PUERTO RICO – Recent Visit by President Obama Should Send a Message to Public Health and Philanthropic Leaders. Will Anyone Heed the Call?
Guest Blog, authored by Kandy Ferree, President & CEO of 360 Strategy Group.
On June 15th, fifty years after the last visit of a sitting president (John F. Kennedy) to the Island, President Barack Obama made a historic but timely visit to Puerto Rico. If the President of the United States of America believes Puerto Rico deserves his attention and that Puerto Rico has the promise of economic opportunity and health for its citizenry, why has U.S.-based philanthropy, and HIV/AIDS philanthropy been slow to do the same? President Obama noted in his remarks, “… I promised to include Puerto Rico not just on my itinerary, but also in my vision of where our country needs to go.” Will public health and leaders in health philanthropy demonstrate the same commitment?
Philanthropy: A Call for Consistency, Equity and Action
Philanthropy as a field, and especially HIV/AIDS philanthropy, has been nobly committed to reaching the most at risk, underserved and marginalized populations. Virtually every major philanthropic institution professes to care deeply about, and reports that they direct resources to: under-served geographies, disenfranchised populations, and communities most impacted by economic and political injustice where human rights violations, gaps in educational achievement and public health disparities could be transformed with strategic and coordinated investments. Yet, few foundations, corporations or individual donors are making substantive philanthropic investments explicitly directed to addressing the HIV/AIDS epidemic in the U.S. Territories.
Funders Concerned About AIDS (FCAA) has chosen the Caribbean as the focus of its annual Spotlight series for 2011, with a particular concentration on trying to understand and bring attention to the fact that Puerto Rico – specifically people at risk for or living with HIV/AIDS in Puerto Rico – have not received a fair share of philanthropic resources devoted to the cause. [Click here to learn more about Puerto Rico’s unique relationship as a U.S. Territory.]
FCAA launched its Spotlight focus on Puerto Rico in February 2011 by collaborating with AIDS United to co-host a meeting of local HIV/AIDS leaders, and a second meeting with local and mainland philanthropic leaders to help educate funders, explore needs and opportunities across Puerto Rico, and to chart a collaborative course forward. AIDS United recently released the full report from those meetings including recommendations for ways that funders can make strategic investments in Puerto Rico. FCAA has also been working closely with Caribbean HIV Funding Collaborative and will co- host a Funder’s Forum at the Caribbean HIV/AIDS Conference November 18–21, 2011 in the Bahamas.
For the purposes of this blog posting, we are focusing specifically on Puerto Rico. The following statistics make a strong case for why strategic investments in Puerto Rico are warranted, and create a case for more equitable distribution of philanthropic resources to the places most impacted by HIV/AIDS.
- In 2006, Puerto Rico had the 2nd highest HIV infection rate and in 2009 Puerto Rico had the sixth highest HIV infection rate (22.9) of all US states and territories with confidential names based reporting (2009). This means that over 900 individuals were newly diagnosed and reported to the Puerto Rico Department of Health (PR DoH) with HIV infection during 2009.
- Puerto Rico continues to be among the top 10 U.S. States and Territories with the highest number of AIDS diagnoses in 2009. This suggests that individuals are learning about their HIV status unnecessarily late in their disease progression.
- Puerto Rico has an AIDS‐related death rate higher than any U.S. state or territory, a rate nearly 4 times the national rate.
Philanthropy and HIV/AIDS Philanthropy – A Call for Reflection and Equity
A vast inequity is revealed when Puerto Rico has: 1) the Highest HIV-related Death Rate; 2) Sixth Highest HIV infection Rate, and; 3) Consistently ranks in the Top 10 for Annual AIDS Cases among US States and Territories yet, in 2009 less than 1% of the entire international and domestic philanthropic HIV/AIDS funding was directed to the entire group of US Territories.
So why is this? Across philanthropy, there are varying definitions of geographic regions and issue-specific portfolios. For example, in some cases the entire group of U.S. Territories is lumped into the “International” portfolio. In others, Puerto Rico and the U.S. Virgin Islands may be included in the “Caribbean Portfolio,” and yet other funders include the U.S. Territories in their “domestic portfolio” or do not mention them at all. The very fact that there is no consistent way to refer to, and therefore to consistently track, philanthropic investments to the U.S. territories contributes to the existing and growing inequity in the distribution of philanthropic resources. Philanthropic institutions are typically eager to report where their funds are directed and the related achievements of these investments. Therefore, the absence of the U.S. Territories, and Puerto Rico in particular, further supports the evidence that few philanthropic investments are being directed to better the lives of individuals and families in these highly impacted and underserved locations.
More on philanthropy and the Caribbean/U.S. Territories
According to the Foundation Center the entire Caribbean received only 0.2% of the $1.9 billion in total overseas philanthropic giving by U.S.-based Foundations in 2006 , with an additional $17,504 in international grants received by U.S.-based organizations for work in the Caribbean region.
