Study: Refundable State-Level Earned Income Tax Credit Could Decrease High-Risk HIV Behavior


A refundable state-level earned income tax credit was associated with a 21% reduction in high-risk HIV behavior among low-income women last year, suggesting that policy can reduce this burden.

State-level earned income tax credit (SEITC) might reduce HIV risk behavior among low-income single mothers, according to a recent study. The primary outcome was a composite HIV risk measure, including factors such as drug use, sexually transmitted disease treatment, and trading money or drugs for sex and risky sexual behavior.

“This is the first study to examine the relationship between state earned income tax credit laws and HIV risk behavior,” said authors of the study, published in AIDS and Behavior.

The highest HIV diagnoses occur among women with a median household income of less than $36,000 per year, according to the CDC. HIV and other sexually transmitted infections (STIs) are directly related to poverty.

The precursor of the SEITC was the 1975 Federal Earned Income Tax Credit (FEITC), a refundable tax for low-income workers. In 2020 it effectively increased the income of poor individuals by $2,411, according to the researchers. The state-level income tax program is enacted by 28 states and the District of Columbia, and its benefits are in addition to those provided by the FEITC.

After noticing few studies on the extent that income support could reduce high-risk sexual behaviors among women in the US, researchers implemented the Behavior Risk Factor Surveillance System (BRFSS) data and a quasi-experimental study design to investigate the SEITC law’s impact on HIV risk behavior among single mothers with a low education.

The team secured data from the BRFSS and other state documents from 2002 to 2018 on single mothers between the ages of 18 and 55 with young children, conducting a multi-state, multi-year difference-in-differences analysis. The measurement for low education was reserved for women with a high school degree or less.

Results suggest a link between a refundable SEITC—equal or greater than 10% of what the FEITC offered—and decreased HIV risk behavior in single female mothers with low education.

Investigators found that HIV risk behavior relatively decreased by more than 30% with a 10%-point increase in generous refundable credit. However, a refundable credit less than 10% of FEITC amounts might not impact risk behavior, according to the study.

The researchers further suggested that non-refundable SEITC laws did not have any association with HIV risk behavior.

“Non-refundable credits and less generous credits did not show statistically significant associations with HIV risk behavior,” the study authors reported. “We find a 10%-point increase in state earned income tax credit generosity is associated with a 2.3%-point reduction in HIV risk behavior.”

The study was limited because it was observational, and BRFSS could form selective biases. Additionally, the researchers admit to potentially underestimating the effect of SEITC laws on certain populations and sensitivity of the questions.

“There may be an important opportunity to influence the trajectory of HIV in this population through increased uptake of state earned income tax credit laws, changes in the way the laws are implemented and increased in benefit generosity,” the researchers concluded.


Narain K. and Harawa N. Evidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single Mothers. AIDS Behav (2022). Accessed September 9, 2022.

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