Social Entrepreneurship for
Sexual Health (SESH):
Using Social Business Principles to Increase
HIV/syphilis testing among MSM in South China
Cedric Bien
University of North Carolina-Project China
Guangzhou, China
June 18, 2013
Annecy, France
Overview
 Syphilis in China today
 Social Entrepreneurship for Sexual Health (SESH)
model
 Feasibility Research
Syphilis epidemic in China
China 2011: 32 syphilis cases/100,000 population
US 2011: 4.5 syphilis cases/100,000 population
UK 2011: 5.6 syphilis cases/100,000 population
35
30
Total
Syphilis
Cases Per
100,000
Population
25
20
15
10
5
0
1988
1992
1996
2000
2004
2008
2012
Lancet 2007;369:132-8, PMID: 17223476
NEJM 2010;362:1658-61, PMID: 20445179
Syphilis: “Guangdong Boils”
Reported syphilis cases per 100,000
population by county/district in 2008
PLoS ONE, 2011, PMID: 21573127
Conventional approach
 Free 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
STD
Clinic
Other
orgs
HIV
Clinic
• Decentralization of testing,
resources, and capacities
MSM
CBO
CDC
• 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
testing
 Cheap, fast, accurate
 Easy to operate, no lab equipment
 Can be done almost anywhere
Feasibility Research: Pilot
programs
Product-based
Service-based
enterprise
enterprise
(selling a product) (selling a service)
 4 hybrid sites included
already piloted revenuegenerating HIV/syphilis
testing programs
intended for MSM.
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 forward
 Building 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!
UK
Rosanna Peeling (LSHTM)
Heidi Larson (LSHTM)
David Mabey (LSHTM)
Martin Holland (LSHTM)
Xiaoxi Zhang (Imperial)
France
Jean-François de Lavison
(AHIMSA)
Olivia Berliet (AHIMSA)
US
Arthur 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)
China
Joseph 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)