Editors’ Note

Anne Aslett is the Chief Executive Officer of the Elton John AIDS Foundation (EJAF). Formerly, she served as Executive Director of the Foundation based in the UK. She has been with the Foundation for almost 20 years, having worked on EJAF UK’s mission in Europe, Africa and Asia, directing all its programming across 23 countries as International Development Director. She joined the Foundation from the commercial sector, where she managed a news information service for the UK leading print and electronic media, following over five years in UK print journalism and documentary film making on health and current affairs issues. Aslett represents the Foundation on the UK HIV Commission.

Foundation Brief

The Elton John AIDS Foundation (eltonjohnaidsfoundation.org) was established in 1992 and is one of the leading independent AIDS organizations in the world. The Foundation’s mission is simple: an end to the AIDS epidemic. The Elton John AIDS Foundation is committed to overcome the stigma, discrimination and neglect that prevents ending AIDS. With the mobilization of its network of generous supporters and partners, the Foundation funds local experts across four continents to challenge discrimination, prevent infections and provide treatment as well as influencing governments to end AIDS.

Will you highlight the history of the Elton John AIDS Foundation (EJAF) and how you define its mission?

The Elton John AIDS Foundation was conceived by Elton John back in 1992 around his kitchen table in Atlanta and established as a nonprofit, grant-making organization operating in North America to support people living with or at risk of HIV/AIDS. Six months later, Elton founded a UK charity with the same name and mission to work in the United Kingdom and Europe. The operating model was tiny – a couple of staff and a handful of volunteers. They sought out community organizations, hospitals and clinics and fund their services to help people die in less pain and with more dignity and counter harmful, discriminatory myths about the disease with accurate medical information.

Over time, as HIV spread across the world, the U.S. entity expanded its remit to cover work in South America and the Caribbean, and the UK extended its support to projects in Sub-Saharan Africa, Asia and Eastern Europe. Initial funding for both Foundations came from royalties from Elton’s singles, and hugely successful fundraising events like the Academy Awards Viewing Party, which still operates today.

As our expertise grew, support from governments, multilateral and bilateral institutions and trusts and foundations increased our income from less than $1 million a year at its start to over $20 million annually today. We developed coalitions with community organizations, national health systems, research institutions, activists and the expanding movement of people living with HIV/AIDS to deliver impact through multifaceted programs in dozens of countries around the world.

Will you provide an overview of EJAF’s work and initiatives?

The Foundation is a grant making charity. We don’t provide services directly but seek out those on the “front lines” of the epidemic who are trusted by their communities to help those who need it: with information about HIV; cheap, effective HIV testing; and linkage to HIV treatment and care. We see ourselves as partners to those we fund, so we work together to develop effective metrics to track progress and course correct where needed. This has seen us play a role in developing an African standard of palliative care for HIV; pioneering work preventing HIV transmission between mother and unborn child for over 800,000 pregnant women; and proving that HIV treatment could effectively be provided to over 140,000 infants and children in extremely resource poor settings.

Beyond the direct services we fund, the Foundation uses its convening power to bring together a diverse group of stakeholders and get consensus on the most important initiatives to bring to scale. Recent examples would be the $1.2 billion MenStar Coalition which was formed to escalate HIV testing and treatment for men in Africa. Whilst multiple initiatives were in place to support young women at risk of HIV – 5,500 young women become infected with HIV in the region every week – there was little targeted work with the men who typically infect them at a rate of one man for up to five young women. MenStar pledged to put an additional 1 million men on treatment within 18 months. It surpassed that goal and programs aimed at getting men to know their HIV status and access treatment are now embedded into national programs across Sub-Saharan Africa.

Finnally, funding services and convening, the Foundation deploys Elton John personally and its network of influencers to challenge policy that hampers the global AIDS fight. For example, over the last decade, the UK has had an intractable rate of approximately 5,000 new HIV infections annually. The Foundation established the world’s first social impact bond for HIV, collaborated with UK hospitals and doctors’ clinics to expand HIV “opt out” testing, then helped convene a national HIV Commission to establish how critical this work and other initiatives would be in ending the UK’s HIV epidemic. So compelling were the results of the social impact bond, and so effective was our advocacy in this space, that the UK government recently pledged £20 million to roll out opt out testing across England, starting this year.

How did EJAF adapt the way it works to address the challenges caused by the global pandemic?

As reports surfaced of the rapid spread of COVID in March 2020, the Foundation closed its physical offices, took our activities online, and immediately reached out to all current grantees to determine the impact they were facing because of the global pandemic. In the first instance, grantees shared that they urgently needed emergency protection equipment. We quickly established a $1 million COVID-19 Emergency Fund in April to support these needs in the short term, followed by a second $1.2 million Fund in August to help with longer term adaptation and resilience.

We worked with a team to develop a rapid response mechanism, shortening our application and approval process so that we could get the funds where needed as fast as possible. In a five-month period, over 100 grants were made to organizations across the world, reaching more than 150,000 people. For many thousands of service users, being quarantined, unable to work or to visit health centers to collect medication, was a major issue. We helped our partners pivot to fund online counselling, drug prescription and diagnostic services and pooled delivery mechanisms for essentials like food and medicine, as well as advocated for longer prescription periods to ensure people don’t run out of medicine.

