When the San Francisco AIDS Foundation launched Pangaea Global AIDS on World AIDS Day 2001, the global HIV/AIDS landscape was at a critical juncture. Antiretroviral treatments existed but remained out of reach for millions in resource-limited settings. Vulnerable populations—injection drug users, sex workers, men who have sex with men, young women—faced not only a deadly virus but also systemic barriers of stigma, discrimination, and inadequate services.
Pangaea’s response to this crisis was built on three interconnected pillars that would define its work for over a decade: Equity, Evidence, and Empowerment. These weren’t just values stated in mission documents—they were operational principles that shaped every program, partnership, and policy intervention the foundation undertook.
Equity: Health as a Human Right, Not a Privilege
At its core, Pangaea operated from a fundamental premise: everyone affected by HIV deserves access to quality prevention, testing, treatment, and care—regardless of circumstances of birth, gender, sexual orientation, or geography. This wasn’t abstract philosophy. It was a daily operational commitment that determined where Pangaea worked and whom it served.
While many global health organizations focused on scaling up treatment in general populations, Pangaea deliberately turned its attention to the margins—the people most at risk and most likely to be left behind. In Dar es Salaam, this meant advocating for and helping implement methadone programs and clean needle distribution for people who inject drugs, populations often criminalized and excluded from healthcare systems. In Zimbabwe, it meant working with the SHAZ!-HUB to address the specific HIV and sexual and reproductive health needs of adolescent and young women, recognizing that generic programs failed to reach those most vulnerable.
Equity also meant challenging the traditional north-to-south flow of global health expertise. Pangaea’s model was genuinely collaborative, recognizing that solutions had to be co-created with local partners who understood context, culture, and community dynamics. The foundation didn’t parachute in with predetermined answers; it convened, it listened, it adapted.
“We envision a world where people affected by HIV lead healthy and productive lives—regardless of circumstances of birth, gender, sexual orientation, or geography—in communities free from the threat of HIV,” stated Pangaea’s vision. Every program decision was filtered through this equity lens: Who isn’t being reached? Whose voices aren’t being heard? Where are the gaps in services for marginalized communities?
Evidence: Implementation Science as the Bridge from Research to Reality
Pangaea was a pioneer in what we now call implementation science—though they were doing it before the term became widespread in global health circles. The foundation understood that knowing what works in controlled research settings and knowing how to make it work in diverse, resource-constrained real-world settings were two entirely different challenges.
This commitment to evidence took multiple forms. Pangaea conducted rigorous implementation research in Tanzania on methadone treatment retention and harm reduction service utilization. They developed detailed case studies of antiretroviral treatment programs, documenting not just outcomes but costs, challenges, and strategies for improving uptake and retention. They worked in Chitungwiza, Zimbabwe to gather evidence about how to effectively deliver PrEP and microbicides for HIV prevention to young women.
But Pangaea’s approach to evidence went beyond generating research. The foundation excelled at translating complex scientific findings into actionable policies and programs. When global HIV treatment guidelines were developed, Pangaea worked with countries like Zimbabwe to adapt those guidelines for national contexts, ensuring that international recommendations could actually be implemented given local resources, infrastructure, and health system capacity.
The foundation also played a crucial convening role, bringing together researchers, healthcare providers, drug manufacturers, policy makers, funders, and community members to collectively examine evidence and develop optimal approaches. The CADO 2 and Vancouver Treatment Optimization meetings exemplified this model—creating spaces where different forms of expertise (scientific, clinical, lived experience) could inform better strategies for HIV care and treatment.
Critically, Pangaea’s commitment to evidence never became an excuse for inaction or endless study. The foundation balanced scientific rigor with operational pragmatism, understanding that in the midst of an epidemic, waiting for perfect evidence while people died was its own form of failure. They gathered evidence while implementing, learning and adapting in real-time.
Empowerment: Communities as Partners, Not Patients
Perhaps nothing distinguished Pangaea’s approach more than its commitment to community empowerment. From its earliest days, the foundation rejected the traditional charity model of global health—where Western organizations provided services to passive recipients. Instead, Pangaea built partnerships with communities and local organizations, recognizing that sustainable change required local ownership and leadership.
This empowerment approach manifested in concrete ways. In China, Pangaea didn’t simply advocate for HIV services for men who have sex with men—the foundation worked with provincial and city authorities to help them establish confidential testing and linkage to care services, building local capacity and systems. When the organization later applied lessons from HIV community mobilization to women’s health, they partnered with local women’s groups to scale up breast cancer screening and treatment services, ensuring that communities drove their own health priorities.
Pangaea also understood that empowerment required addressing the social and political barriers that made people vulnerable to HIV in the first place. The foundation was vocal about fighting stigma and discrimination, recognizing that these weren’t just unfortunate side effects of the epidemic but active drivers of transmission and barriers to care. Whether facilitating the Global Fund’s Partnership Forums or participating in high-level policy roundtables, Pangaea consistently amplified community voices and advocated for rights-based approaches to HIV prevention and treatment.
The foundation’s work in Oakland bringing Pre-Exposure Prophylaxis (PrEP) services to young men of color who have sex with men demonstrated this empowerment principle close to home. Rather than simply opening a clinic, Pangaea supported local partners who understood the specific barriers, cultural contexts, and trust-building necessary to reach a community that had valid reasons to be skeptical of medical institutions.
