Resourcing Harm Reduction Blog Series: Elton John AIDS Foundation

Recently, FCAA released a data spotlight illustrating the intersection of HIV and people who inject drugs (PWID). Given that PWID are 22 times more likely to acquire HIV than the rest of the global population, we felt that it was important to understand where private philanthropy was supporting harm reduction programs. As we worked with partners to analyze the data, it was clear that the numbers tell only one part of the story. We wanted to dig deeper, to understand what challenges grant makers and recipients are facing in funding and implementing these programs.

 As part of this important conversation, we are proud to feature the following blog from the Elton John AIDS Foundation.

Learn more about this blog series and other entries. 

How did your organization begin/enter into funding harm reduction work?

The Elton John AIDS Foundation (EJAF) has funded work to support people who use drugs in geographies including Russia, the Ukraine, India, and the United States since the early 2000s. We identified harm reduction as a key factor in ending AIDS early on, so the decision to fund it was simple. It resonated with the Foundation’s core beliefs of compassion and love. We recognised that people who use drugs faced huge stigma from society and immense barriers to receiving lifesaving HIV services.

Acknowledging that funding for harm reduction is far below adequate levels, over the last six or seven years, people who use drugs, along with LGBT communities and adolescents, have been at the forefront of our grant making strategy. This has meant increasing our commitments to organisations supporting people who use drugs and expanding our geographical coverage, including a new fund that mainly supports community-based harm reduction initiatives in Eastern Europe and Central Asia

What are the challenges you have faced/ overcome in funding harm reduction work? How have you navigated those challenges?

We’ve constantly had strong support for our harm reduction work from our board and the Foundation’s supporters. They understand why we are investing in this area and see the clear link between injection drug use and HIV risk, as well as the barriers (criminalization, stigma) that prevent so many from accessing health services.

The biggest challenge has been in securing support from other foundations to join us in the response. While there are committed funders of this work – including, among others, the Global Fund, Levi Strauss Foundation, Open Society Foundation, MAC Viva Glam Fund – more funds must be leveraged to make a significant impact on reducing the epidemic among people who use drugs.

Going forward, we aim to play a more central role in motivating other foundations that fund HIV work to also commit to supporting harm reduction. Similarly, securing more commitments from funders focused on drug treatment and recovery to support evidence-based harm reduction approaches also will be crucial in mobilizing more resource for the response.

What is the most effective strategy, tool, piece of data, or resource that you have used to successfully overcome barriers to funding harm reduction work?

Our work at the Foundation – across all portfolios – is based on data and evidence; that is how we make decisions on what and where to fund. We also recognise the limitations of data in certain situations (for example, in Russia). When that is the case, we also try to collect anecdotal evidence from communities to guide decision-making.

Resources from UNAIDS are always useful, as are policy guidelines from places like Harm Reduction International  and the International Drug Policy Consortium, among others. We also look to longstanding harm reduction work domestically in the United Kingdom as evidence of the effectiveness of syringe access.

Are there other ways your organization has been able to take part in the response without directly funding harm reduction (i.e. convenings, advocacy, etc.)?

We are taking more steps to publicly highlight harm reduction as an effective tool in addressing the global HIV epidemic, as we have done for our work to support LGBT communities and adolescents. We are planning to take a more active role in convening funders to mobilize funding for harm reduction and recently had a strong presence at the Harm Reduction International Conference, where we supported the film festival and put on a public event around funding for harm reduction.

Earlier this year, we convened a session at the Lancet Commission on the Future of Global Health and the HIV Response in Kyrgyzstan where grantees from the Eastern Europe Central Asia region were able to discuss their work on harm reduction and the models they are implementing to reach people who use drugs. The session also was attended by health officials from the region, who saw the impressive, evidence-based work being done in often highly criminalised settings.

Occasionally, we will fund advocacy work directly, for example Harm Reduction International’s “10 by 20” campaign and the amazing Support. Don’t Punish. campaign, with which I urge everyone to get involved!

What is your biggest success story as a funder of harm reduction work?

There are many! On a project level:

• Funding the first scaled up harm reduction programme in sub-Saharan Africa (with Médecins du Monde –MdM –in Tanzania)
• Establishing a model for supporting young people who use drugs in Ukraine (with the Alliance for Public Health)
• Decentralizing HIV services for people who inject drugs in rural Myanmar (Kachin state)
• Expanding access to low dead space syringes through innovative channels in Vietnam (with PSI)

In addition, we have had huge successes in our nearly decade-long support of the Syringe Access Fund in the United States. Together, Syringe Access Fund partners have made a remarkable impact on public policy and public health, awarding more than $20 million through 409 grants to 177 organizations in 33 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. With this support, grantees have distributed over 66 million syringes to more than 350,000 clients and have led advocacy efforts to change laws around the country helping these programs to reach more people in need.

Our work in Eastern Europe and Central Asia has also been a high point. Recognising the lack of financial support for harm reduction in Russia – both domestically and from international donors – and the increasing rates of HIV, we established a Key Populations Fund to support HIV and harm reduction work. The $10m fund has supported a range of organisations across Russia and the region, and has provided direct support for community-based work. A large portion of the funding will be used to improve services for key populations – including people who use drugs – at the public health level (i.e. working with doctors, nurses, treatment providers). Funding will also be used to reduce healthcare provider stigma and to streamline access to care.