition after vaccination, neglecting medium- and high-risk groups, and a disease-modifying vaccine were also considered. The number of new infections and deaths were reduced by 73% and 30%, respectively, by 2050, when 80% of adult population aged 15-49 was vaccinated with a 40% efficacy vaccine. Vaccinating medium- and high-risk groups reduced new infections by 52% and deaths by 21%. A vaccine with 70% efficacy produced a great decline in new infections and deaths. Neglecting medium- and high-risk population groups as well as disinhibition of vaccinated population reduced the impact or even increased the number of new infections. Disease-modifying vaccine also contributed to reducing AIDS deaths, the need for ART and new HIV infections.Even in a country with a concentrated epidemic and high levels of ARV coverage, such as Brazil, moderate efficacy vaccines as part of a comprehensive package of treatment and prevention could have a major impact on preventing new HIV infections and AIDS deaths, as well as reducing the number of people on ARV. Targeted vaccination strategies may be highly effective and cost-beneficial

ARV patients and model fit.

<p>Number of patients receiving ARV and model fit. Brazil, 1999–2007. The blue line, number of patients of all age reported by the Brazilian STD, AIDS and Viral Hepatitis Department; the red line, Spectrum estimates of number of patients receiving ARV aged 15–49.</p