1. 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

2. Overview Syphilis in China today Social Entrepreneurship for Sexual Health (SESH) model Feasibility Research

3. Syphilis epidemic in China Lancet 2007;369:132-8, PMID: 17223476 NEJM 2010;362:1658-61, PMID: 20445179 Total Syphilis Cases Per 100,000 Population 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

4. Syphilis: “Guangdong Boils” Reported syphilis cases per 100,000 population by county/district in 2008 PLoS ONE, 2011, PMID: 21573127

5. Conventional approach Free or low-cost STD testing Hospital-based or government clinics Vertically organized medical services

6. 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

7. 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 STD Clinic HIV Clinic CDC MSM CBO Other orgs SESH network in Guangzhou, China

8. 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

9. 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

10. 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

11. Thank you! 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) 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)