Social entrepreneurship for sexual health (SESH): a new approach for enabling delivery of sexual health services among most-at-risk populations.

Abstract

Each year there are over one billion estimated new curable sexually transmitted infections [1]. This is a daunting number, especially in the face of dwindling public health resources and difficulty reaching and retaining individuals in most-at-risk populations, who are the main drivers of these infections. Yet a growing number of community-based organizations focused on reaching most-at-risk populations have the capacity to move beyond condom distribution and conventional outreach to deliver novel point-of-care HIV/sexually transmitted disease (STD) testing [2], enhance partner notification [3], and link patients into treatment and care programs. The growing organizational and technical capacity of community-based organizations has been recognized by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the Joint United Nations Programme on HIV/AIDS, all of which have community-based organization representation at their highest levels [4]. But community-based organizations' growing capacity has yet to reach its full potential for service delivery since a substantial portion of most-at-risk populations in regions with substantial sexual disease burden remain out of care, untested, and unengaged [5]. Social entrepreneurship provides a new approach to more completely realize this full potential through identifying new prevention, treatment, and retention strategies. Optimizing health systems and program implementation are increasingly understood to be key drivers for improving health [6]. Social entrepreneurship uses entrepreneurial principles to promote the sustainable and innovative use of human, fiscal, and technological resources for social good. In the context of sexual health, social entrepreneurship focuses on developing novel, sustainable, community-responsive sexual health services. A number of social entrepreneurial tools, such as social marketing, conditional cash transfers, and microenterprise, have been effective in sexual health promotion in small pilot studies, but they have not been widely applied or systematically evaluated. Here we discuss the shortcomings of the dominant sexual health approach, explain the benefit of using social entrepreneurship for sexual health (SESH), and articulate key principles for moving forward.