Abstract
BackgroundUNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability.MethodsWe undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data.ResultsOur qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing.ConclusionMany MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.
Highlights
UNAIDS has called for greater higher among men who have sex with men (MSM) in Guangdong Province (HIV)/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered
We examined organizational and financial characteristics of conventional HIV/ syphilis testing for MSM and new pilot programs focused on revenue-generation for sustainability
Seven MSM had never tested for HIV or syphilis, seven MSM had just undertaken their first test, and 21 MSM reported more than one test in the past
Summary
UNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability. Marshaling public resources for what are often private HIV/syphilis services among stigmatized key populations has been historically challenging [4], exacerbated in the context of global financial uncertainty. In China, despite strong government resources to promote HIV testing, direct support from government public health agencies to community-based organizations (CBOs) has been challenging [9,10]. Sustainable models are critical for ensuring access across the cascade of HIV/syphilis services [12], establishing trusting long-term relationships between physicians and patients [13], and providing cost-effective care [14]
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