Conditional cash transfers in Brazil were associated with a 10 percentage-point reduction in the number of new AIDS diagnoses in poor areas with a high HIV burden. Results were even more impressive among women and children, with 15 and 39 percentage-point reductions respectively.
Dr Gabriel Sampaio Morais from the Federal University of Bahia presented these results from one of the largest national conditional cash transfer programmes to the recent 11th International AIDS Society Conference on HIV Science (IAS 2021).
Brazil’s vast income inequality results in pronounced health disparities. Although the HIV epidemic is classified as stable at national level, the number of new HIV infections, AIDS cases and deaths varies geographically, with the poorest municipalities carrying the heaviest burden.
The Bolsa Familia Programme is a conditional cash transfer programme that was launched in 2004; it is aimed at families who are poor or extremely poor (households earning between $35 to $70 per person per month). The conditions are that children need to be vaccinated and enrolled in school and that pregnant women must attend all prenatal care visits to receive the cash transfers.
Researchers aimed to investigate if there was an association between being covered by the cash transfer programme and a reduction in certain HIV-related outcomes – AIDS diagnoses (defined as a CD4 count below 350), HIV/AIDS-related hospitalisations and AIDS-related deaths – by using aggregated data from 5507 municipalities between 2004 and 2012.
They considered these outcomes for municipalities that had low (0-29%), intermediate (30-69%) or high (70% and above) coverage of Bolsa Familia among eligible households.
In terms of the number of new AIDS diagnoses, the researchers found marked statistically significant results for those municipalities with the highest incidence of AIDS (more than 30 cases per 100,000 inhabitants per year). In municipalities that also had 70% coverage or more under the cash transfer programme, there was an overall 10% decrease in the number of new AIDS cases over the study period.
This effect was more pronounced when looking specifically at women and children in these municipalities: there was a 15% reduction in new AIDS diagnoses for women and a 39% reduction among children under the age of 14 between 2004 and 2012. Additionally, there was an overall decline in AIDS-related hospitalisations (by 26%) and AIDS-related deaths (just under 10%) for these municipalities.
There were also some declines seen in municipalities with a high AIDS burden and intermediate Bolsa Familia Programme coverage (30-69% of eligible families covered). Among children aged under 14, there was a 33% decline in new AIDS diagnoses, with an overall decline in AIDS-related hospitalisations (by 23%) and AIDS-related deaths (just over 10%) for these municipalities.
In conclusion, the Bolsa Familia Programme in Brazil was associated with lower numbers of new AIDS diagnoses, hospitalisation and deaths in the poorest areas with the highest HIV burden. The strongest effect was noted for women and children.
“The mechanism by which the cash transfers work is that the mother must be tested for HIV and monitored. This works to prevent vertical transmission. It’s the conditions linked to the cash transfers that had an effect on health outcomes and the strongest effect was seen on children,” Morais explained during questions and answers.
“Cash transfer programmes should be maintained and expanded, especially during health and economic crises as the current COVID-19 pandemic, to protect the most vulnerable from the effects of the AIDS pandemic,” he concluded.
Morais GS et al. Reduction in AIDS incidence, hospitalisations and mortality rates associated with conditional cash transfer coverage in Brazil: an ecological study. 11th International AIDS Society Conference on HIV Science, abstract OALD0803, 2021.
Update: Following the conference presentation, an updated analysis of this study with additional data was published in a peer-reviewed journal:
Morais GS et al. Effect of a conditional cash transfer programme on AIDS incidence, hospitalisations, and mortality in Brazil: a longitudinal ecological study. The Lancet HIV, 9: e690-e699, October 2022.