Increasing Disparities in AIDS Outcomes within a Large Metropolitan Area in the Post-HAART Era.

Paul L. Robinson1, Ph.D, Keisha Paxton, Ph.D1, Richard Baker, MD1,2, Roberto Vargas, MD2, Arleen Leibowitz, Ph.D2

1Charles R. Drew University of Medicine and Science, Los Angeles, CA, 2University of California, Los Angeles

Background: Although highly active antiretroviral therapy has drastically reduced AIDS mortality in the United States after 1996 there is no evidence that the benefits of AIDS therapy have been equitably distributed.

Hypotheses: 1) In the period after the widespread availability of highly active antiretroviral therapy (1996 and later) widened disparities in AIDS fatality rates would exist by geographic area and by zip code income during the POST-HAART era (after 1996) versus the PRE-HAART era. 2) The aforementioned relationship would persist even after controlling for relevant community characteristics, including geographic distance to AIDS services.

Methods: Changes in AIDS fatality rates were examined at the zip code level for all persons diagnosed with AIDS in Los Angeles County using AIDS incidence and AIDS mortality data from the Los Angeles Department of Health Services. Community characteristics and geographic access to HIV/AIDS services were incorporated as control variables.

Results: Significant trends and differences were observed in AIDS outcomes at the zip code level. Individuals living in low income areas experienced smaller declines in fatality after the introduction of HAART in 1996. For every $10,000 increase in a zip codes median household income there is a corresponding 3.2% additional reduction in AIDS fatality rates for that zip code after 1996 (P=.0001). The relationship between income and AIDS mortality persists even after racial/ethnic population dynamics and geographic distance to HIV/AIDS services are controlled for (P=.0153). Geographic proximity to ancillary AIDS services is positively associated with high AIDS fatality rates.

Conclusion and Implications: The benefits of AIDS therapy have been inequitably distributed with individuals living in low income communities now being even more likely to die from AIDS when compared to residents of more affluent parts of the metropolitan area. Technological advancements have, in the case of AIDS outcomes, widened disparities rather than reduce them. This occurs despite evidence that Ryan White CARE Act funding has reached areas where low income persons living with HIV/AIDS are likely to reside, calling into question whether the CARE Act funding has been sufficient, as well as the efficiency of the programs receiving that funding.

Support for this research was provided by:NIH/NCRR grant 5G12RR003026NIH/NCMHHD grant 5P20MD000182The Drew Center for Collaborative AIDS Research and Education funded by Center for HIV Identification, Prevention and Treatment Services (CHIPTS)The authors would also like to thank Ricky Bluthenthal, PhD, Kevin Heslin, PhD, Senait Teklehaimanot, MPH and Melanie Rodriguez, BSc

BLOCK 1 BLOCK 2 BLOCK 3

Median Household

Income

P= 0.0001

B = 0.00032

S/E = 0.00005

P= 0.0011

B = 0.00027

S/E = 0.00006

P= 0.0153

B = 0.00023

S/E = 0.00005

Percent Black

P= 0.7591

B = N/A

S/E =N/A

P= 0.7795

B = N/A

S/E = N/A

Percent Hispanic

P= 0.3180

B = N/A

S/E = N/A

P= 0.3263

B = N/A

S/E = N/A

Persons per Square

Mile

P= 0.4966

B = N/A

S/E = N/A

P= 0.5956

B = N/A

S/E = N/A

Distance to Medical

Services

P= 0.3327

B = N/A

S/E = N/A

Distance to Ancillary

Services

P= 0.0067

B = 2.409

S/E = 0.7502

Predictor Variables

Table II. Results of Spatially Adjusted OLS Model

Adjusted R2= 0.1768

P = Adjusted Pvalue

B = Beta

S/E = Standard Error

Adjusted R2 = 0.1825

P= Adjusted Pvalue

B = Beta

S/E = Standard Error

Adjusted R2 = 0.2091

P = Adjusted Pvalue

B = Beta

S/E = Standard Error

Model BockThree

Model BlockOne

Model BlockTwo