Reigniting the Fight: The Robert Wood Johnson Foundation

For the second entry in FCAA’s 30th anniversary blog series, we are highlighting the Robert Wood Johnson Foundation (RWJF), one of the first grant making institutions to provide significant support to AIDS-related programs and services. Today, we are taking a look back at this important contribution, as well as the many others RWJF has made to the fight over the past three decades.

About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation (RWJF) was formed in 1972 as a $1.2 billion organization. Today, it has grown to approximately $9 billion, becoming the nation’s largest philanthropy devoted exclusively to health and health care. The Foundation focuses on the most pressing health care issues of our time and supports a diverse group of organizations and individuals as it works to identify solutions and achieve comprehensive, measurable, and timely change.

While RWJF does not traditionally fund programs focused on one specific disease, in the early 1980s it saw clearly the broad impact of HIV/AIDS would have across the health spectrum. Mervyn Silverman, director of public health in San Francisco — and, later, the director of the RWJF AIDS program — said that, at that time, HIV-infected patients “were filling up hospitals…but there was no back door; there was nowhere to send them.” As a result, the Foundation felt compelled to act.

A Pioneer: Launching the Most Far-Reaching Philanthropic HIV/AIDS Program

In 1986, RWJF launched a $17.2 million AIDS Health Services Program, marking the beginning of an important collaborative funding effort. These resources were intended to replicate and evaluate what was known as “the San Francisco Model” — developed by activists and organizations and focused on building community-based, rather than in-patient, responses — at a nationwide level.

Through the AIDS Health Services Program, RWJF awarded grants in 11 cities over a period of four years. The initiative provided specialized services in multiple settings, with a focus on in-home and community-based care. While proven best practices were utilized, each program reflected the unique needs of the local communities it served.

At the same time, the U.S. government’s Health Resources & Services Administration (HRSA) AIDS Service Demonstration Grants took note of RWJF’s groundbreaking work. According to Sheila McCarthy, director of policy and branch chief for the HIV/AIDS Bureau’s Division of Science and Policy, “The work that RWJF was doing helped HRSA grantees shorten the learning curve and use their funds more efficiently.”[1] Often, RWJF not only funded the same communities and organizations as HRSA, coordinating closely, but even participated in site visits together.

By supporting community-based care networks in urban communities struggling to respond to the growing epidemic, the combined efforts of RWJF and HRSA established the platform upon which the Ryan White Comprehensive AIDS Resources Emergency Act (1990) was later built. The groundwork for Title I (now Part A) of the Act had been laid, HRSA had a relationship with the first eight Eligible Metropolitan Areas, and the local response to AIDS in cities across the country was already well under way.

Driving Collaboration

Though a select group of other foundations were making HIV/AIDS-related grants at the time, RWJF’s program was the most far-reaching, comprising 50 percent of all philanthropic funding. By extending financial support to service providers, health professionals, health care institutes, public agencies and nonprofits — and facilitating increased collaboration and coordination — its grants helped to create more effective and efficient systems of care.

“We put money in the middle of the table and asked everyone to come sit around the table. We wanted to fund cooperative, collaborative projects.”

 – Mervyn Silverman, Former Director of RWJF’s AIDS Health Services Program

RWJF’s early contributions to the fight, along with those of its fellow philanthropic funders, also served to highlight the relatively small amount of resources allocated to the HIV/AIDS response and the critical unmet needs. As the reach of the disease spread further and the media highlighted how indiscriminant the epidemic was, more Foundations joined the ranks of those funding the fight, government funding increased, and progress began in earnest.

Private Philanthropy Paves the Way for Broader Investment

 One of the distinguishing characteristics of philanthropy’s response to HIV/AIDS — as compared with other social issues and needs — is the way in which funders organized themselves and made long-term commitments to the issue. 
This is exemplified by RWJF’s contributions.

The Foundation’s initial $17.1 million investment, and the implementation of its AIDS Health Services Program, paved the way for other philanthropic involvement and signaled the beginning of the full U.S. response. Other support from throughout the sector was soon to follow.

Now, 30 years later, as we face new challenges — dangerous cuts to health and development budgets; the expansion of the Global Gag Rule — it is imperative to remember the contributions of pioneers like RWJF. The trials we are experiencing now are not without precedent. We have overcome such barriers in the past and we can and must do it again. Perhaps, by recalling the game changing contributions that have come before us, we will be able to reignite that fighting spirit.