Background:  Gender differences in morbidity and mortality have been reported and mainly attributed to poor care and research access. This study evaluated these differences between HIV⁺ men and women with equitable access to HAART and health care.   

Methods:  Using a longitudinal design, gender differences in utilization of health services and HAART that may affect HIV immune status, morbidity, and mortality were investigated. A total of 539 HIV⁺ subjects (307 men and 232 women) consecutively admitted to Jackson Memorial Hospital were followed during a 2-year period. Analyses were conducted using SPSS 11. Univariate, multivariate, GEE, and Cox regression models were used to assess final models. 

Results:  Fewer than half of the participants were receiving HAART. Although no statistical gender differences were evident in demographics, HAART, viral load, or CD4 counts, univariate analyses revealed gender differences in rate of hospitalization (1.9/100 men-years vs 3.9/100 women-years). Women were twice as likely to be hospitalized > 3 times during the length of the study than men (p = 0.003) and more likely to be admitted with genitourinary infections (2 times, p = 0.003). Men were more likely to present with renal insufficiency (OR = 1.68, p = 0.05) or with malignancies (11% men vs 2.1% women, p = 0.0008). After controlling for HAART and CD4, regression analysis showed that cancer and renal insufficiency were significantly associated with mortality. A higher number of emergency admissions were also evident among women (11.4 ± 0.8 vs 19.5 ± 1.2; p = 0.0001). Interestingly, no gender differences in out-patient follow-up (46 ± 3.8 vs 50 ± 4.3) were apparent. Overall mortality during the study period was 7.9% (n = 43) with 70% of the deaths occurring among men. Neither alcohol, drug use, nor HAART accounted for these differences. When data were analyzed in patients 50 years and older, the variables that were substantially different between genders failed to remain significant.

Conclusions:  Despite similar access to health care and HAART, hospitalization and emergency visits are more prevalent among HIV⁺ women. Death rate, on the contrary, is higher among HIV⁺ men, and is associated with an increased proportion of malignancies and renal insufficiency. The effect of aging factors, such as hormonal fluctuation, may be related to these gender differences and warrants further study.

Keywords: Gender; Hospitalization; Mortality