Of the $20 billion in grant dollars directed to the United States, only 0.001% ($3.9 million) went to all the U.S. Territories (including American Samoa, Guam, Puerto Rico and the Virgin Islands) combined.
This is also true among the majority of U.S-based HIV/AIDS funders. There is no record - in annual reports, resource-tracking reports or within philanthropic trade publications - of any major HIV/AIDS related philanthropic investments in Puerto Rico by any U.S.-based philanthropic institution that focuses on “domestic” or “international” geographies. It seems funders with “domestic” portfolios, forget that Puerto Rico is a U.S. Territory, while funders that have “international” portfolios, including those with a unique focus on the Caribbean, disqualify Puerto Rico, because it is, in fact, a U.S. Territory.
Private HIV/AIDS Funding in the Caribbean/U.S. Territories
According to FCAA’s most recent resource tracking report, U.S. Philanthropic Support to Address HIV/AIDS in 2009, less than 1% of the $472 million in international HIV/AIDS funding disbursed by U.S.-based private philanthropies in 2009 went to the entire Caribbean region.
In addition, less than 1% of the $112 million in domestic HIV/AIDS funding went to the U.S. territories (Puerto Rico and the U.S. Virgin Islands). In total, of the top 67 HIV/AIDS funders listed in the report (those giving $300,000 or more to HIV and AIDS), less than 20 organizations specified disbursing any funds to address the epidemic in the Caribbean region and/or U.S. territories in 2009.
Where do we begin? Target, Scope and Scale: An Opportunity for Funders
Puerto Rico has the largest proportion (49%) of its cumulative AIDS cases attributed to injection drug use among all U.S. states and territories, and the fourth largest proportion among U.S. states and territories (25.3%) attributed to heterosexual contact. (CDC, 2010). Scientific studies have proven that syringe exchange programs (SEPs) are effective at stopping the spread of HIV/AIDS and hepatitis and they do not increase injection drug use. Further, these programs serve as a gateway for individuals to access HIV testing, healthcare and drug treatment services. HIV/AIDS funders have been advocates for and supporters of syringe exchange programs for many years. New York City and the District of Columbia have seen dramatic decreases in new HIV infections among injecting drug users. However, there has yet to be a coordinated and concerted effort to stop HIV/AIDS among injection drug users in Puerto Rico.
The challenge in reaching full effectiveness in any HIV prevention effort is ultimately about scope and scale. The funder community has a unique opportunity to work with prevention scientists, public funders and community-based providers to assess needs and invest in SEPs at scope and scale that could dramatically reduce HIV infections among substance users and their sexual partners. And, in turn, to change the course of the HIV/AIDS epidemic in Puerto Rico.
Leveraging Public-Private Partnerships to End the HIV/AIDS Epidemic in the US
Increasingly, public and private funders see the value and the leverage in working together to address complex social, economic and public health challenges. Two recent initiatives have created a “perfect storm” for public private partnerships.
In July 2010, the Obama Administration released the first comprehensive National HIV/AIDS Strategy (NHAS) for the United States. The NHAS has three primary goals:
- Reducing New HIV Infections
- Increasing Access to Care and Improving Health Outcomes for People Living with HIV/AIDS, and
- Reducing HIV-related Health Disparities
In response, the Centers for Disease Control and Prevention (CDC) launched a new HIV prevention effort in 12 jurisdictions called Enhancing Comprehensive HIV/AIDS Prevention Planning (ECHPP). The premise is that in order to significantly change the course of the HIV/AIDS epidemic in the United States, including the Territories, we need to focus and direct the majority of public resources to the most impacted locations. Building on the CDC’s ECHPP effort, the entire Department of Health and Human Services (HHS) has now focused attention on what is being called the 12 Cities Initiative. Twelve highly impacted jurisdictions, including San Juan, Puerto Rico, are being targeted with federal resources, multi-faceted HIV prevention planning and combination HIV prevention strategies.
The defined geography, the concentration of the population, the specificity of the challenges within Puerto Rico, and these new “points of entry” for collaboration offer funders unparalleled opportunities to make a positive impact. Strategic, targeted and relatively modest investments can provide sufficient scope and scale offer for public and private funders to make meaningful and measurable achievements and to actually change the course of the HIV/AIDS epidemic in Puerto Rico.
As the public health and philanthropic communities strive to effectively address the issue of HIV/AIDS domestically and globally, we should be reminded, by the President’s words, that “Puerto Rico must be in our collective vision” if we hope to truly bring an end to the AIDS epidemic – in the world, in the Caribbean, and in the in the United States of America.
Additional Resources:
Philanthropic Strategies for Ending HIV/AIDS in Puerto Rico: A Meeting Report. AIDS United, July 2011