Ponente
Descripción
The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have caused a global pandemic for decades, resulting in over 40 million deaths worldwide. In 2024, approximately 40.8 million people were living with HIV, and 630,000 people died from AIDS-related illnesses. The pandemic has disproportionately affected populations in low- and middle-income countries (LMICs), particularly those facing socio-economic vulnerabilities (McClarty L, et al. Curr HIV/AIDS Rep., 19, 76-85, 2022). Brazil has been one of the hardest hit countries in Latin America. Since 1980, 1,165,599 cases and 392,981 deaths of AIDS have been registered in Brazil, and, in 2023, 46,495 cases of HIV infection were reported, representing an increase of 4.5% over the previous year, with an AIDS detection rate of 17.8 cases per 100,000 inhabitants. Social Determinants of Health (SDH) plays a critical role in influencing the risk of acquiring HIV, access to healthcare services, adherence to treatment, and overall health outcomes (Gillespie, S & Kadiyala, S & Greener, R, AIDS, 21, 2007). Social mobility is a change in social status. Positive social mobility, e.g. shifting from low to high socioeconomic status, is important to advancing individuals' opportunities and well-being. Despite economic improvements in recent years, such as an increase in gross domestic product and real wages, a drop in inflation, and a reduction in unemployment, inequality remains high in Brazil. Conditional cash-transfer programs (CCTs) can increase social mobility by providing cash to low-income communities based on specific conditions. The Brazilian CCT - called Bolsa Família (BF) - has had well-documented positive impacts on education, health, and social mobility, highlighting the importance of effective income and social interventions (Martins, APB & Monteiro, CA, BMC Public Health, 16, 2016). In this study, we aimed to forecast the impact of income-based social mobility resulting from alternative cash transfers schemes on AIDS incidence across different low-income populations and subpopulations in Brazil. To achieve this, we utilized a large, dynamic microsimulation model with four compartments: S (people susceptible to HIV infection), I (HIV-positive individuals who are infectious), A (individuals with full-blown AIDS), and D (death from AIDS). The model was calibrated using retrospective analyses parameters and data of a cohort of 28.3 million individuals. We incorporated national, subnational, and municipal-level demographic, social and economic changes into the population, and simulated the impact until 2030 of four different scenarios of income social mobility based on income quintiles. A high-coverage, income-based social mobility intervention could reduce the overall incidence of AIDS by 11.8% (IRR 0.88, 0.81-0.96) by 2030. Among people living in extreme poverty, the reduction could reach 24% (IRR 0.76, 0.56-0.96). For those with no or limited literacy, a 17.9% (IRR 0.81, 0.62-1.03) decrease in AIDS incidence could be achieved, while the Black population could see a 12.4% (IRR 0.87, 0.42-1.24) reduction. Income-based social mobility policies could significantly reduce AIDS incidence in low-income populations, particularly in the most vulnerable individuals. These policies should be considered an important strategy for achieving the Sustainable Development Goal of ending AIDS by 2030 in Low- and Middle-Income Countries.