Additionally, we partnered with Funders Concerned About AIDS to commission an evaluation of what had worked well in both ours and other COVID-19 emergency responses. This was shared widely in the funding community, and we also advocated with the G7 and others to capitalize on the systems developed to fight HIV/AIDS in the management of future pandemics.

EJAF was founded almost 30 years ago. Will you discuss the progress that has been made in addressing the AIDS epidemic and battling the stigma around AIDS?

When EJAF was founded, effective treatment or a vaccine were nowhere in sight. Life expectancy post HIV diagnosis was roughly two years. Marginalization and shaming of people infected with the disease, driven by fear and fueled by misinformation, saw people living with HIV scapegoated and judged.

Although HIV treatment programs have expanded across the world with astonishing results, offering those on medication a normal life expectancy, HIV perhaps more than any other disease is still driven by stigma and discrimination. People who are more vulnerable to HIV – the LGBTQ+ community, people who sell sex or use drugs, and young people who lack the information or agency to protect themselves, today form the majority (roughly 62 percent) of new HIV infections. They are scared to identify themselves as at risk. This is true in high-, middle- and low-income countries. Global LGBTQ+ and People Living with HIV movements have successfully challenged this environment in many places, but their human rights and social inclusion are fragile – over 60 countries and territories still criminalize consensual same sex relations, for example. In 2020, American states proposed more anti-trans legislation than in the whole of the previous decade.

Ultimately, taking advantage of the unprecedented advances in fighting HIV disease will require that no one gets left behind in this progress. We have the tools to address HIV, both for those infected and at risk. What we lack is the empathy and pragmatism to change laws and attitudes that treat some groups as unequal or undeserving of those tools. HIV is not a death sentence, unless you are excluded from the medicine that treats it.

How critical are metrics to measure the impact of EJAF’s work?

The global fight against AIDS is under-resourced in most places where it is spreading. In addition, pressures for resources from COVID and other diseases, climate change and civil unrest means we have to make sure that every dollar for HIV works as hard as it can to achieve impact. This makes monitoring and evaluation of our work essential.

The Foundation uses a grants management system to monitor and analyze our funded work alongside our partners. Tracking numbers of people tested for HIV or linked to care in a defined geography are relatively straightforward. The United Nations program on AIDS has developed a “clinical cascade” metric driving countries to reach or surpass the 90-90-90 metric: 90 percent of people living with HIV know their status; of which 90 percent are on treatment; and for which 90 percent have viral HIV suppression. The Foundation measures this, where applicable, for all its programs. Evaluating the total cost, or cost range, of programs in different contexts or for different groups is more difficult, but also possible. We also seek to evaluate “critical enablers” for impact: the quality of program management, the strength or efficiency of local healthcare delivery, external political and social risk, financial leverage and communication opportunities.

As a funder, we also look to monitor our own effectiveness: do our funded programs meet or exceed their targets? To what extent are they delivered on time or on budget? We are developing geospatial mapping for the programs we support that we can overlay with external data on demographics like the human deprivation index to give us greater insights on where we are most needed and what we are achieving.

Will you discuss Elton John’s passion and commitment for the work of EJAF and how deeply engaged he is in its efforts?

Elton’s passion for this cause has never waned over its 30-year history. Whether he is visiting programs in the field and talking to the people we seek to help, giving evidence before a government committee, hosting a gala event or penning an opinion piece for the press, he always gives 100 percent to the work. He is always open to new ideas and reaching out to people with different mindsets. It’s an enormous boost to the Foundation to have such a high profile and influential founder that is still in the fight with such commitment and energy. More than anything, Elton has been the “beating heart” of the Foundation. He believes that love and compassion are the cornerstones not just of the fight against AIDS, but of a thriving, fair society. He has laid out these beliefs in his book, Love is the Cure.

Did you always know that you had a passion for this type of work?

I had never envisaged a career in charity or international development. I became involved because I was personally touched by the HIV fight and simply wanted to do something in a small way to help people I had friends who were succumbing to this terrible disease without the love and support they could reasonably have expected. The more I learned, the more I became absorbed in the process of figuring out how to mitigate the difficulties and the pain that vulnerable people experience with local, national and regional changes to healthcare and information systems, social attitudes, and laws and policies. It has taught me that social justice, whatever the issue, is something we can never give up on.

Could you have imagined over 20 years ago when you joined EJAF that this would be a place that you would spend so much of your career and what has made the experience so special for you?

When I joined the Foundation, I imagined I would be involved for maybe three years. Two things have kept me here and propelled me forward: the hundreds of amazing, brave, big hearted people I have met who are involved in this work all over the world (sometimes in the most challenging and unlikely places), and the opportunity to be part of the Foundation’s innovation and evolution. The Foundation has grown to be one of the largest private AIDS funders in the world and continues to “think outside the box” on how people, science, technology and connection can change the world for the better. I never anticipated that being involved in something much bigger than yourself and your own immediate needs and desires could be so incredibly rewarding and fulfilling.