Kindness is the greatest healer

As many as one in every seven HIV-positive people globally are thought to be unaware of their status. Some may feel reluctant to take a test despite knowing they are at greater risk. For others, it does not even occur to them that they might have been exposed to the virus. Undetected HIV is a ticking timebomb, says David. Early diagnosis is in everyone’s interests. It can prevent a person developing AIDS, prevent onward transmission and save huge treatment costs over a patient’s lifetime.

The United Kingdom is among the countries to have achieved notable success in fighting HIV. Thanks to its public health system’s testing and therapy regime, it was one of the first to achieve the United Nations’ 90-90-90 target, with 90% of HIV-positive individuals diagnosed, undergoing treatment and having undetectable viral loads. But even in this advanced economy, there are glaring gaps. The south London boroughs of Lambeth, Lewisham and Southwark have some of the highest rates of HIV in the country, including many undetected cases.

Having observed the stagnation of new diagnoses and the surge in late diagnoses during the mid-2010s, the Elton John AIDS Foundation stepped in. Austerity measures following the Global Financial Crisis had left many healthcare budgets frozen, says David. We identified the need and opportunity for a private investment solution to fund efforts in the public sphere in south London.

In 2018, the foundation launched a social impact bond, under which healthcare providers in the three boroughs would receive funds based on targeted outcomes. This first-of-its-kind scheme ran for three years. Not only were tests administered in the traditional surroundings of hospital emergency units, HIV clinics and doctors’ surgeries but also in various community spaces.

To boost testing rates, the scheme sought to change the conversation with south Londoners. Traditionally, healthcare providers had contacted people asking them to opt in to testing. In some cases, those invited would feel they were being profiled or judged. Under the foundation’s pilot project, however, people would be routinely tested whenever they had blood drawn at the doctor’s surgery or a hospital for any reason, unless they asked not to be. 

In just over three years, over 260,000 tests were conducted, identifying more than 200 new cases of HIV among south Londoners. The scheme also persuaded some 250 lapsed patients to resume treatment. Many of the cases identified were among residents identifying as heterosexual and from the black community. They included individuals in their fifties and sixties, with a few who were even older. But for the scheme, many would not have received a test. Following diagnosis, trusted community organizations would intervene to encourage patients to enter specialist treatment.

Homophobia and resulting discrimination remain highly destructive forces within the HIV epidemic. They are prevalent at multiple levels, from within families and communities up to governments. Numerous studies have revealed that the stigmatization of gay relations hinder people from engaging in HIV prevention, undertaking testing and seeking treatment if infected. Those fearing stigmatization or having endured past discrimination are also likelier to experience stress, depression and suicidal tendencies.

Eradicating stigmatization is thus critical to ending the epidemic. In South Africa, where almost one in seven of the population is living with HIV, the foundation supported the first ever nationwide campaign specifically addressing gay men and other men who have sex with men. Spearheaded by a local organization called We The Brave, the initiative highlights prevention and treatment issues in affirming, non-judgmental and sex-positive ways. It promotes safe sex and regular testing and connects people to preexposure prophylaxis and HIV treatment. 

The world has the tools to end AIDS, says Elton. But persistent stigma surrounding HIV is now the main source of transmission. Hate crimes, politically sanctioned exclusion and punishment, and social marginalization are just some of the barriers that keep people from accessing the care they desperately need. And those barriers are growing.

In response, the foundation is launching a new $125 million global campaign. The Rocket Fund seeks to tackle rising levels of stigmatization, marginalization and poverty that combine to produce high rates of HIV and low access to healthcare. It will focus upon the most HIV-vulnerable groups globally: LGBTQ+ populations, people who use drugs and young people.

As well as enhancing access to testing, prevention and treatment, promoting human rights is at the heart of the Rocket Fund’s agenda. We’re committed to combatting punitive, judgmental attitudes and laws targeting HIV – and the groups most vulnerable to them, says David. Nearly a third of global nations classify LGBTQ+ people as criminals. And in 13 countries, homosexuality is punishable by death. We are investing in advocacy to empower LGBTQ+ communities to be heard and seen wherever their rights are threatened.

Likewise, the threat of violence, abuse and incarceration from the authorities keeps many drug users globally from seeking healthcare. The Rocket Fund is thus seeking to expand non-judgmental programs that address HIV, opioid use, unclean needles and overdoses. We’re also pressing the case for a reallocation of funding away from criminalization of people who use drugs and toward services that benefit public health, says David.

This emphasis on fresh, evidence-based thinking goes hand in hand with the Rocket Fund’s support for other innovations in the fight against HIV. In Kenya, for example, it will extend the foundation’s backing for a scheme that enables young people to use their phones to order drone deliveries of vital medical supplies. In South Africa, it is partnering with a local app developer to create confidential forums for young people to discuss sensitive sexual and reproductive health issues.