Modern antiretroviral therapy improves life expectancy of gay and bisexualmales in Vancouver's West End

Despite vast improvements in population health that have been achieved over the last several decades, variations in health status across geographical areas and between population sub-groups persist. Such spatial and social va riation is characteristic of the incidence of and mortality from HIV/AIDS.( 1,2) For example, the highest incidence of HIV/AIDS in Canada occurs in the urban centres of Vancouver, Toronto, and Montreal, and evidence suggests t hat high rates of mortality attributed ses to this cause are concentrated w ithin central neighbourhoods and among specific population sub-groups.(3,4) In these cities, HIV/AIDS was the leading cause of potential years of life lost and was responsible for a significant decrease in the life expectancy of males as early as 1992.(3) At this time it was forewarned that as the H IV epidemic evolved, the death rate from AIDS was likely to rise sharply. As a result of the geographic and social clustering of HIV, certain neighbo urhoods have been hardest hit by the HIV/AIDS epidemic. This is true of Van couver's West End, which is recognized as the home of British Columbia's la rgest: gay community. This area has suffered from one of the highest HIV/AI DS mortality rates in Canada.(4) In recent years, however, new antiretrovir al therapies have provided a great deal of hope to those suffering from HIV infection. New anti-HIV regimens have proven extremely effective in improv ing CD4 cell counts and decreasing plasma viral load, and significant decli nes in AIDS-related mortality have been documented among persons on antiret roviral therapy,(5,6) The present study was undertaken to determine the impact of HIV/AIDS on the life expectancy of gay and bisexual males who reside in the West End of Va ncouver, British Columbia during two time periods. Over time we have attemp ted to determine how advances in, and the expanded availability of, highly active antiretroviral therapy has impacted the life expectancy of gay and b isexual males in this neighbourhood. Restricting our analyses to the West E nd enabled us to evaluate the life expectancy in an area where the HIV prev alence is extremely high, and where antiretroviral therapy is very accessib le and highly utilized by persons with HIV.