Inequities in HIV/AIDS mortality in 315 Latin American cities: a population-based cross-sectional analysis.

Abstract

HIV/AIDS mortality trends to concentrate in large urban settings but studies on HIV/AIDS mortality in Latin American cities remain scarce. This study aimed to describe HIV/AIDS mortality and its association with indicators of deprivation and income inequality in 315 Latin American cities. This was a cross-sectional ecological study of 315 cities from eight Latin American countries, with cities as the unit of analysis. We calculated city-level HIV/AIDS-related mortality rates from 2016 to 2020 data for all countries, except Chile, for which 2015-2019 data were available, using empirical Bayes models. We estimated the proportion of the variability in HIV/AIDS-related mortality that was between-country and between-city. Associations with city socio-environmental conditions and city income inequality were examined, overall and by sex, through multilevel regression models. Mortality rates were higher among men than women across all countries. Between-city differences explained 48·3% of the variance in men and 41·5% in women. After adjustment for country and age, each one-point increase in the city-level Social Environment Index (SEI) z-score was associated with a 25% (95% CI 15-30%) lower risk of death among women and a 19% (95% CI 11-26%) lower risk among men. This association varied by age and sex, with the strongest effects observed in those aged 14 years or younger. HIV/AIDS mortality in the cities examined shows marked inequalities by sex, age, and place, with a substantial proportion of variability explained by urban-level conditions. Better socio-environmental conditions were associated with reduced mortality, underscoring the importance of addressing structural determinants to reduce urban health inequities. The Salud Urbana en América Latina (SALURBAL)-Urban Health in Latin America project is funded by the Wellcome Trust.