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.
Net patient resources, including avoided bills and extra access costs, are not identified; much of the broader portfolio remains unquantified.

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 $193K per DALY in the Bay Area, or $202K for San Francisco benefits alone, per DALY. It retains the finite clinical estimate and explicitly sets unidentified net patient resources to zero centrally, with positive and negative economic scenarios. This is not evidence that housing or benefits counseling has no value. Actual avoided bills must be net of fees, travel, lost work and other assistance; retail drug prices and public payments are not household income. 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 sexual-health services, overdose prevention, substance-use support, and services for people living with HIV. Its clinics and outreach teams help people access PrEP, testing, medication and community support. Housing and financial-benefits counseling also help clients navigate assistance and remain connected to care.

Timely overdose response

Training, naloxone access and peer response can help witnesses act during an overdose. Reported doses, trainings and reversals are different units; none alone establishes additional unique lives saved.

Effective PrEP access

PrEP can prevent HIV acquisition when access adds effective protection beyond existing care. The randomized evidence supports the mechanism, not this clinic’s incremental coverage or current recipient risk.

Household resources and support

Avoided payments and better access to benefits may preserve household resources. Extra fees, transport, missed work and benefit offsets can reduce them; organizational payroll and public reimbursement are not automatic recipient gains.

Scope of this review. The calculation prices ordinary organizational support while quantifying selected overdose and PrEP mechanisms. The other 65% of the illustrative allocation remains priced but its health and income benefits are unquantified—not demonstrated to be zero. The supported exploratory budget is capped at $100,000 in the calculator; this is a reproducibility limit, not a fundraising request or proof of scalable capacity.

2. Monitoring and information sharing

SFAF clinics and community programs

Current official service and billing pages. Prevention, testing, overdose response and housing/benefits services remain active. Current PrEP and billing pages describe insurance billing, possible cost sharing, assistance and waived costs in some circumstances.

Our assessment. These pages establish operations and payer alternatives, not an additional recipient count, measured net savings or verified current funding tranche.

PROUD participants in England; historical U.S. post-overdose survivors

Randomized PrEP trial and historical overdose cohorts. The PrEP trial reports 86% relative reduction in acquisition. Survivor studies establish substantial later mortality and recurrent risks.

Our assessment. Trial efficacy and historical mortality do not identify current SFAF coverage gaps, hazards, rescue increments or local utility contrasts.

San Francisco AIDS Foundation, EIN 94-2927405

Latest three original independent audits. Gross comparable expenses were $46.7M, $46.3M and $47.2M in fiscal 2023, 2024 and 2025: mean $46.7M.

Our assessment. Figures convert thousands to dollars and reconcile functional spending with netted event costs and separately stated expense; they do not identify marginal donor capacity.

PrEP participants and people living with HIV

Official benefits-navigation and payer descriptions. Resources may be preserved through actual avoided bills or benefits access, while patient fees, transport, missed work and offsets may impose costs.

Our assessment. No linked marginal recipient distribution identifies their net amount or incidence. Payroll, public transfers and full retail drug prices cannot substitute for that causal household ledger.

3. Qualitative assessment

Timely overdose response and additional effective PrEP access address severe, preventable harms through established mechanisms.

Key reservations

Current additional funding capacity and recipient costs are not established.
Most clinical parameters and geographic shares are conditional judgments, not locally measured causal effects.
Housing, benefits-navigation and other economic effects remain unquantified in the priced budget.
Shared partner outcomes and financial-distress utility can overlap.

Benefits not included in our estimate

A fresh lifetime for every reported reversal
HIV mortality, secondary transmission and untreated-AIDS lifetimes
Retail drug value, 340B revenue or public reimbursement as household income
Entire future earnings of surviving patients
Gross staff payroll as causal net wages
Unmeasured housing and benefits-navigation effects represented as measured zero

4. What do you get for your dollar?

About $193K per DALY in the Bay Area

The clinical central is retained because the refreshed sources do not identify a replacement local causal estimate. Overdose protection lasts one modeled service year, with equal hazards afterward; PrEP uses a finite HIV-free-state comparison. A separate signed household-resource ledger considers actual avoided payments and net earnings or benefits after patient costs. It does not convert drug retail prices, insurance payments or surviving patients’ entire future wages into income.

