Trends on AIDS mortality and social index in São Paulo city

Background: The role of the socioeconomic factors in the HIV/AIDS epidemic has been a subject of discussion in the scientific literature. We studied the correlation between AIDS mortality rate and social inclusion/exclusion indexes among persons aged 25 to 49 years in the 96 administrative districts in the city of  São Paulo,  between 1994 and 2005.
Methods: We have conducted an ecological study using mortality data collected from the Program for Improving Local Mortality Data and from population estimates based on the 1991 and 2000 census of the State System data Analysis. The social  indexes were obtained from the city’s map of exclusion (1996 and 2003). Linkages between the census, mortality registry and variables of the map of exclusion files were carried out. Statistical analysis was performed using Pearson’s correlation test (at 5% level) on the historic series.
Results: A significant positive correlation was seen among men between AIDS mortality and the district life quality index from 1994 to 1998. A significant negative correlation was seen among men and women during the period between AIDS mortality and the equity index, which measures the proportion of women who are family heads. From 2000 to 2005, it was observed a significant negative correlation among women between AIDS mortality and the social inclusion indexes. 
Conclusions: Despite free antiretroviral therapy in Brazil, the study suggest a relationship between AIDS mortality and socioeconomic factors. Social inequality could explain the differences observed at the neighborhood level. Because our data refer to areas rather than individuals, multilevel analysis operating simoultaneously at the level of individuals and at the level of contexts will be required.