Intersectional impact of cash transfers on AIDS among 12.3 million Brazilian women

Abstract

Multiple socioeconomic vulnerabilities are associated with an increased burden of human immunodeficiency virus and its progression to acquired immunodeficiency syndrome (AIDS). Here, using a quasi-experimental impact evaluation design and a cohort of 12.3 million low-income Brazilian women (daughters and mothers) from 2007 to 2015, we evaluated the impact and intersectional effectiveness of the world's largest conditional cash transfer, the Programa Bolsa Família (PBF) on AIDS incidence and AIDS-related mortality. Among daughters, PBF was associated with reductions in AIDS incidence (rate ratio (RR) 0.53, 95% confidence interval (CI) 0.42-0.66) and AIDS-related mortality (RR 0.45, 95% CI 0.27-0.74). Among mothers, PBF was associated with reductions in AIDS incidence (RR 0.58, 95% CI 0.55-0.61) and AIDS-related mortality (RR 0.57, 95% CI 0.53-0.63). The effects of PBF were stronger among mothers with 1 vulnerability, and even higher with 2 intersecting vulnerabilities, specifically for AIDS incidence among brown/Black and extremely low income (RR 0.47, 95% CI 0.44-0.49). The greatest effect was observed in extremely low-income, brown/Black mothers with higher education (RR 0.44, 95% CI 0.38-0.53). Conditional cash transfer could substantially contribute towards reducing AIDS-related inequalities and achieving the AIDS-related Sustainable Development Goal.