摘要：Objectives. We sought to describe Black–White differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART). Methods. Black–White mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 25–84 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 1999–2002. Results. National Black–White disparities widened significantly after the introduction of HAART, especially among women and the elderly. In county regression analyses, contextual socioeconomic status (SES) was not a significant predictor of Black:White mortality rate ratio after we controlled for percentage of the population who were Black and percentage of the population who were Hispanic, and neither contextual SES nor race/ethnicity were significant predictors after we controlled for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among Black men. Conclusions. Although nearly all segments of the Black population experienced widened post-HAART disparities, disparities were not inevitable and tended to reflect pre-HAART levels. Public health policymakers should consider the hypothesis of unequal diffusion of the HAART innovation, with place effects rendering some communities more vulnerable than others to this potential problem. In the United States, Blacks have a disproportionate share of mortality from HIV compared with Whites. 1 – 2 Blacks comprised less than 15% of the US population during the course of the epidemic 3 but accounted for 39.7% of all cases (368 169 of 928 188) reported through 2003. 4 The approval by the US Food and Drug Administration of protease inhibitors for marketing in December 1995 and March 1996 introduced the use of highly active antiretroviral therapy (HAART) for US adults, which has led to significant declines in HIV mortality. 5 Rates of decline have been unequal, 5 – 7 however, with mortality rates among Blacks and women remaining high. 7 We used multiple strategies to describe national trends in HIV-related mortality among Blacks and Whites before and after the introduction of HAART in 1996 (hereafter referred to as pre-HAART and post-HAART).
