The intersecting effects of race/ethnicity, wealth, education, and gender on AIDS among 28.3 million Brazilians

Health inequities in Latin America are rooted in historical systems of oppression, including slavery, patriarchy, and colonialism, which disproportionately affect socially marginalized groups. Intersectionality theory offers a framework to examine how overlapping social markers interact to shape health outcomes. While HIV/AIDS research has explored the effects of individual markers, few studies have addressed their intersections. We conducted a retrospective cohort study using data from 28.3 million Brazilians aged ≥13 years. We examined associations between race/ethnicity, education, and wealth-individually and in combination-stratified by gender. Over nine years, AIDS incidence was 23.37 and 18.63 per 100,000 person-years among men and women, respectively; mortality rates were 8.06 and 5.81 per 100,000 person-years. Isolated markers of social difference were associated with increased risk, but combined markers revealed pronounced intersectional effects. Here we show that intersections of race/ethnicity, education, and wealth substantially amplify the risk of AIDS-related illness and death in Brazil, with greater effects among women. These findings underscore the necessity of incorporating intersectionality into public health research and policy, and of addressing structural racism, sexism, and poverty through coordinated intersectoral actions to reduce HIV/AIDS inequities.