Market for Impact

Summary

What do they do? San Francisco AIDS Foundation provides HIV prevention and care, sexual health services and community support. Its work includes overdose prevention and access to PrEP, medication that reduces the risk of acquiring HIV. General donations support this broader range of services rather than only naloxone distribution. More

We include San Francisco AIDS Foundation among our top-ten research candidates because of its:

Established clinical and community services with current audited financial reporting.
Concrete prevention mechanisms, including timely overdose response and effective HIV prophylaxis.
Ability to address practical access barriers alongside medical care and community support.

Our main reservations about San Francisco AIDS Foundation are:

The allocation of additional donations and delivery prices in our model are assumptions, not verified marginal budgets.
Added access beyond public coverage, partner services and existing rescue networks has not been measured.
Much of the organization's work remains outside the quantified health pathways, while its costs remain included.

What do you get for your dollar?

GiveBetter is interested in extending effective prevention to people who otherwise miss it. The model assumes $300 per overdose-response offer and $700 per PrEP offer, including branch delivery and follow-up. After assumptions about replacing existing funding, branch spending is about $750 per additional overdose offer and $2,333 per additional PrEP offer, before other organizational costs and overlap adjustments; these are analyst budgets, not provider quotes. Source

Overdose response can extend survival when it changes an otherwise untreated emergency, while PrEP can add time living without HIV. The model compares each with the care people would otherwise receive, follows finite health trajectories and avoids double-counting overlapping participants. It does not treat each naloxone dose or reported reversal as a separate life saved.

The central estimate is about $1.93 million per better life (10 Bay Area QALYs), or $2.02 million for San Francisco benefits alone. Including gross associated outside resources raises the Bay estimate to about $2.66 million. The earlier $56,328 estimate was for targeted naloxone spending and is not the estimated return on general giving. More

What information has San Francisco AIDS Foundation shared about its program?

SFAF shares audited accounts, annual reporting and service information. These establish the scale and breadth of its work, but doses, contacts and reversals are not a patient-linked counterfactual evaluation. The most useful additional information would connect incremental funding with unique people gaining sustained protection beyond existing access. More

What is GiveBetter’s qualitative assessment of San Francisco AIDS Foundation?

Established delivery, clinical expertise and community relationships make SFAF a credible organization for a donor to investigate. HIV care, housing and behavioral-health support may add benefits not captured by our calculation. Our positive view of the organization is therefore distinct from confidence in any particular marginal QALY estimate. More

1. What do they do?

San Francisco AIDS Foundation provides HIV prevention and care, sexual health services, overdose prevention, substance-use support, and community services. Its work combines direct care with help accessing treatment, housing and social support.

Support a range of services

The central model allocates 15% of additional support to overdose prevention, 20% to PrEP access and 65% to other services and central operations. These are modeling assumptions, not a donor restriction or a published budget for new donations.

Reach additional people

The model starts with assumed costs of $300 per overdose-response offer and $700 per PrEP offer. It then adjusts for funding that would otherwise be available, people who already have access, and overlap between the two groups.

Compare two finite trajectories

Recurring overdose rescues affect one person's survival curve. PrEP changes finite time without HIV, allowing later infections in both arms.

Deduplicate and value health

No new lifetime per reported reversal. Exclude overlap from PrEP gains; retain its costs/harms. No extra HCV/MOUD survival, transmission or other portfolio health added.

Scope of this review. Neither a dose, a training nor a PrEP prescription is a causal life saved. All quantities beyond service existence are scenario inputs.

2. Monitoring and information sharing

Whole SFAF organization

Official FY2025 audited functional portfolio. Multiple clinical/support/policy functions plus central operations are present.

Our assessment. Historical expense categories guide breadth; none is a verified marginal gift share.

Adults following nonfatal opioid overdose

Historical Medicaid cohort. Repeated overdose and subsequent fatal overdose are observed.

Our assessment. A recurrent-event survival model is warranted, but current SFAF event/rescue hazards remain priors.

High-risk sexual-health clients in England

PROUD randomized immediate versus deferred PrEP. 86% relative acquisition reduction; substantial background incidence.

