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Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians

Author

Listed:
  • Andréa F. Silva

    (Federal University of Bahia (UFBA)
    Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Inês Dourado

    (Federal University of Bahia (UFBA))

  • Iracema Lua

    (Federal University of Bahia (UFBA)
    Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Gabriela S. Jesus

    (Federal University of Bahia (UFBA)
    Federal University of Bahia (UFBA))

  • Nathalia S. Guimarães

    (Federal University of Bahia (UFBA))

  • Gabriel A. S. Morais

    (Federal University of Bahia (UFBA))

  • Rodrigo V. R. Anderle

    (Federal University of Bahia (UFBA))

  • Julia M. Pescarini

    (Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Daiane B. Machado

    (Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
    Harvard Medical School)

  • Carlos A. S. T. Santos

    (Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Maria Y. Ichihara

    (Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Mauricio L. Barreto

    (Federal University of Bahia (UFBA)
    Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ))

  • Laio Magno

    (Federal University of Bahia (UFBA)
    State University of Bahia (UNEB))

  • Luis E. Souza

    (Federal University of Bahia (UFBA))

  • James Macinko

    (Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health)

  • Davide Rasella

    (Federal University of Bahia (UFBA)
    Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
    ISGlobal, Hospital Clinic - Universitat de Barcelona)

Abstract

Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world’s largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 −0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.

Suggested Citation

  • Andréa F. Silva & Inês Dourado & Iracema Lua & Gabriela S. Jesus & Nathalia S. Guimarães & Gabriel A. S. Morais & Rodrigo V. R. Anderle & Julia M. Pescarini & Daiane B. Machado & Carlos A. S. T. Santo, 2024. "Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians," Nature Communications, Nature, vol. 15(1), pages 1-13, December.
    • Handle: RePEc:nat:natcom:v:15:y:2024:i:1:d:10.1038_s41467-024-44975-z
    DOI: 10.1038/s41467-024-44975-z
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    References listed on IDEAS

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    1. de Walque, Damien & Dow, William H & Nathan, Rose & Abdul, Ramadhani & Abilahi, Faraji & Gong, Erick & Isdahl, Zachary & Jamison, Julian & Jullu, Boniphace & Krishnan, Suneeta & Majura, Albert & Migue, 2012. "Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania," Department of Economics, Working Paper Series qt4vw984q0, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    2. Brian K Lee & Justin Lessler & Elizabeth A Stuart, 2011. "Weight Trimming and Propensity Score Weighting," PLOS ONE, Public Library of Science, vol. 6(3), pages 1-6, March.
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