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Cash Transfer Programs and HIV-Related Outcomes: an Analysis of 42 Countries from 1996 to 2019

Background
Many low- and middle-income countries have introduced cash transfer programs as part of their poverty reduction and social protection strategies. These programs have the potential to overcome various drivers of HIV risk behaviors and usage of HIV services, but their overall effects on a broad range of HIV-related outcomes remains unknown.

Methods
We used publicly reported data to determine whether low- and middle-income countries with HIV prevalence >1% and baseline annual incidence >1/1000 had conditional or unconditional cash transfer programs that covered >5% of the impoverished population, and the year in which those programs began and ended. We obtained country- and individual-level data on HIV-related outcomes from UNAIDS and population-representative household surveys, focusing on the period between 1996 and 2019. We conducted difference-in-differences analyses with country and year fixed effects to evaluate the effects of cash transfer programs on country- and individual-level HIV-related outcomes.

Findings
Forty-two countries across three continents were included. Among these, 21 were in the intervention group, having implemented cash program(s) with impoverished population coverage greater than 5% during the study period. Cash transfer programs were associated with lower probability of reporting sexually transmitted infection within the last 12 months among females (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.50-0.91) and higher probability of an HIV test within the last 12 months among females (OR 2.61, 95% CI 1.15-5.88) and males (OR 3.19, 95% CI 2.45-4.15). For country-level outcomes, cash transfer programs were associated with a reduction in new HIV infections (incidence rate ratio [IRR] 0.94, 95% CI 0.89-0.99), but not with the proportion of people with HIV receiving antiretroviral therapy (5.0%, 95% CI -0.2-10.1) or AIDS-related deaths (IRR 0.99, 95% CI 0.95-1.03), though temporal analyses showed delayed improvements in both antiretroviral coverage and deaths.

Interpretations
Cash transfer programs, which are being expanded in the context of the COVID-19 pandemic, have the potential to promote ongoing efforts to end HIV as a public health threat. Alongside the already existing focus on expanding biomedical services, these anti-poverty programs can play a greater role in achieving global targets for HIV prevention and treatment. 
 
Funding
None