Our assessment. Neither local incidence, added access, utility gap nor funding additionality is supplied by this trial.

SFAF programs and eligible PrEP clients

Current public budget/benefit sources. Existing public and assistance routes support care.

Our assessment. They neither prove every client is reached nor identify a priced unfunded cohort.

3. Qualitative assessment

SFAF delivers overdose prevention and PrEP alongside HIV, HCV, behavioral health, housing and community support. Flexible funds may extend protection to people not reached by current funding.

Key reservations

Most whole-organization health remains unquantified; retained cost is not evidence those services lack value.
Unique-person costs and recurrence/rescue hazards are unmeasured, replacing the old repeated-report shortcut with an explicit prior-based survival comparison.
PrEP morbidity utility is an assumption; no direct patient utility, secondary transmission or mortality advantage is credited.
Current spending authority, additional staff/medicine supply and final public cuts/restorations remain unverified.
Combine models only after person-level deduplication with HYA, GLIDE, HRTC, SFPHF, clinical partners and other funded providers.

Benefits not included in our estimate

HCV cure and HIV linkage/retention benefits
MOUD, other behavioral health and drug-use morbidity
Housing, food, community support and trans/sexual health beyond PrEP
HIV mortality and secondary transmission prevention
Policy, statewide appropriations and broader welfare
Nonfatal overdose brain-injury prevention and health beyond finite horizons

4. What do you get for your dollar?

Costs per better life across SFAF's services

The model compares health with and without additional overdose-response and PrEP support. Overdose prevention accounts for most of its central quantified benefit. Other services remain included in costs but do not receive a separate quantified health benefit where the evidence is insufficient.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

Cost-effectiveness calculation: Unique people = gift × branch allocation / direct offer cost × financing additionality (× disjoint fraction for PrEP). OD benefit integrates supported survival minus baseline survival. PrEP benefit integrates supported HIV-free survival minus baseline HIV-free survival × treated-HIV utility gap. Subtract distinct present-valued harms. Whole-gift price = 10 × gift / regional net Q.
Central donor cost per 10 QALYs: $1,905,230 US; $1,926,860 Bay Area; $2,018,525 San Francisco. Including gross associated resources: $2,664,572 per 10 Bay Area QALYs.

Model inputs and assumptions

OD /PrEP gift allocation: 15% /20% (range: 5–30% /10–25%; zero-quantified allocation case). Audit establishes portfolio breadth, not next-gift shares. Central other 65% priced but unquantified. Funding additionality does not stand in for allocation. Explicit marginal portfolio prior.
Direct cash per supported offer: $300 OD /$700 PrEP (range: $150–$600 OD /$350–$1,500 PrEP). Includes recruitment failures, branch staff, follow-up and program administration. Central corporate management/fundraising is in separate 15% retained spending. Outside medication/lab inputs priced separately. Unpriced delivery prior.
Financing additionality: 40% OD /30% PrEP (range: 10–70% /10–60%; explicit zero). Existing government support, assistance, 340B operations and other donors stay baseline. Does not measure clinical change or unrestricted allocation. Unverified capacity/replacement prior.
Recurrent events /fatality without effective rescue: 0.5 per year /10% (range: 0.3–1 /5–15%;2-event stress). External Medicaid recurrence and mortality inform scale only. Events can recur in survivors; fatal hazard is event rate × untreated fatality × failure of effective rescue. Historical recurrence context; local priors.
Effective rescue baseline /increment: 80% /+10 points (range: 75–90% /+2–20 points;−5-point harm). Includes witness access, timely dosing, EMS and alternative rescue. It is not the pharmacological reversal rate or reported reversals/doses. Unmeasured counterfactual.
OD protection /finite survival: 1-year protection;15-year horizon; utility .7; other hazard .06 (range: .5–2-year support;10–20-year horizon;5-year stress). Baseline fatal hazard totals .07 centrally. The .06 hazard excludes overdose death already modeled. Following support both arms return to baseline risk; survival difference is integrated once. Explicit competing-risk model.
PrEP baseline HIV hazard /additional effective coverage: 1% yearly /25% extra coverage (range: .3–3% /5–50%;zero). PROUD's 86% relative effect is an external active-PrEP scale. Its much higher control incidence is not imported. Coverage increment is added protected time beyond actual care. Local priors versus current care.
PrEP support /finite morbidity: 1 year /20-year horizon /.08 utility gap (range: 10–25-year horizon /.03–.15 gap;5-year stress). Common mortality .01 and later infection continue. Gap compares HIV-free with treated HIV, not untreated AIDS; no HIV mortality/transmission credit. Not direct SFAF utility evidence. Utility/duration judgment.
Disjoint PrEP health fraction: 90% (range: 70–95%;zero disjoint health stress). Excludes people/person-time already credited under overdose survival. Full PrEP costs and harms remain; no added MOUD/HCV tail on those same survivors. Unmeasured overlap prior.
Outside resources per nominal offer: $80 OD /$1,200 PrEP (range: Donor-pays sensitivity moves these into direct cash). Medication/lab/other real inputs outside branch cash and corporate overhead. Not insurance transfers or 340B revenue. Assumes associated inputs before replacement; no savings subtraction. Unpriced gross envelope.
OD Bay/SF;PrEP Bay/SF: 99%/95%;95%/75% (range: Favorable PrEP SF 85%; zero SF case). SF nests within Bay. Shares include mobility over health horizon; service-site location alone does not prove residence. Future health-residence priors.
Shared /independent loss: 0 centrally (range: .04 OD /.01 PrEP per incremental offer;.1 independent QALY). Already gift-date PV, no extra discount. PrEP shared harm applies even to overlap-excluded people; independent harm survives zero funded activity. Diagnostic outside counted clinical effects.

