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ARE BLACKS WITH HIV TREATED LESS AGGRESSIVELY?

A growing literature suggests that racial minorities receive less aggressive treatment for a variety of disorders, for reasons that remain unclear. This study asked whether race affects HIV care.

Researchers at Johns Hopkins evaluated data from all 838 HIV-infected patients, 79 percent of whom were black, who visited one clinic for the first time during a 33-month period. In particular, they examined the frequency of antiretroviral drug prescriptions for patients with CD4 counts of 500 per cubic millimeter or less and the frequency of PCP prophylaxis for patients with CD4 counts of 200 or less.

Multivariate analysis showed no significant differences in the use of these treatments associated with age, sex, source of HIV infection, income, education, place of residence, or insurance status. However, there was an independent association with race: blacks were about 40 percent less likely than whites to receive antiretroviral drugs and about 70 percent less likely to receive PCP prophylaxis.

Comment: Although blacks tend to be poorer, less educated, and less well insured, and more likely than whites to abuse IV drugs, this analysis shows that these factors do not explain why they are treated less aggressively. Perhaps blacks are less inclined to ask for or accept drug therapy, or perhaps racial prejudices lead to different treatment decisions.

— AL Komaroff

Published in Journal Watch General Medicine April 1, 1994

Citation(s):

Moore RD et al. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med 1994 Mar 17 330 763-768.

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