Socioeconomic inequalities in HIV/AIDS mortality in Colombia (2008-2024): A nationwide study

Background: Colombia has the fourth highest incidence rate of HIV/AIDS among countries in the Americas, with a progressive increase since 1990. In addition, HIV/AIDS (excluding tuberculosis) remains among the ten leading causes of mortality in the country. Despite this burden, studies explicitly examining socioeconomic inequities associated with HIV/AIDS mortality remain limited.
Objective: To analyse territorial socioeconomic inequities in HIV/AIDS mortality in Colombia between 2008 and 2024, using the Multidimensional Poverty Index (MPI) as a proxy indicator of socioeconomic deprivation.
Methods: Ecological study based on the following official data sources from the National Administrative Department of Statistics (DANE): (i) HIV/AIDS-related deaths (ICD-10 codes); (ii) Departmental population projections by sex and five-year age groups; and (iii) Departmental MPI, using the estimate from the 2018 population census. Cause-specific mortality rates were calculated and expressed as deaths per 100,000 persons per year. Age-adjusted annual rates were estimated using the direct method, with the WHO world standard population as the reference. To measure inequities, the MPI was operationalized into quintiles (Q1 lowest deprivation–Q5 highest deprivation) and as a continuous rank variable (ridit). Death counts were modeled with a population offset. Poisson regression with offset was fitted and, in the presence of overdispersion, negative binomial regression with offset was used.
Results: Territorial socioeconomic inequities in HIV/AIDS mortality were identified when stratifying by deprivation (MPI). After confirming overdispersion, rates were estimated using negative binomial models with a population offset and adjustment for year. Departments in the highest deprivation quintile (Q5) showed lower relative mortality than those in the lowest deprivation quintile (Q1) (IRR=0.49; 95% CI: 0.30–0.80), suggesting an inverse gradient (RII=0.61; 95% CI: 0.32–1.14; p=0.12) consistent with urban concentration of the epidemic and differences in diagnostic capacity and death registration.
Conclusion: HIV/AIDS mortality in Colombia reflects complex territorial inequities that cannot be attributed solely to socioeconomic deprivation. The findings reveal a highly heterogeneous pattern across the country, consistent with the potential influence of urbanization, institutional capacity, and the quality of registration factors that shape the distribution of risk.
Keywords: HIV/AIDS, Mortality, Social Inequality, Public Health, Colombia.

I am Julio Cesar Martínez Angarita, a bacteriologist and clinical laboratory professional from Universidad de Pamplona (Colombia), with master’s degrees in public health from the University of East London (UK) and a PhD (c) in public health at Universidad de Antioquia (Colombia). I have over 10 years of experience in public health surveillance, health policy and health systems, and research on non-communicable, infectious, and vector-borne diseases, supported by strong training in advanced research methods. My current research focuses on health inequalities related to HIV/AIDS. I currently lecturer in epidemiology and public health for healthcare professionals (undergraduate and postgraduate levels) at Universidad Industrial de Santander, Colombia.