How cost-effectiveness changes under different assumptions

central: SF donor: $2,018,525/10 QALYs. US/Bay donor costs per 10 QALYs: $1,905,230 / $1,926,860. Including gross associated resources, US/Bay/SF costs: $2,634,660 / $2,664,572 / $2,791,332 per 10 QALYs.
favorable joint: SF donor: $20,263/10 QALYs. US/Bay donor costs per 10 QALYs: $19,215 / $19,422. Including gross associated resources, US/Bay/SF costs: $38,759 / $39,178 / $40,873 per 10 QALYs.
pessimistic positive: SF donor: $2,583,049,910/10 QALYs. US/Bay donor costs per 10 QALYs: $2,436,629,960 / $2,464,570,754. Including gross associated resources, US/Bay/SF costs: $2,647,804,556 / $2,678,166,886 / $2,806,914,236 per 10 QALYs.
no quantified allocation: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
replacement only: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
no clinical increment: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
quarter year preservation: SF donor: $7,712,310/10 QALYs. US/Bay donor costs per 10 QALYs: $7,280,223 / $7,362,723. Including gross associated resources, US/Bay/SF costs: $10,067,508 / $10,181,594 / $10,665,022 per 10 QALYs.
high recurrent risk: SF donor: $749,173/10 QALYs. US/Bay donor costs per 10 QALYs: $710,004 / $717,507. Including gross associated resources, US/Bay/SF costs: $981,834 / $992,209 / $1,036,000 per 10 QALYs.
five year health horizon: SF donor: $4,301,174/10 QALYs. US/Bay donor costs per 10 QALYs: $4,067,952 / $4,112,550. Including gross associated resources, US/Bay/SF costs: $5,625,396 / $5,687,070 / $5,947,909 per 10 QALYs.
prep fully overlaps: SF donor: $2,068,896/10 QALYs. US/Bay donor costs per 10 QALYs: $1,965,451 / $1,985,304. Including gross associated resources, US/Bay/SF costs: $2,717,938 / $2,745,392 / $2,860,987 per 10 QALYs.
negative rescue effect: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
independent harm zero activity: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
adverse shared burdens: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.
donor pays outside inputs: SF donor: $2,590,435/10 QALYs. US/Bay donor costs per 10 QALYs: $2,453,382 / $2,479,620. Including gross associated resources, US/Bay/SF costs: $2,453,382 / $2,479,620 / $2,590,435 per 10 QALYs.
no sf health: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: $1,905,230 / $1,926,860. Including gross associated resources, US/Bay/SF costs: $2,634,660 / $2,664,572 / No finite positive ratio per 10 QALYs.
zero health horizon: SF donor: No finite positive ratio/10 QALYs. US/Bay donor costs per 10 QALYs: No finite positive ratio / No finite positive ratio. Including gross associated resources, US/Bay/SF costs: No finite positive ratio / No finite positive ratio / No finite positive ratio per 10 QALYs.

