People living with HIV can live as long as people without HIV. But that doesn’t mean all do. Data released at ID Week 2021 showed that Black women continue to have the highest rate of premature death among anyone living with HIV.

Longstanding research shows that unequal treatment of Black women in health care clinics contributes to worse health outcomes. One recent study ­found that as late as 2014, pregnant Black women living with HIV were still receiving HIV monotherapy—a treatment approach that hadn’t been recommended for more than a decade.

Rachael Pellegrino, MD, of Vanderbilt University Medical Center in Nashville, and colleagues reviewed mortality rates for 6,531 people living with HIV who received care at Vanderbilt’s Care Clinic between January 1998 and December 2018. Of those, 956 people died.

Overall, people with HIV lived far longer in recent years than they did in the early years of HIV treatment—with a 73% decrease in mortality during the most recent antiretroviral era, compared with when HIV meds were first available.

And while 21% of participants in the analysis were women, they were 32% more likely to die than their male counterparts. What’s more, this was the case when controlling for other factors that could increase the likelihood of untimely death, such as hepatitis C, a history of AIDS-defining illnesses, year of HIV diagnosis, age, injection drug use and CD4 counts and viral load levels at first clinic visit.

However, Pellegrino did point out that clinicians are likely to recognize and diagnose HIV in women and Black and Latino people later, and that Black people are more likely to disengage from care at some point in their HIV journey. Perhaps as a result, Black people, especially those between ages 13 and 29 were the least likely to have an undetectable viral load.

Researchers saw no increase in mortality when they looked at Black race across genders, but when they narrowed in on Black women, they found that this group had the highest number of years of potential life lost—123 more years than their Black male male peers and a full 181 years compared with their white female peers. When compared with white men, Black women were expected to lose 284 more years of life.

“Years of potential life lost, or premature mortality, is a measure that hasn’t been widely used in HIV research,” Jessica L. Castilho, MD, a coauthor of the study and an assistant professor of infectious diseases at Vanderbilt University Medical Center, said in a press release. “We tend to focus on death as the outcome, but looking at years of potential life lost gives us a different perspective on the impact of health disparities.”

Click here to read the study abstract.

Click here to read more new about health equity for people with HIV and HIV in women.