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Inequities in HIV/AIDS mortality in 315 Latin American cities: a population-based cross-sectional analysis
Journal article   Open access   Peer reviewed

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

Sebastián Genero, Andrés Trotta, Laio Magno, Mónica Serena Perner, Tania Alfaro, Diana Higuera-Mendieta, Usama Bilal and Marcio Alazraqui
Lancet Regional Health - Americas (Online), v 62, 101580
Oct 2026
DOI: https://doi.org/10.1016/j.lana.2026.101580
PMID: 42495267
Featured in Collection :   Drexel's Newest Publications
url
https://doi.org/10.1016/j.lana.2026.101580View
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Abstract

Health inequities HIV/AIDS mortality Social inequalities Latin America Urban Health
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.

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