Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models

BMC Infectious Diseases

Rosanna W Peeling⁵  Heidi Larson⁵  Bin Yang⁸  Li-Gang Yang⁸  Feng-Ying Liu⁸  Larry Han⁴  Kaidi Wang²  Ramon Lee³  Elaine J Lo⁴  Cedric H Bien¹  Rosa Cui⁶  Kathryn E Muessig⁴  Joseph D Tucker⁷ 

[1] Icahn School of Medicine at Mt. Sinai, 1428 Madison Ave, New York 10029, USA;Stanford University School of Medicine, 450 Serra Mall, Stanford 94305, CA, USA;Harvard Medical School, 25 Shattuck Street, Boston 02115, MA, USA;University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill 27599, NC, USA;London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;Columbia College of Physicians and Surgeons, 630 West 168th Street, New York 10032, NY, USA;University of North Carolina Project-China, Number 2 Lujing Road, Guangzhou 510095, China;Guangdong Provincial Centers for Skin Diseases and STI Control, Number 2 Lujing Road, Guangzhou 510095, China

关键词: Social enterprise;    Social entrepreneurship;    MSM;    Syphilis;    HIV;    China;   

Others  :  1121981
DOI  :  10.1186/s12879-014-0601-5

 received in 2014-02-09, accepted in 2014-10-31,  发布年份 2014

【 摘 要 】

Background

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.

Methods

We 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.

Results

Our 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.

Conclusion

Many 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.

