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The effects of cash transfer programmes on HIV-related outcomes in 42 countries from 1996 to 2019

Nature Human Behaviour volume 6, pages 1362–1371 (2022)Cite this article

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Abstract

Many countries have introduced cash transfer programmes as part of their poverty reduction and social protection strategies. These programmes have the potential to overcome drivers of HIV risk behaviours and usage of HIV services, but their overall effects on HIV-related outcomes remain unknown. Here we evaluate the effects of cash transfer programmes covering >5% of the impoverished population on country- and individual-level HIV-related outcomes in 42 countries with generalized epidemics. Cash transfer programmes were associated with a lower probability of sexually transmitted infections among females (odds ratio, 0.67; 95% confidence interval (CI), 0.50–0.91; P = 0.01), a higher probability of recent HIV testing among females (odds ratio, 2.61; 95% CI, 1.15–5.88; P = 0.02) and among males (odds ratio, 3.19; 95% CI, 2.45–4.15; P < 0.001), a reduction in new HIV infections (incidence rate ratio, 0.94; 95% CI, 0.89–0.99; P = 0.03) and delayed improvements in antiretroviral coverage (3%; 95% CI, 0.3–5.7 at year 2; P = 0.03) and AIDS-related deaths (incidence rate ratio, 0.91; 95% CI, 0.83–0.99 at year 2; P = 0.03). Anti-poverty programmes can play a greater role in achieving global targets for HIV prevention and treatment.

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Fig. 1: Causal framework.
Fig. 2: Timeline.
Fig. 3: Temporal trends in country-level outcomes.
Fig. 4: Interaction analyses.

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Data availability

The analysed data can be requested from the DHS programme website (individual, men’s and household recodes from the included countries are at https://www.dhsprogram.com/Data/) or are publicly available from UNAIDS (data sheets for HIV prevalence, new HIV infections, AIDS-related deaths and people living with HIV receiving antiretroviral therapy (%) from http://aidsinfo.unaids.org/), the World Bank (population, GDP per capita and Worldwide Governance Indicator datasets from https://data.worldbank.org/data-catalog/), PEPFAR (PEPFAR Operating Unit Budgets by Financial Classifications FY04–FY20 dataset from https://data.pepfar.gov/financial) and the Global Fund (Grant Agreement Disbursements dataset from https://data-service.theglobalfund.org/downloads).

Code availability

The analysis code is available upon request from the corresponding author.

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Acknowledgements

The authors received no specific funding for this work. We acknowledge the work of the numerous individuals who collected and prepared the publicly available data used in this study.

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Authors and Affiliations

  1. Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Aaron Richterman

  2. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA

    Harsha Thirumurthy

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  1. Aaron Richterman
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  2. Harsha Thirumurthy
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Contributions

A.R. and H.T. conceptualized and designed the study. A.R. conducted the primary analysis and wrote the first draft of the manuscript, both with critical feedback from H.T.

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Correspondence to Aaron Richterman.

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Nature Human Behaviour thanks Jeremy Barofsky, Eran Bendavid, Jacob Bor, Erin Torkelson and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary Tables 1–35, Figs. 1–8 and methods.

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Richterman, A., Thirumurthy, H. The effects of cash transfer programmes on HIV-related outcomes in 42 countries from 1996 to 2019. Nat Hum Behav 6, 1362–1371 (2022). https://doi.org/10.1038/s41562-022-01414-7

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