DALY is our one-year comparison unit. QALY-based health gains and income-welfare equivalents retain their original assumptions; they are not measured clinical DALYs. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

Additional prevention and net household resources: Bay combined years = assigned Bay health + assigned Bay net-resource years − assigned induced-applicant burden − positive overlap. Dollars per DALY = donor cost / positive combined years.
At an illustrative $100,000 budget: 20 additional overdose offers and 8.5714 additional PrEP offers before clinical deduplication; Bay health = 0.5189791509, central net resources = 0, combined Bay = 0.5189791509. Price = $193K. The SF-only diagnostic is $202K.

Model inputs and assumptions

Program allocation and cash costs: 15% overdose; 20% PrEP; $300/$700 per offered package (range: Allocation, delivery-cost and replacement stresses). These prospective costs include branch administration and failed uptake, not public medication retail value. Other programs and corporate operations remain in the full donor budget. Annual expense divided by reported contacts is not a marginal unit cost. Explicit judgment unless identified as an observed source value.
Additional recipients: 40% overdose; 30% PrEP funding response (range: Zero additional activity; independent induced attempts). Existing city contracts, 340B operations, insurance and other donations are baseline. Funding response is applied once. The PrEP .90 clinical disjoint fraction removes overlapping health credit, not automatically resource recipients or shared harms. Explicit judgment unless identified as an observed source value.
Overdose survival: One service year; 15-year finite comparison (range: Five-year tail; no rescue increment; adverse response). Event hazard .50, fatality without rescue .10, existing effective rescue .80 and added rescue .10 are selected-cohort judgments. Other mortality .06 gives baseline total hazard .07 and supported .065. After support, both groups face .07. Utility .70, three-month delay and 3% discount are explicit; each reported reversal does not earn a new lifetime. Explicit judgment unless identified as an observed source value.
PrEP morbidity: One service year; 20-year finite comparison (range: No added coverage; adverse coverage; common alternatives). Trial relative effectiveness .86 has primary randomized support. Local annual acquisition .01, extra effective coverage .25, common mortality .01 and treated-HIV utility gap .08 are judgments. Future infections remain possible in both arms; no additional HIV mortality, transmission or ART-cost credit is added. Explicit judgment unless identified as an observed source value.
Net participant resources: Central $0; illustrative +$150/−$100 for one year (range: Independent income-only, negative-income and overlap cases). Resource-eligible fraction .25, $50,000 annual household baseline and resource incidence are unmeasured assumptions. The +$150 diagnostic represents $200 actually avoided payments minus $50 extra costs, not a retail drug valuation; −$100 allows costs to exceed gains. Insurance, PrEP-AP and other assisted care are counterfactual alternatives. Explicit judgment unless identified as an observed source value.
Income comparison and timing: 0.5 × log resource ratio; .75-year midpoint (range: Alternative baseline and no economic increment). Additional PrEP offers × eligible fraction × .5 × ln(1 + net resources / annual baseline), discounted once to .25-year start plus .50-year midpoint. This normative Coefficient Giving crosswalk produces income-equivalent years, not clinical QALYs; no recurring 15-/20-year earnings tail is attached. Explicit judgment unless identified as an observed source value.
Induced unsuccessful access: Zero central; separately adjustable exposure (range: Failed applications retain signed losses). A gift-induced application may impose costs even when additional completed care fails. Only changed attempted access counts. Costs already included in net participant resources cannot be charged again; unchanged baseline visits are not attributed to a gift. Explicit judgment unless identified as an observed source value.
Resident and portfolio attribution: OD 99% Bay/95% SF; PrEP resources 95% Bay/75% SF (range: Separate resource geography; zero assignment). Shares concern future beneficiary residence, not clinic addresses, and are judgments. SF nests within Bay per stream. Portfolio assignment applies once to benefits and harms; shared SFAF, GLIDE and partner outcomes must not be summed as independent full credit. Explicit judgment unless identified as an observed source value.

