Social Entrepreneurship for Sexual Health (SESH):

Using Social Business Principles to Increase HIV/syphilis testing among MSM in South China

Cedric BienUniversity of North Carolina-Project China

Guangzhou, China

June 18, 2013Annecy, France

OverviewSyphilis in China today

Social Entrepreneurship for Sexual Health (SESH) model

Feasibility Research

Syphilis epidemic in China

Lancet 2007;369:132-8, PMID: 17223476 

NEJM 2010;362:1658-61, PMID: 20445179

TotalSyphilisCases Per 100,000Population

1988 1992 1996 2000 2004 2008 20120

5

10

15

20

25

30

35

China 2011: 32 syphilis cases/100,000 populationUS 2011: 4.5 syphilis cases/100,000 populationUK 2011: 5.6 syphilis cases/100,000 population

Syphilis: “Guangdong Boils”

Reported syphilis cases per 100,000 population by county/district in 2008 PLoS ONE, 2011, PMID: 21573127

Conventional approachFree or low-cost STD testing

Hospital-based or government clinics

Vertically organized medical services

Poor sexual health services for most-at-risk

populations“I am not afraid to say it, I felt

discrimination from all kinds of people at other places…like the CDC clinic …The way they spoke to me and the way they looked at me.”

#10, age 27, multiple-time tester

Services are not “gay-friendly”

“I think gay-friendly is the most important thing - and I can talk to people, you know, talk to you. You can’t find this service in the hospital.”

#05, age 29, first time tester

Social Entrepreneurship for Sexual Health (SESH)

Use of business principles to promote innovative use of human, fiscal, and technological resources for sexual health

• Multi-sectoral partnerships

• Decentralization of testing, resources, and capacities

• Community-based organizations (CBO) have increased capacity to provide sexual health services

SESH network in Guangzhou, China

SESH: Now is the time Global financial crisis and shrinking public

sector budgets

Increased capacity of community-based organizations

Technological advances in point-of-care STI testingCheap, fast, accurateEasy to operate, no lab equipmentCan be done almost anywhere

Feasibility Research: Pilot programs

4 hybrid sites included already piloted revenue-generating HIV/syphilis testing programs intended for MSM.

  Product-based enterprise (selling a product)

Service-based enterprise (selling a service)

Direct social benefit 

Selling condoms, point-of-care tests

 Private clinic tailored to most-at-risk population

Indirect social benefit

Selling clothes, books, tea (not marketed with any connection to MSM)

 

 Online advertisements, partnerships with businesses

Moving SESH forwardBuilding local networks linking

CBOs to clinics and business expertise

Transitioning revenue-generating operations into sustainable enterprises Innovation Accountability Evaluation

Identifying viable social business models and partnerships

Thank you!ChinaJoseph Tucker (UNC Project China)Dee Poon (Esquel)Po Chi Wu (independent)Bin Yang (GD STD Control)Ligang Yang (GD STD Control)Zheng Heping (GD STD Control)Robert Peckham (HKU)Maria Sin (HKU)Thomas Cai (AIDS Care China)Xiangsheng Chen (NCSTD)Vivian Gee (Skoll)

UKRosanna Peeling (LSHTM)Heidi Larson (LSHTM)David Mabey (LSHTM)Martin Holland (LSHTM)Xiaoxi Zhang (Imperial)

FranceJean-François de Lavison (AHIMSA)Olivia Berliet (AHIMSA)

USArthur Kleinman (Harvard)Kate Muessig (UNC)Rosa Cui (Columbia)Ramon Lee (Harvard)Ben Cheng (Pangaea)Ben Plumley (Pangaea)Myron Cohen (UNC)Kevin Fenton (UCL/PHE)Myat Htoo Razak (NIH)