Patterns and sex differences in HIV/AIDS reported mortality trends in Latin American countries (1996-2007)
M. Alonso Gonzalez1, L. Martin1,2, S. Munoz3, N. Garcia Arezana1
1Pan American Health Organization, HIV, Washington, United States, 2DAAD (German Academic Exchange Service), Carlo Schmid Program, Bonn, Germany, 3Pan American Health Organization, HSD/Health Statistics and Information, Washington, United States
Background: Cohort studies have shown that antiretroviral treatment has substantially improved survival of HIV infected individuals. By contrast, few population studies of mortality based on vital statistics exist in low to mid-income countries. Our objective was to investigate HIV mortality trends in Latin American (LA) countries in context of the initiation of public provision of highly active antiretroviral treatment (ART) with attention to differences by sex using cause of death mortality data from vital statistic information.
Methods: Mortality data from eleven national vital statistics systems (1996 and 2007) were used. The quality of mortality registration data was an inclusion criterion and only LA countries with “good” or “average” quality were included, according to PAHO quality of mortality composite index. Crude and age-standardized mortality rates (SMRs) and Poisson regression models were developed to obtain adjusted rate ratios per year, age-group and sex using as baseline the year of commencement of national public ART provision, and to test differences in trends by sex.
Results: Panama and El Salvador showed the highest, and Chile the lowest, HIV SMRs. Argentina, Brazil, Chile, Costa Rica, Panama, and El Salvador presented mortality declines after the initiation of public provision of ART; while Colombia, Ecuador and Venezuela showed increases. Mexico and Uruguay HIV mortality trends stayed rather stable after public ART provision start. All countries showed higher HIV mortality among males than females but differences in trends by sex were significant in most countries (p< 0,000).
Conclusions: Analysis of HIV mortality through vital statistics can be a valid source of information in LA to assess impact and trends of the HIV epidemic. Evidence of declines in HIV mortality after the initiation of public ART, illustrate the impact of national ART programs on the epidemic. Additional explanations should be sought and sex differences analyzed in order to explain trends.
Back to the Programme-at-a-Glance