Health, resources and counterfactual diagnostics

Central: $193K Bay; $202K SF. Retained clinical central plus explicit zero net resources; zero is a provisional judgment, not evidence of no economic mechanism.
Net resources +$150: $192K Bay. One resource-year for the distinct eligible fraction of additional PrEP offers, before the clinical deduplication fraction.
Net resources −$100: $193K Bay. Patient costs exceeding savings reduce total welfare rather than being clipped to zero.
Five-year clinical tails: $411K Bay. A finite duration stress, not a statistically estimated confidence bound.
Donor also pays outside inputs: $248K Bay. Move assumed outside inputs into cash package costs once, reducing offers; do not also add them to the same donor numerator.
No additional completed care, induced attempts: A signed loss is possible. Separately gift-induced unsuccessful application costs can remain while positive clinical and resource benefits are absent.

Uncertainty. Before: $193K Bay / $202K SF health-only. Now: the same central prices with an explicit net-resource ledger and signed economic diagnostics. Sources establish current services, accounts and the prevention mechanism, not a new causal rescue or coverage coefficient. The zero-resource central does not erase unquantified housing, benefits-navigation, workforce or other program effects. Zero or negative combined benefit has no meaningful positive price.

Health and income effects

PrEP resource recipients start from 8.5714 financially additional offers, before the .90 health-only disjoint fraction. At a .25 eligible fraction, the diagnostic includes 2.1429 participant-equivalents. The central net increment is zero because actual additional avoided payments, earnings, benefit retention and extra costs are not identified. That is not a finding that housing assistance or financial counseling lacks value.

For +$150 net resources, 2.1429 × .5 × ln(1 + 150 / 50,000) / 1.03^.75 = .0031391056 all-US income-equivalent years. Bay attribution .95 gives .0029821504. Adding this to .5189791509 Bay health gives 0.52 combined years and $192K per DALY. The adverse −$100 case gives −.0020979733 all-US income years and $193K Bay.

Health and disposable resources are distinct only to the extent the clinical utility contrast does not already contain the same financial welfare. The full-positive-overlap diagnostic subtracts the smaller of positive resources and positive PrEP health separately in each region. Negative resources are never erased by overlap adjustment. No caregiver earnings, saved public medication price or mental-health bonus is added.

A separate induced-attempt knob models access costs incurred without successful additional care. Its costs are additional to, and must be disjoint from, costs in the successful-participant ledger. Setting both funding responses to zero does not erase a burden from genuinely changed unsuccessful applications; setting changed exposure to zero does. Portfolio and geography are applied once to every benefit and harm.

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.

Obtain a current priced additional-service plan and linked recipient access, costs and outcomes before claiming a verified marginal opportunity.

The May 2026 public contract request proposes $8.6M including contingency, conditional on appropriations; it is not a verified current private funding gap. Subsequent partial restorations mean earlier cuts cannot be treated as today’s exact shortfall. FY2025 government grants and 340B revenue are financing, not extra participant income. Current clinic pages report an insurance-billing transition, potential cost sharing and financial assistance; services should not be described as universally free. Obtain a costed current additional-care plan, payer alternatives and recipient follow-up before claiming marginal productivity.

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.
Current PrEP and PEP services. San Francisco AIDS Foundation. Official operations and billing transition. Published: Current, undated; retrieved: 2026-10-01.
Insurance billing frequently asked questions. San Francisco AIDS Foundation. Official payer and patient-cost description. Published: Fall 2026 transition; retrieved: 2026-10-01.
Housing subsidies and financial benefits. San Francisco AIDS Foundation. Official service description; not causal recipient income. Published: Current, undated; retrieved: 2026-10-01.
Audited financial statements, fiscal 2024. San Francisco AIDS Foundation / independent auditor. Original financial statement, thousands converted to dollars. Published: Fiscal 2024; retrieved: 2026-10-01.
Audited financial statements, fiscal 2023. San Francisco AIDS Foundation / independent auditor. Original financial statement, thousands converted to dollars. Published: Fiscal 2023; retrieved: 2026-10-01.
PROUD randomized trial, indexed primary abstract. McCormack et al.; The Lancet. Primary randomized efficacy context, not local additionality. Published: 2015; retrieved: 2026-10-01.
Cost-effectiveness comparison methodology. Coefficient Giving. Normative health-and-income crosswalk. Published: Current methodology; retrieved: 2026-10-01.

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.