Forty percent of all those who died of AIDS in British Columbia, a province in Canada with true universal access to HIV care and treatment, died without having accessed HIV treatment, according to a study published in the April 1 issue of the Journal of Acquired Immune Deficiency Syndromes.

Ruth Joy, MSc, of the British Columbia Centre for Excellence in HIV/AIDS in Vancounver, and her colleagues studied the matched health and death records of 1,406 people with HIV who died between September 1, 1997 and November 30, 2005, and whose stated cause of death was either AIDS or HIV-related. By matching records of death with data from the national health system, Joy’s team determined that just over 40 percent of those who died did so without having accessed HIV treatment, and 16 percent of those who died had waited to access treatment until their CD4 count was 50 or less. Women were somewhat more likely to have died without having accessed treatment than men, however, this difference was not statistically significant, meaning that it could have occurred by chance.

Although Joy’s team found no difference in socioeconomic status between those who accessed treatment before dying and those who didn’t access treatment, they did find that survival time following an HIV diagnosis among people who used antiretroviral drugs was lower for those who lived in neighborhoods with high unemployment, lower education levels, a high percentage of residents living below the poverty line, and a high percentage of aboriginal people. Poverty was a stronger predictor of decreased survival time than injection-drug use.

Joy’s team states that the high percentage of people found to have died without accessing treatment is striking, given that treatment was available for free to all of them. The team is encouraging scientists, policymakers and service providers to determine what measures over and above universal health care access may be needed to increase the numbers of people from poor neighborhoods on HIV treatment.