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

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. Santos, Maria Y. Ichihara, Mauricio L. Barreto, Laio Magno, Luis E. Souza, James Macinko and Davide Rasella ()
Additional contact information
Andréa F. Silva: Federal University of Bahia (UFBA)
Inês Dourado: Federal University of Bahia (UFBA)
Iracema Lua: Federal University of Bahia (UFBA)
Gabriela S. Jesus: 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)
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)
Laio Magno: Federal University of Bahia (UFBA)
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)

Nature Communications, 2024, vol. 15, issue 1, 1-13

Abstract: 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.

Date: 2024
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DOI: 10.1038/s41467-024-44975-z

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