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

Abstract

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.

Twenty-five years of the AIDS epidemic in Brazil: principal epidemiological findings, 1980-2005

“…As of the beginning of the present decade AIDS is no longer the principal cause of death among young male adults, and there was a pronounced increase in the median age of death 51 . Meanwhile even though women always have had a lower death rate than men, a persistent growth in the AIDS mortality rates among women and in the Southern Region of the country has been observed 48 .…”

“…Infectious and parasitic diseases and multiple infections have been the main diseases associated with AIDS deaths. In addition it has been observed that black men and women have a higher mortality rate from AIDS, with growth persisting until the beginning of the present decade 51 . Therefore men, and in general the population referred to as "white", have been the main beneficiaries of the reduction in AIDS mortality since the introduction of HAART 51 , pointing to inequalities in the actual implementation of universal public health policies.…”

Epidemiological aspects mortality of acquired immunodeficiency syndrome in the city of Florianópolis, Brazil (1986–2006)

“…Skin color is a gap in data collection, as the study shows. Historically, it leads our society to social and economic inequality, hampering an equal access to assistance and treatment in some parts of the country (17) .…”

Aspectos epidemiológicos da AIDS em Florianópolis/SC, Brasil

“…Os resultados apontam como fator de risco, no sexo feminino, as relações sexuais sem proteção com parceiros infectados pelo HIV, otimizada pelo crescente aumento de doentes expostos pela categoria de exposição heterossexual, quadro que determina o diagnóstico tardio e o prognóstico incerto entre as mulheres. 9 É importante ressaltar que as mulheres casadas acreditavam que estavam invulneráveis a AIDS por terem parceiros sexuais fixos, dispensando o uso de preservativos nas relações sexuais. Tinham dificuldade de negociação quanto ao uso do preservativo, seja pelo modelo educacional recebido quanto à submissão aos desmandos do marido, pela falta de habilidade no uso do diálogo para negociar e/ou pelo medo do estigma e do preconceito social.…”