Conditional cash transfer programs linked to reduction in AIDS cases and deaths among Brazilian women

The world's largest conditional cash transfer programme, the Bolsa Família Programme (BFP), is associated with a substantial reduction in AIDS cases and deaths, especially among brown and black women with lower income and limited education. This was the main conclusion of a study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa" Foundation, in collaboration with the National Institute of Allergy and Infectious Diseases (NAIDS/NIH). The results were published in Nature Human Behaviour.

Conditional cash transfer (CCT) programs, which provide financial aid to low-income households in exchange for fulfilling health and education requirements, are a key policy tool for addressing the social determinants of health. Implemented in nearly all low- and middle-income countries, CCTs aim to improve the living conditions of families in vulnerable situations.

Education amplifies the impact of conditional cash transfer programmes

"We analyzed data from 2007 to 2015, focusing on mothers and daughters in households receiving Bolsa Família, using a causal inference framework and a robust quasi-experimental design," explains Andréa F. Silva, PhD in the Institute of Collective Health, Federal University of Bahia (UFBA) (Salvador, Brazil) and lead author of the study. The analysis covered 12.3 million low-income women, and explored how intersecting vulnerabilities - such as poverty, race, and education - affected the programme's effectiveness.

Among daughters, the programme was associated with a 47% reduction in AIDS incidence and a 55% reduction in AIDS-related mortality. Among mothers, the reductions were 42% and 43%, respectively.

The programme's impact was particularly significant among women facing multiple intersecting vulnerabilities. In particular, brown or black mothers living in extreme poverty and with higher levels of education experienced the greatest improvements: a 56% reduction in AIDS incidence. These findings suggest that education enhances the protective effects of cash transfers on health outcomes.

How Brazil is successfully reducing AIDS cases

Brazil has already reported a national decline in AIDS, with the relative incidence dropping by nearly 30% from 2007 to 2021, and over 40% among women. This study suggests that the BFP may be one of the reasons for this success, highlighting the importance of integrated social and health policy approaches.

Beyond financial aid, the BFP includes health and education conditionalities, such as mandatory school attendance, routine health checkups, and participation in health education activities, including sexual and reproductive health, which may further support HIV prevention and treatment. By improving nutrition, reducing food insecurity, and encouraging early engagement with healthcare services, these conditions create a multi-pronged approach to disease prevention.

This is the first large-scale study to assess the intersectional effectiveness of cash transfer programmes on HIV/AIDS outcomes. By linking massive socioeconomic and health datasets, the researchers were able to evaluate the effects of the Bolsa Família Programme across diverse subpopulations, many of whom are often underrepresented in traditional epidemiological studies or clinical trials. This is particularly relevant in policy evaluation: public interventions could have a very different impact according to the characteristics and baseline conditions, and of its beneficiaries.

In the current global context of increasing inequalities and poverty rates, CCT programmes have the potential to significantly reduce morbidity and mortality from AIDS, especially among populations with multiple vulnerabilities. Our findings show that these programmes not only reduce HIV risks and AIDS-related deaths, but also support progress toward the Sustainable Development Goals in Brazil and beyond."

Davide Rasella, ICREA researcher at ISGlobal and coordinator of the study