# The intersecting effects of race, wealth, and education on AIDS incidence, mortality, and case-fatality rate: a Brazilian cohort study of 28.3 million individuals

## TL;DR

This study shows that Black individuals in Brazil with low education and wealth face higher AIDS risks, highlighting the need for intersectional policies.

## Contribution

The study introduces a novel intersectional analysis of race, education, and wealth on AIDS outcomes in a large Brazilian cohort.

## Key findings

- Black individuals with low education and wealth had a 3.07 higher risk of AIDS illness.
- The same group had a 4.96 higher risk of AIDS-related death.
- Intersectional factors increased case-fatality rates by 1.62 in this group.

## Abstract

The relationships between race, education, wealth, their intersections and AIDS morbidity/mortality were analyzed in retrospective cohort of 28.3 million individuals followed for 9 years (2007–2015). Together with several sensitivity analyses, a wide range of interactions on additive and multiplicative scales were estimated. Race, education, and wealth were each strongly associated with all of the AIDS-related outcomes, and the magnitude of the associations increased as intersections were included. A significantly higher risk of illness (aRR: 3.07, 95%CI:2.67–3.53) and death (aRR: 4.96, 95%CI:3.99–6.16) from AIDS was observed at the intersection of Black race, lower educational attainment, and less wealth. A higher case-fatality rate (aRR: 1.62, 95%CI:1.18–2.21) was also seen for the same intersectional group. Historically oppressed groups lying at the intersections of race, education, and wealth, had a considerably higher risk of illness and death from AIDS. AIDS-related interventions will require the implementation of comprehensive intersectoral policies that follow an intersectionality perspective.