Universal Basic Income and Structural Racism in the US South: HIV Care

Universal Basic Income and Structural Racism in the US South: Differences in HIV Care Utilization Between Low-income African American Men Living With HIV

Universal Basic Income (UBI) is a promising strategy aimed at recalibrating economic systems that are grounded in structural racism. Black men have long been the target of oppressive and interconnected systems of finance and healthcare access, leading to a disproportionate burden of exposure to infectious disease with little healthcare support. Yet to our knowledge, no published UBI studies have ever been implemented exclusively with Black men living with HIV in the US. Motivated and inspired by the innovative health and social science being conducted in extremely resource-limited environments in other parts of the world, we recognize an urgent need to better understand the effect of cash transfers on HIV care among Black men in the US South. The proposed study will be based in Arkansas, which, like other Southern states, has a long history of institutional racism and extremely high rates of racial health disparities, poverty, and chronic disease. We will use a mixed methods research design to conduct an in-depth exploration of a UBI intervention to reduce the racial wage gap and promote the use of culturally relevant protective factors. The provision of a UBI is intended to increase receipt and retention of HIV care services and treatment for Black men through the influx of capital and subsequent increases in culturally-based protective factors such as personal agency and social connections. We hypothesize that providing UBI of $500 per month for 6 months will result in increased HIV care utilization among low-income Black men living with HIV. Secondarily, we hypothesize that the effect of UBI will also increase adherence to HIV medication, such that more UBI recipients will achieve and maintain viral suppression compared to individuals in the control condition.

The proposed supplement from the parent R01 grant will expand on the parent grant by enrolling a larger sample (n=80) of Black men living with HIV as their diagnosed chronic disease. To date, no published UBI studies have ever been implemented exclusively with Black men living with HIV in the US. Motivated and inspired by the innovative health and social science being conducted in extremely resource-limited environments in other parts of the world, we recognize an urgent need to better understand the effect of cash transfers on HIV care among Black men in the US South. The proposed study will be based in Arkansas, which, like other Southern states, has a long history of institutional racism and extremely high rates of racial health disparities, poverty, and chronic disease. We will use a mixed methods research design to conduct an in-depth exploration of a UBI intervention to reduce the racial wage gap and promote the use of culturally relevant protective factors. The provision of a UBI is intended to increase receipt and retention of HIV care services and treatment for Black men through the influx of capital and subsequent increases in culturally-based protective factors such as personal agency and social connections. We hypothesize that providing UBI of $500 per month for 6 months will result in increased HIV care utilization among low-income Black men living with HIV. Secondarily, we hypothesize that the effect of UBI will also increase adherence to HIV medication, such that more UBI recipients will achieve and maintain viral suppression compared to individuals in the control condition. This study is designed to generate generalizable evidence to inform decisions by policymakers, scientists, and the general public about the inner-workings of UBI, the biases underlying who is deemed as "qualifying" or "deserving", and its downstream effects on public health, particularly related to access to HIV care, and structural racism.

Inclusion Criteria:

1. be at least 25 years old;
2. self-report as having received from a medical professional a diagnosis for HIV;
3. have an annual income up to 400% of the federal poverty threshold (the 2023 federal poverty threshold is defined as an annual income of less than $14,580 for single adults) in the 12-month period prior to study enrollment;
4. be able to understand and speak English and to provide written and verbal informed consent;
5. plan to remain in the central Arkansas area for the duration of the study period;
6. be willing and able to provide weekly information about all activities related to seeking employment and to share financial and income-related information with the study team;
7. self-identify as Black or African American;
8. have been assigned the male gender at birth;
9. be willing to provide medical releases to allow project staff to access healthcare records, and
10. in need of HIV care services (defined as having a detectable viral load meaning >200 copies/mL on most recent viral load test or not having attended a HIV medical care visit in the past 6 months, excluding any visits to the emergency department or rooms or urgent care clinics)

Exclusion Criteria:

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