【 授权许可】

   
2014 Tucker et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Low N, Broutet N, Adu-Sarkodie Y, Barton P, Hossain M, Hawkes S: Global control of sexually transmitted infections. Lancet 2006, 368(9551):2001-2016.
• [2]Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. In. Geneva: World Health Organization; 2001.
• [3]Holmes KK: Sexually Transmitted Diseases. 4th edition. McGraw-Hill Medical, New York; 2008.
• [4]Beyrer C, Sullivan PS, Sanchez J, Dowdy D, Altman D, Trapence G, Collins C, Katabira E, Kazatchkine M, Sidibe M, Mayer KH: A call to action for comprehensive HIV services for men who have sex with men. Lancet 2012, 380(9839):424-438.
• [5]UNAIDS: UNAIDS Global Report. Geneva: 2011.
• [6]Adam PC, de Wit JB, Toskin I, Mathers BM, Nashkhoev M, Zablotska I, Lyerla R, Rugg D: Estimating levels of HIV testing, HIV prevention coverage, HIV knowledge, and condom use among men who have sex with men (MSM) in low-income and middle-income countries. J Acquir Immune Defic Syndr 2009, 52(Suppl 2):S143-S151.
• [7]Smolak A, El-Bassel N: Multilevel stigma as a barrier to HIV testing in central Asia: a context quantified. AIDS Behav 2013, 17(8):2742-2755.
• [8]Tun W, Kellerman S, Maimane S, Fipaza Z, Sheehy M, Vu L, Nel D: HIV-related conspiracy beliefs and its relationships with HIV testing and unprotected sex among men who have sex with men in Tshwane (Pretoria), South Africa. AIDS Care 2012, 24(4):459-467.
• [9]Li H, Kuo NT, Liu H, Korhonen C, Pond E, Guo H, Smith L, Xue H, Sun J: From spectators to implementers: civil society organizations involved in AIDS programmes in China. Int J Epidemiol 2010, 39(Suppl 2):ii65-ii71.
• [10]Parry J: Global Fund pressures China to engage with civil society groups. BMJ 2011, 342:d3327.
• [11]Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, Siba P, Kaldor JM, Vallely A: Now we are in a different time; various bad diseases have come, Understanding men’s acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012, 12:67. BioMed Central Full Text
• [12]Trapence G, Collins C, Avrett S, Carr R, Sanchez H, Ayala G, Diouf D, Beyrer C, Baral SD: From personal survival to public health: community leadership by men who have sex with men in the response to HIV. Lancet 2012, 380(9839):400-410.
• [13]Saha S, Jacobs EA, Moore RD, Beach MC: Trust in physicians and racial disparities in HIV care. AIDS Patient Care STDs 2010, 24(7):415-420.
• [14]Goosby E, Dybul M, Fauci AS, Fu J, Walsh T, Needle R, Bouey P: The United States President’s emergency plan for AIDS relief: a story of partnerships and smart investments to turn the tide of the global AIDS pandemic. J Acquir Immune Defic Syndr 2012, 60(Suppl 3):S51-S56.
• [15]Dees JG: The Meaning of “Social Entrepreneurship”. Duke University, Durham; 1998.
• [16]Tucker JD, Fenton KA, Peckham R, Peeling RW: Social entrepreneurship for sexual health (SESH): a new approach for enabling delivery of sexual health services among most-at-risk populations. PLoS Med 2012, 9(7):e1001266.
• [17]Viravaidya M, Hayssen J: Strategies to Strengthen NGO Capacity in Resource Mobilization through Business Activities. In UNAIDS Best Practice Collection. UNAIDS, Geneva; 2001.
• [18]Piot B, Mukherjee A, Navin D, Krishnan N, Bhardwaj A, Sharma V, Marjara P: Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India. Sex Transm Infect 2010, 86(Suppl 1):i56-i61.
• [19]Tedmanson D, Guerin P: Enterprising social wellbeing: social entrepreneurial and strengths based approaches to mental health and wellbeing in “remote” Indigenous community contexts. Australas Psychiatry 2011, 19(Suppl 1):S30-S33.
• [20]Allen LK, Hetherington E, Manyama M, Hatfield JM, van Marle G: Using the social entrepreneurship approach to generate innovative and sustainable malaria diagnosis interventions in Tanzania: a case study. Malar J 2010, 9:42. BioMed Central Full Text
• [21]WHO/UNAIDS: The Treatment 2.0 Framework for Action: Catalysing the Next Phase of Treatment, Care and Support. Geneva: World Health Organization; 2011.
• [22]Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ: Syphilis: a reemerging infection. Am Fam Physician 2012, 86(5):433-440.
• [23]Pant Pai N, Balram B, Shivkumar S, Martinez-Cajas JL, Claessens C, Lambert G, Peeling RW, Joseph L: Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis. Lancet Infect Dis 2012, 12(5):373-380.
• [24]Tucker JD, Bien CH, Peeling RW: Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013, 26(1):73-79.
• [25]Castro AR, Esfandiari J, Kumar S, Ashton M, Kikkert SE, Park MM, Ballard RC: Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis. J Clin Microbiol 2010, 48(12):4615-4619.
• [26]Rodriguez HP, Chen J, Owusu-Edusei K, Suh A, Bekemeier B: Local public health systems and the incidence of sexually transmitted diseases. Am J Public Health 2012, 102(9):1773-1781.
• [27]Schell SF, Luke DA, Schooley MW, Elliott MB, Herbers SH, Mueller NB, Bunger AC: Public health program capacity for sustainability: a new framework. Implementation Sci 2013, 8:15. BioMed Central Full Text
• [28][http:/ / www.unaids.org/ sites/ default/ files/ en/ dataanalysis/ knowyourresponse/ countryprogressreports/ 2012countries/ ce_CN_Narrative_Report[1].pdf] webcite Ministry of Health People’s Republic of China: 2012 China AIDS Response Progress Report. Beijing; 2012. Available online: .
• [29]Guo Y, Li X, Song Y, Liu Y: Bisexual behavior among Chinese young migrant men who have sex with men: implications for HIV prevention and intervention. AIDS Care 2012, 24(4):451-458.
