Date of Award

8-9-2016

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Richard Rothenberg

Second Advisor

Betty Lai

Abstract

Background: While Mexico has maintained a relatively low prevalence of HIV/AIDS and provides universal coverage of highly active antiretroviral therapy (HAART), HIV/AIDS mortality rates have failed to decrease at the national level. However, national trends mask heterogeneity in HIV/AIDS incidence and mortality across states and regions, a finding which likely parallels the distribution of social and economic inequality in Mexico.

Objectives: As HIV/AIDS mortality likely differs as a function of community social and material deprivation, I evaluated the states’ annual HIV/AIDS mortality rates in Mexican residents aged 15 and over as a function of the Social Gap Index (SGIx) for each year from 2004-2011. Additionally, I evaluated the relationship between indicators of a state’s educational attainment, healthcare deprivation, and prevalence of poverty with annual mortality rates for each year from 2004-2011.

Methods: Using demographic information and mortality data from the Mexican Ministry of Health’s Epidemiological and Statistical Mortality System and population level measures of social and material deprivation from The National Council for Evaluation of Social Development and Policy, univariate regression analysis and Pearson correlation were conducted to examine the relationship between annual mortality rate with state level indicators of educational gap, healthcare access, and poverty. Additionally ANOVA was conducted to examine the relationship with between annual mortality rate and state SGIx. All analyses were conducted for each year from 2004-2011.

Results: Mean annual mortality rate at the national level steadily increased from 2005 (M=3.11, SD=1.67) to 2011 (M=3.97, SD=2.32), with the greatest mortality rate in the state of Tabasco (10.45 per 100,000) in 2010. Regression analysis and Pearson correlation indicated no statistically significant relationship between annual mortality and the component variables at the state level. Similarly, the relationship between state SGIx score and annual mortality rate was not statistically significant.

Conclusions: This study demonstrates the limited predictive validity of state and population level measures in determining HIV/AIDS mortality rates. This is likely due to the concentration of HIV/AIDS among high-risk subpopulations in Mexico. Coupled with the limited effectiveness of universal HAART therapy, this suggests the need for future research which specifically samples from high-risk population groups, including men who have sex with men and female commercial sex workers.

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