Background <p>This study analyzes trends in HIV-related mortality disparities between Black and White populations in the USA from 1999 to 2023.</p> Methods <p>CDC WONDER data were utilized to assess absolute disparities, measured as the age-adjusted mortality rate difference, and relative disparities, measured as the age-adjusted mortality rate ratio, in Black-White HIV mortality. Trends were analyzed using Joinpoint regression, with the average annual percentage change (AAPC) serving as a summary measure for the entire period and the annual percentage change (APC) used to evaluate the magnitude of change within specific intervals.</p> Results <p>The absolute disparity showed a consistent decline, with an AAPC of − 6.46% (<i>p</i> &lt; 0.001). Similarly, the relative disparity significantly decreased, with an AAPC of − 1.10% (<i>p</i> &lt; 0.001). A detailed analysis of relative disparity revealed a notable inflection point in 2007, marked by an initial increase from 1999 to 2007 (APC 0.96%, <i>p</i> = 0.002), followed by a decline from 2007 to 2023 (APC − 2.12%, <i>p</i> &lt; 0.001). The findings for both Black-White females and males consistently demonstrated reductions in both relative and absolute disparities, aligning with the overall trend. Among age categories, the 45–54 age group showed the greatest improvement in absolute (− 8.11%) and relative (− 2.65%) disparities, while the 25–34 group showed the least, with a slight increase in relative disparity (+ 0.23%, <i>p</i> = 0.66).</p> Conclusion <p>This study shows significant progress in reducing absolute Black-White HIV mortality disparities, while the reduction in relative inequalities is more modest, emphasizing the need for continued and strengthened public health efforts.</p>