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Big Issue joins Elton John for world’s first social impact bond to combat HIV

Our social investment arm Big Issue Invest put £200,000 into the Elton John AIDS Foundation project which has seen 120,000 HIV tests carried out in London's hardest hit areas over 18 months

Big Issue Invest is among a group of investors, local councils and health groups working to boost testing for HIV/AIDS in three of London’s hardest hit areas.

Our social investment arm is working with the Elton John AIDS Foundation (EJAF) on the world’s first social impact bond (SIB) to combat HIV/AIDS. To coincide with AIDS 2020 ⁠— the 23rd international AIDs conference being held this week, it has been revealed that 120,000 HIV tests have been carried out in Lewisham, Lambeth and Southwark in the first 18 months of the three-year programme.

EJAF’s payment-by-results programme has seen 114 people receive a new diagnosis of HIV as well as attending their first treatment while GPs and health agencies were able to re-engage 68 others who had previously left treatment.

The social impact bond, called the Zero HIV SIB, is the first in the world designed to tackle HIV. It does this through an innovative partnership between investors, local authorities, hospitals, primary care, and HIV support charities.

The SIB is based on an outcomes-based contract, in which a commissioner pays a contractor for certain measurable outcomes. The outcomes – diagnosing new cases of HIV and re-engaging patients who dropped out of HIV care – are chosen on the basis that achieving them now will save the health service money in future years by preventing the spread of the virus.

Dr Grace Bottoni, a GP with One Health Lewisham, told The Big Issue that the SIB meant that they could increase their HIV testing by 70 per cent and they identified nine new patients with HIV in the year compared to three in the previous year. Covid-19 has seen a decrease in the number of people attending GP surgeries, which has affected the number of people they are able to test, but Dr Bottoni has pivoted to focusing on re-engaging lost patients, bringing seven back into the fold including two during lockdown.

“A lot of people in the community don’t know that you can lead a normal, healthy life with HIV because there is still a lot of stigma, especially in Lewisham, due to different religions, health beliefs and cultures,” she said.

“In order for someone to lead a healthy life with HIV they need to know that they have it and to be on treatment. We were trying to increase the number of HIV tests in our area so that people knew their status. So we’re doing universal testing – they were already doing that in the A&E but we tried to do that in the GP practices.


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“This is great for the individual because they are in treatment and they also can’t pass it on. It’s a huge success for the Lewisham community as a whole.

“I don’t think it would be possible without the bond. The SIB has made it more of a priority because GPs have so many different things to think about and HIV sometimes gets lost and thanks to tis we have been able to put a little prompt on their screen to remind them to test for HIV. I think that has really helped.”

The project is not just making a difference in GP surgeries, it is also reaching out into communities who traditionally do not interact with services. That work is being carried out by NAZ, a BAME-led sexual health agency. Carlos Corredor is a veteran member of the NAZ outreach team and he said that the SIB funding is transforming the work he has been doing for 21 years.

It’s a very good initiative that should be replicated not only other areas of London but also in other parts of the country and even the whole world

“Through the Elton John Aids Foundation we have been targeting the Latin Americans who are invisible – I call them that because they live among us but don’t appear in any statistics,” Carlos told The Big Issue. “They don’t access any mainstream services, they’re not registered with a GP and don’t go to one. They don’t go to any clinic. They don’t get any support. They are lonely, they are isolated, they are poor.

“So with the investment of the bond I have been able to reach some of these people by going to the places where they meet – in London there are hundreds of places where communities go to meet and they are totally out of sight.

“So far I have been able to find 21 of these outcomes, bringing people to hospital and clinics, and they are all getting treatment and accessing services where they can get help regardless of their immigration status.

“This work wouldn’t be possible with the social impact bond. We are also working on prevention. Early treatment means a normal life. It’s a very good initiative that should be replicated not only in other areas of London but also in other parts of the country and even the whole world.”

Big Issue Invest put £200,000 into the project and are one of four investors, alongside EJAF, Comic Relief and ViiV Healthcare.

Social impact bonds are structured so that, if they are successful in achieving their outcomes, investors are later reimbursed by outcomes funders. Those funders are Lambeth Council, on behalf of Lambeth, Southwark and Lewisham Councils, Commissioning Better Outcomes in The National Lottery Community Fund, and The Elton John AIDS Foundation.

Since treatment is also prevention, it is critical for us to find and support people living with HIV

Alan Tudhope, Investment Manager at BII, said: “We are so pleased to have been able to be part of the social investment effort behind this pioneering programme of support for those living with HIV/AIDS in South London. The impact of the activity undertaken by EJAF in just 18 months is clear for all to see and we look forward to seeing even more progress in the second half of the programme.”

EJAF CEO Anne Aslett added: “The Elton John AIDS Foundation are proud to have championed the world’s first HIV social impact bond to bring South Londoners into life-saving HIV care.

“Our partners work directly with the community to test for HIV in hospitals and GP surgeries and re-engage people living with HIV who have dropped out of care in three London boroughs who have some of the highest rates of HIV in Europe. Since treatment is also prevention, it is critical for us to find and support people living with HIV so they can have a healthy life and to prevent the onwards spread of HIV.”

Image: Getty Images/Michael Kovac