• [30]Wei C, Guadamuz TE, Stall R, Wong FY: STD prevalence, risky sexual behaviors, and sex with women in a national sample of Chinese men who have sex with men. Am J Public Health 2009, 99(11):1978-1981.
• [31]Kong TS, Laidler KJ, Pang H: Relationship type, condom use and HIV/AIDS risks among men who have sex with men in six Chinese cities. AIDS Care 2012, 24(4):517-528.
• [32]Liu H, Yang H, Li X, Wang N, Wang B, Zhang L, Wang Q, Stanton B: Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Dis 2006, 33(2):68-76.
• [33]Wong FY, Huang ZJ, Wang W, He N, Marzzurco J, Frangos S, Buchholz ME, Young D, Smith BD: STIs and HIV among men having sex with men in China: a ticking time bomb? AIDS Educ Prev 2009, 21(5):430-446.
• [34]Chow EP, Wilson DP, Zhang L: HIV and syphilis co-infection increasing among men who have sex with men in China: a systematic review and meta-analysis. PLoS One 2011, 6(8):e22768.
• [35]Zhang L, Chow EP, Wilson DP: Distributions and trends in sexual behaviors and HIV incidence among men who have sex with men in China. BMC Public Health 2012, 12:546. BioMed Central Full Text
• [36]Tucker JD, Wong FY, Nehl EJ, Zhang F: HIV testing and care systems focused on sexually transmitted HIV in China. Sex Transm Infect 2012, 88(2):116-119.
• [37]Li X, Lu H, Ma X, Sun Y, He X, Li C, Raymond HF, McFarland W, Pan SW, Shao Y, Vermund SH, Xiao Y, Ruan Y, Jia Y: HIV/AIDS-related stigmatizing and discriminatory attitudes and recent HIV testing among men who have sex with men in Beijing. AIDS Behav 2012, 16(3):499-507.
• [38]Zou H, Hu N, Xin Q, Beck J: HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav 2012, 16(7):1717-1728.
• [39]Neilands TB, Steward WT, Choi KH: Assessment of stigma towards homosexuality in China: a study of men who have sex with men. Arch Sex Behav 2008, 37(5):838-844.
• [40]Wei C, Yan H, Yang C, Raymond HF, Li J, Yang H, Zhao J, Huan X, Stall R: Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study. AIDS Care 2014, 26(3):372-378.
• [41]Yang LG, Tucker JD, Yang B, Shen SY, Sun XF, Chen YF, Chen XS: Primary syphilis cases in Guangdong Province 1995–2008: Opportunities for linking syphilis control and regional development. BMC Public Health 2010, 10:793. BioMed Central Full Text
• [42]Zhao J, Cai W, Gan Y, Zhang Y, Yang Z, Cheng J, Lin S, He M, Chen L, Wang X: A Comparison of HIV infection and related risk factors between money boys and noncommercial men who have sex with men in Shenzhen, China. Sex Transm Dis 2012, 39(12):942-948.
• [43]Zhong F, Lin P, Xu H, Wang Y, Wang M, He Q, Fan L, Li Y, Wen F, Liang Y, Raymond HF, Zhao J: Possible increase in HIV and syphilis prevalence among men who have sex with men in Guangzhou, China: results from a respondent-driven sampling survey. AIDS Behav 2011, 15(5):1058-1066.
• [44]Pope C, Ziebland S, Mays N: Qualitative research in health care, Analysing qualitative data. BMJ 2000, 320(7227):114-116.
• [45]Tucker JD, Bien CH, Fenton KA, Peeling RW: Social Entrepreneurship for Sexual Health. SESH Workshop: 2012; Hong Kong University 2012.
• [46]McDonough JE: Budget sequestration and the U.S. health sector. N Engl J Med 2013, 368(14):1269-1271.
• [47]Yunus M, Jolis A: Banker to the Poor: Micro-Lending and the Battle Against World Poverty. PublicAffairs, New York; 1999.
• [48]Khandker SR: Development Research Group. Rural Development.: Micro-finance and poverty evidence using panel data from Bangladesh. In Policy research working paper 2945. World Bank, Washington, D.C; 2003.
• [49][http://asiacatalyst.org/blog/2013/04/11/CMTHF-Eng.pdf] webcite China Male Tongzhi Health Forum: Evaluation of Impact and Effectiveness of HIV Rapid Testing Services Provided by MSM Community-Based Organizations Based on Individual Case-Studies. Beijing, China: 2012. Available online: .
• [50]Cai T: AIDS Care China HIV/Syphilis Testing Experience. SESH Conference, Hong Kong University; 2012.
• [51]Mayer K, Appelbaum J, Rogers T, Lo W, Bradford J, Boswell S: The evolution of the Fenway Community Health model. Am J Public Health 2001, 91(6):892-894.
• [52]Schwappach DL, Bruggmann P: An integrated model of care to counter high incidence of HIV and sexually transmitted diseases in men who have sex with men - initial analysis of service utilizers in Zurich. BMC Public Health 2008, 8:180. BioMed Central Full Text
• [53]Peeling RW: Testing for sexually transmitted infections: a brave new world? Sex Transm Infect 2006, 82(6):425-430.
• [54]Tucker JD, Bu J, Brown LB, Yin YP, Chen XS, Cohen MS: Accelerating worldwide syphilis screening through rapid testing: a systematic review. Lancet Infect Dis 2010, 10(6):381-386.
• [55]Tucker JD, Hawkes SJ, Yin YP, Peeling RW, Cohen MS, Chen XS: Scaling up syphilis testing in China: implementation beyond the clinic. Bull World Health Organ 2010, 88(6):452-457.
• [56]Tan W, Williams J, Tan T: Defining the ‘Social’ in ‘Social Entrepreneurship’: Altruism and Entrepreneurship. Int Entrep Manag J 2005, 1:353-365.
• [57]Light PC: The Search for Social Entrepreneurship. Brookings Institution Press, Washington, D.C; 2008.
• [58]Kelly JA, Somlai AM, Benotsch EG, Amirkhanian YA, Fernandez MI, Stevenson LY, Sitzler CA, McAuliffe TL, Brown KD, Opgenorth KM: Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. AIDS Care 2006, 18(1):12-21.
• [59]Atun R, Knaul FM, Akachi Y, Frenk J: Innovative financing for health: what is truly innovative? Lancet 2012, 380(9858):2044-2049.
• [60]Cui R, Lee R, Muessig K, Thiramurthy H, Tucker JD: Microenterprise Interventions for Sexual Risk Reduction: A Systematic Review. AIDS Behav 2013, 17(9):2864-2877.