Elton John is Elton John. In 1992, inspired by his friend Ryan White (who had died of the disease two years earlier), he founded the Elton John AIDS Foundation, a major nonprofit working on HIV prevention, as well as care and treatment for those with the disease. The initial organization, based in New York, was followed the next year by a London branch. The U.S. and U.K. branches have, together, raised over $300 million to support programs in 55 different countries, making it one of the 20 largest private philanthropic HIV/AIDS grant-makers. A list of the foundation's areas of specialty, as well as specific projects and grantees, is available here. John's book on the subject, Love is the Cure, was released last year. The paperback will be out in November, with a new foreword from Dr. Paul Farmer.
We corresponded about John's philanthropic work by e-mail; a transcript follows.
There's a divide between AIDS activists who think vaccine research is an immensely promising avenue and those who think it's a diversion of money that should be going to antiretroviral treatments. What are your thoughts on that?
Activists in the fight against HIV/AIDS, myself included, are good at voicing opinions, and we have lots of healthy debates about strategies to end AIDS. But you raise a false choice that's not really a leading debate at all. Most activists, and the Elton John AIDS Foundation, believe in attacking this disease from all fronts, including investing in vaccine research and investing in access to antiretroviral treatments. Both of these approaches are vital, and slighting either diminishes our opportunity to eliminate the insidious effects of HIV/AIDS.
To use an analogy, when flu season rolls around each winter, the scientific community researches and manufactures both vaccines for prevention and medications for treatment. It's common sense. The HIV/AIDS effort is doing the same and should keep doing it: apply what works now and invest in researching improved options for the future.
If you want a divide to discuss, how about the gap between our leaders' rhetoric - to end AIDS - and the total investment being made to bring that about? How about the gap between what we manage to do and what we could actually achieve? In my book I write about how eradication of HIV/AIDS is within our grasp, if we commit to it. That's what the Elton John AIDS Foundation is focused on: aiming for everything that science, funding, and compassion can deliver.
There's been a big move in philanthropy toward randomized evaluations of interventions. What role do you think that can play in AIDS policy?
One important thing to remember is that we know a lot about HIV/AIDS. We may not yet have a cure, but this is a disease that we understand very well. At this moment, 30 years into the crisis, we know what solutions will truly make a measurable impact in the fight to end HIV and AIDS: the use of condoms, clean injection equipment, antiretroviral medicines, and yes—fighting stigma and discrimination. And the evidence for the effectiveness of these interventions is thoroughly documented and published by the World Health Organization (WHO) and, in the United States, by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).
Since the beginning of the epidemic, the Elton John AIDS Foundation has based its grant-making on scientific evidence of what works. While HIV research is not our focus, we work alongside other philanthropic grant-makers that do fund research, dating back to early work and advocacy for HIV treatments, opportunistic infection treatments, use of antiretroviral drugs to prevent mother-to-child HIV transmission, and distribution of clean injection supplies to prevent injection-related HIV transmission. So we view this research and this type of philanthropy as crucial.
The challenge for philanthropists, doctors and policymakers is how we make those solutions available to all. One major focus of philanthropy should be supporting research, which underpins good policy. But it needs to go hand in hand with grant making that ensures access to these solutions as well. That's what EJAF prioritizes in its’ grant-making: making sure people access effective HIV prevention and treatment options.
How much progress do you think we've made in combating the idea that AIDS is caused by antiretrovirals, since former South African president Thabo Mbeki et al were propagating that?
I think we’ve made tremendous strides in fighting that stupid, dangerous myth. The HIV virus is the cause of AIDS and antiretrovirals are essential in the treatment and prevention of infection—everyone knows this. Unfortunately this myth has led to real stigma against people living with HIV/AIDS worldwide. So while the myth is nearly gone, the stigma remains, and that is a huge challenge we face today—as big as any other challenge, from where I sit.
Most of the studies I've seen suggest that the President's Emergency Plan for AIDS Relief (PEPFAR) is a huge success. Is this an area where effort should be shifting from the private sector to public?
Yes, PEPFAR is a huge, historic success. George W. Bush has my eternal thanks for that. PEPFAR and other US programs have saved millions of lives and they’re continuing to change the course of the global HIV epidemic.
But if we truly want to eradicate AIDS, we need both governments and the private sector involved. Governments in most of the world are the main investors in hospitals and health clinics and are the main driver of national health programs. On the private side, pharmaceutical companies develop and supply medicines, and faith-based organizations and community-based charities deliver essential services. It’s key that both work together, and we’ve seen that kind of cooperation have a real impact. That’s something I address in my book and that the Clinton Foundation in particular has pioneered with great success.
Obama has been reducing budget requests from PEPFAR. My understanding is you are generally supportive of his administration. What do you make of that?
The U.S. government is the world’s largest contributor to the fight against AIDS, both internationally — such as through PEPFAR and to the Global Fund — and domestically through Medicaid, Ryan White, and other programs. This has made a significant impact.
The reality, though, is we need more. Not even that much more. We only need on the order of $5-7 billion in new funds each year for the next decade or so to make the end of AIDS an eventual reality. But we need those extra funds NOW. This is a disease that can be eradicated with adequate funding, and as I explore in my book, the experts have put together a very realistic and detailed plan to do so. We can create an AIDS-free generation and save millions of lives (and billions of dollars) but only if we turn the tide of the epidemic by making investing NOW.
President Obama’s budget request for next year asks for a 9 percent increase in domestic US spending on HIV and a 2 percent increase in global spending, and notably a 27 percent increase in funding for the Global Fund. The total investment for the Global Fund would be around $1.65 billion.
As I said, I do think the U.S. government could step up and do even more. I say this everywhere and I think everyone needs to say it, because even the White House request I describe above isn’t going to happen without a lot of advocacy with the U.S. Congress. But I see the current U.S. administration as allies in the fight against AIDS and willing to hear the advocacy.
How would you say David Cameron has done on this issue to date?
The U.K. has always been a leader in the fight against HIV/AIDS, at home and around the world. I admire David Cameron and his government for sticking to the U.K.’s commitment to invest in international aid at a level of 0.7 percent of Gross Domestic Product (GDP) – a goal achieved by only five other countries in the world. I also admire the honesty and frankness of the U.K. government in speaking out about HIV and human rights in times when other countries have remained silent.
As with the U.S., I want the U.K. government to do more, including committing £1 billion (US$ 1.55 billion) to the Global Fund for 2014-2016. The world is making progress against the HIV epidemic and it’s essential we not stop now. We have a once-in-a-generation chance to end AIDS. Let’s not miss it.