Background and Objective:
Poverty is a risk factor for HIV/AIDS but previous studies on the impact of conditional cash transfer programs (CCT) have shown inconsistent results. We evaluated the effects of one of the world’s largest CCTs, the Programa Bolsa Família (PBF), on all sequential AIDS outcomes, using data from a nationwide cohort of the poorest Brazilian people on the Unified Registry for Social Programs (Cadastro Único).

Methods:
We analyzed a cohort of 22.7 million low-income Brazilian people for the period between 2007 and 2015, comparing PBF beneficiaries and non-beneficiaries, using a quasi-experimental impact evaluation design. We used inverse probability of treatment weighting (IPTW) to adjust for selection into receipt of BFP benefits and then fitted multivariable Poisson regressions, adjusted for all relevant socioeconomic and demographic confounding variables, to estimate the effect of PBF on AIDS incidence, mortality, and case-fatality rates. We also performed subgroup analyses.

Results:
Exposure to PBF was associated with a lower incidence of AIDS (RR: 0.59; 95% CI: 0.57-0.61), mortality (RR: 0.61; 95% CI: 0.57-0.64) and case-fatality rates (RR: 0.75; 95% CI: 0.66-0.85). PBF associations were significantly stronger among individuals living in extreme poverty, in comparison with those experiencing poverty (RR0.53 versus RR0.84 for incidence; RR0.54 versus RR0.90 for mortality, and RR0.72 versus RR1.00 for case-fatality). PBF impact was also stronger among females and adolescents.

Conclusions:
Conditional cash transfers could significantly reduce AIDS morbidity and mortality, especially in extremely poor populations. During the current dramatic rise in global poverty, due to the COVID-19 pandemic, CCT investments could protect against potential increases in the HIV/AIDS burden, and contribute towards achieving AIDS-related Sustainable Development Goals (SDGs). (Funded by the National Institute of Allergy and Infectious Diseases - NAIDS/NIH, Grant Number: 1R01AI152938).