Uncertainty. The central value is a judgmental partial-health best estimate for the whole gift. Joint favorable inputs are not a confidence bound or high-expected-value claim. Null and harm cases retain gift costs. Shorter protection and health horizons can substantially worsen value; new recurring risk can increase both need and survivor attrition. These modeled unit costs are not a promise that impact scales proportionally with donation size.

5. Funding and previous grants

Current audited accounts and established clinical services support further diligence. The model’s allocation between overdose prevention, PrEP and other services is an assumption, not a donation restriction. Obtain a current additional-funding plan before relying on the estimated health return.

No verified marginal unrestricted-gift budget or patient-linked additional-effect estimate. This replaces the scope of the organization estimate, not the historical program calculation or organization count.

May 2026 contract request remains conditional on appropriations; June partial restorations do not resolve the current Pick Up Crew gap. Public PrEP benefits and 340B operations remain baseline. Liquid assets do not establish spare cash or absence of need. Verified funding room remains null.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

San Francisco AIDS Foundation FY2025 audited financial statements. SFAF; independent auditor. Primary full portfolio statement, in thousands; historical categories are not marginal allocation.. Published: November 21, 2025; retrieved: September 8, 2026.
Health services. San Francisco AIDS Foundation. Primary service description; not measured incremental outcomes.. Published: Undated current page; retrieved: September 8, 2026.
Overdose prevention and response. San Francisco AIDS Foundation. Primary reported doses/reversals; repeat reports do not establish unique lives saved.. Published: Undated; 2025 outputs; retrieved: September 8, 2026.
Annual Report 2025. San Francisco AIDS Foundation. Primary portfolio and pharmacy/PrEP expansion; outputs and joint fundraiser totals are not causal outcomes or unrestricted receipts.. Published: 2025 reporting; undated page; retrieved: September 8, 2026.
May 2026 contract 1000037481 request. SF Health Commission. Primary proposed public bundle; appropriations condition and unverified final execution retained.. Published: May 4, 2026; retrieved: September 8, 2026.
Cuts to City-wide HIV Programs Partially Averted. San Francisco AIDS Foundation. Primary organization update; cannot infer remaining Pick Up Crew gap by subtracting unrelated restorations.. Published: June 26, 2026; retrieved: September 8, 2026.
Risks of fatal opioid overdose during first year following nonfatal overdose. Olfson et al.; Drug and Alcohol Dependence. Primary Medicaid cohort; historical recurrent-event scale, not fentanyl-era SFAF probabilities.. Published: 2018; retrieved: September 8, 2026.
Causes of Death After Nonfatal Opioid Overdose. Olfson et al.; JAMA Psychiatry. Primary historical all-cause mortality context. Additional non-overdose hazard is kept separate from modeled overdose mortality.. Published: 2018; retrieved: September 8, 2026.
PROUD open-label randomized trial. McCormack et al.; The Lancet. Primary indexed trial results; 86% relative acquisition reduction is an efficacy context, not local incidence/access gain.. Published: 2015 online; 2016 volume; retrieved: September 8, 2026.
PrEP Assistance Program benefits. California CDPH. Primary existing payer/assistance coverage; coverage is not verified individual uptake.. Published: Current page; retrieved: September 8, 2026.
SFAF official giving. San Francisco AIDS Foundation. General organization giving; no program restriction or additional tranche established.. Published: Current page; retrieved: September 8, 2026.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): $46,737,000. Organization size is separate from the modeled cost-effectiveness of a donation.

San Francisco AIDS Foundation

Audited whole-organization expenses including event costs, amortization and termination benefits. Fiscal years end June 30; originals reported in thousands.