Where the Three Pillars Met: Integration in Action
While these three pillars can be described separately, Pangaea’s real innovation was how it integrated them into a coherent operational model. Consider their work supporting Tanzania’s harm reduction programs:
- Equity: Choosing to work with people who inject drugs—a highly stigmatized, criminalized, and medically underserved population
- Evidence: Conducting research on methadone treatment feasibility, retention, and predictors of attrition; documenting inequities in harm reduction service utilization between men and women
- Empowerment: Working with the Tanzanian government to help them design and deliver services, building national capacity and ownership rather than creating parallel systems
Or their partnership with the SHAZ!-HUB in Zimbabwe:
- Equity: Focusing on adolescent and young women, recognizing their specific vulnerabilities and the ways generic programs failed them
- Evidence: Implementation research to determine how to best meet HIV and sexual/reproductive health needs, including studying PrEP and microbicide use
- Empowerment: Working through a local youth center, supporting young women to access services in a safe, youth-friendly environment designed with their input
Adapting the Model Beyond HIV
One of Pangaea’s most forward-thinking moves was recognizing that the lessons learned in HIV response could transform other areas of global health. The foundation’s work adapting HIV community mobilization strategies for breast cancer screening and treatment in China and Tanzania demonstrated the versatility of the equity-evidence-empowerment model.
This wasn’t mission creep—it was mission evolution. Pangaea understood that the systems, partnerships, and approaches that worked for HIV could address other urgent health priorities affecting the same communities. Women mobilized around HIV prevention could also organize around cancer screening. Harm reduction models for injection drug users informed approaches to hepatitis C. The bridges Pangaea built between researchers, policymakers, and communities could carry multiple health priorities.
The Legacy: Principles That Outlast Programs
Pangaea Global AIDS Foundation is no longer in operation, but the model it championed continues to influence global health practice. The foundation helped normalize several ideas that were once controversial:
- That marginalized populations deserve not just services, but programs specifically designed for their contexts and needs
- That implementation science is as valuable as basic research in saving lives
- That effective global health requires genuine partnership with communities, not charity delivered to them
- That evidence, equity, and empowerment aren’t competing priorities but mutually reinforcing strategies
From its founding on World AIDS Day 2001 to its closure, Pangaea demonstrated that it was possible to operate at multiple levels simultaneously—conducting rigorous research while implementing programs, shaping global policy while supporting local adaptation, maintaining scientific credibility while centering community voices.
The foundation’s work in Tanzania, Zimbabwe, China, Oakland, and beyond created ripples that extended far beyond individual programs. Healthcare workers trained through Pangaea partnerships went on to train others. Policies influenced by Pangaea’s evidence-based advocacy shaped services for millions. Communities mobilized through Pangaea-supported initiatives continued organizing around health priorities.
Perhaps most importantly, Pangaea helped shift the conversation in global health from “doing for” to “partnering with”—from seeing vulnerable populations as problems to be solved to recognizing them as partners with expertise essential to solutions.
Lessons for the Future of Global Health
As we document Pangaea’s legacy, several lessons emerge for current and future global health efforts:
Equity must be operational, not aspirational. It’s not enough to say everyone deserves healthcare—organizations must make deliberate choices about whom they serve and how they address systemic barriers. This means working with the hardest-to-reach populations, even when it’s more complicated and expensive.
Evidence generation and program implementation can’t be siloed. The gap between research and practice kills people. Pangaea’s implementation science model—learning while doing, adapting based on evidence from real-world contexts—offers a template for making interventions both scientifically sound and practically effective.
Sustainable change requires local ownership. Programs imposed from outside, no matter how well-intentioned, rarely outlast external funding. Pangaea’s partnership model, which emphasized building local capacity and supporting government systems rather than creating parallel structures, offers a more sustainable path.
Communities hold essential expertise. The people most affected by health challenges understand their contexts, barriers, and potential solutions in ways that outside experts never will. Effective programs integrate community knowledge with scientific evidence.
Convening power matters. In an increasingly siloed world, organizations that can bring together diverse stakeholders—scientists and community members, pharmaceutical companies and patient advocates, national governments and multilateral institutions—play a crucial role in developing holistic solutions.
Conclusion: A Model Worth Remembering
Pangaea Global AIDS Foundation operated during a specific historical moment—the early 2000s through the 2010s, when the global response to HIV/AIDS was scaling up dramatically but still failing to reach many of those most at risk. The foundation carved out a distinctive niche, focusing on the implementation challenges and marginalized populations that others overlooked.
But the three pillars that guided Pangaea’s work—equity, evidence, and empowerment—remain relevant for addressing today’s global health challenges, from emerging infectious diseases to non-communicable diseases to health systems strengthening. These principles offer a framework for health interventions that are not only effective but also just, not only evidence-based but also community-centered, not only ambitious but also sustainable.
As we preserve the history of Pangaea Global AIDS Foundation, we preserve more than an institutional record. We preserve a model of what’s possible when organizations commit to equity as an operational principle, evidence as a guide to action, and empowerment as the foundation for sustainable change.
The foundation’s closure doesn’t diminish its legacy—it challenges those who remain in global health to carry these principles forward, adapting them for new contexts and new challenges, but holding fast to the insight that drove Pangaea’s work: that everyone affected by health challenges deserves to lead healthy and productive lives, and that achieving this vision requires working in partnership with communities, guided by evidence, and committed to justice.
That legacy—practical, principled, and deeply human—is worth remembering.