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Despite Huge HIV Treatment Gains, Many Left Out

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WebMD Health News
Reviewed by Louise Chang, MD

Oct. 9, 2012 -- Newer drugs that fight HIV have cut AIDS death rates dramatically over the last two decades. But a new study shows that those gains have not been shared equally.

The study, published in the Archives of Internal Medicine, found that death rates have plunged over the last two decades for those who are well educated. But deaths among people with less education, which is usually an indicator of poverty, haven’t really budged.

“It really is quite chilling,” says researcher Edgar P. Simard, PhD, MPH, a senior epidemiologist with the American Cancer Society, in Atlanta.

The study looked at the education levels more than 91,000 adults aged 25 to 64 who died because of HIV between 1993 and 2007.

A new generation of medications called highly active antiretroviral therapies (HAART) first became available in 1996. Researchers were interested in how death rates had changed since the availability of the drugs.

Indeed, they found that overall death rates had dropped for all races. The biggest drops were seen among blacks, who also had the highest infection rates.

For example, among black men with a college degree, HIV deaths for every 100,000 people in the population plummeted from 117 before HAART to 15 after those medications became available. For similarly educated white men, those numbers slid from 26 to two.

But when researchers looked just at men and women with less education -- those who had gone no farther than high school, the numbers were alarming.

Black women with no more than a high school diploma saw almost no change in death rates from HIV over 15 years of the study. From 1993 to 1995, about 30 black women for every 100,000 people in the general population died of AIDS. From 2005 to 2007, that number was about 27.

“This is very, very striking and probably one of the bellwether findings of the study,” says Simard.

Large Disparities in HIV Treatment

Though the drugs have made an impact, they aren’t reaching people of all races.

For example, the study found that death rates from HIV among black men with no more than a high school education were still higher post-HAART than they were for high school-educated white men in the early 1990s, before the drugs were available.

Experts who were not involved in the study praised its methods, saying it sheds light on something about HIV treatment that often goes unnoticed.

William E. Cunningham, MD, MPH, a professor of medicine and public health at UCLA, has spent his career studying health disparities in HIV. 

“I was not surprised, but I was really impressed by how stark the differences actually are,” Cunningham says.

“It is this group of people who are black or Latino, but the differences are really the biggest for blacks, who are doing relatively poorly despite the fact that we have available much better treatment right now.”

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