SOCIAL
BUSINESSGUIDE

Screening &Counseling for HIV
and Other Sexually
Transmitted Infections

Social Business Guide: Screening and Counselingfor HIV and Other Sexually Transmitted Infections.
2023
The development of this guide was completed by the
Yunus Foundation in Thailand (Yunus Thailand) incollaboration with the AMS-PHPT Research
Collaboration, Faculty of Associated Medical
Sciences, Chiang Mai University. The researchleading to this guide was conducted in consultation
with stakeholder organizations and innovators in
Thailand. It was made possible thanks to the supportof Expertise France–L’Initiative, which works to fight
HIV/AIDS, tuberculosis and malaria. The contents ofthis guide reflect the views of its authors and notnecessarily those of Expertise France, L’initiative,
AMS-PHPT, or Yunus network organizations at large.

Authors:
Jonathan Brenes Salazar, Tanawan Samleerat
Carraway, Callum MacKenzie, Pathit Ongvasith,
Wiwat Maneematcha, Faiz H. Shah, Gonzague
Jourdain, Nicolas Salvadori.

Acknowledgements
We extend our heartfelt gratitude to the dedicated individuals and teams who
contributed their insights, feedback, and other support for the development of thisguide. In particular, we thank Pra-Ornsuda Sukrakanchana, Suwalai
Chalermpantmetagul, Sawitree Chairahaeng, Sirintip Piyarad, Sawat Teeyalom,
Theeravit Ponsuntikul, Saksin Simsin, Rujira Limpaisarn, Sarocha Panboun,
Nattawat Yuwaree, and the rest of the AMS-PHPT Research Collaboration team fortheir inputs and guidance. We also thank Sakorn Pornprasert of the Faculty of
Associated Medical Studies at Chiang Mai University. We would also like to thankthe teams from the different stakeholder organizations engaged in thedevelopment of this guide. Your work and passion for community health andtireless efforts in the field of screening and counseling for HIV and other sexuallytransmitted infections (STIs) have been instrumental in shaping this guide. We also
acknowledge the broader community of healthcare professionals, researchers, andstakeholders whose collaboration and support have contributed to the success ofefforts to this date in combating HIV and other STIs in Thailand and beyond, and inengaging at-risk and marginalized individuals and groups. Together, we strive to
make a positive impact on the well-being of individuals and communities, fosteringa healthier society.

Foreword
In the early 1980s, when the first whispers of the HIV/AIDS epidemic began to echo across the globe,
Thailand entered a crisis that demanded more than just medical intervention. It required support at the very
highest national level and profound societal shift: a collective awakening to the power of unity rather thanpanic and fear. In those trying times, the combined spirits of many organizations and their tireless work inpromoting prevention and compassion eventually became a beacon of success. Through public awarenesscampaigns, grassroots education and in some cases humor. We also embarked on a mission to prevent the
spread of the disease as well as to find an alternative to the stigma that clung to its victims through thepositive partnership program between people who are HIV positive and those who are HIV negative.* This
program used economic empowerment as a means to reduce stigma and discrimination where thepartners are provided a micro-credit loan fund to do business together.
More recently, as we emerge from the COVID-19 epidemic, the lessons learned during the first wave of the
HIV/AIDS crisis resonate profoundly. The combined spirit of many organizations’ resilience, innovation, andcontinued community support that defined the nation’s work then were in bloom again, reminding us thatin the face of adversity, our greatest strength lies in our determination and ability to come together.
Social entrepreneurs, armed with empathy and determination, play a pivotal role in reshaping ourcommunities and fostering social progress. This guide is an invitation to harness the potential ofcollaboration and compassion by empowering entrepreneurs to cultivate a culture of sharing with those
who need it.
I invite you to join those who have walked before you on this journey and to explore the possibilities thatsocial business holds to support those that still face challenges to access healthcare and friendship. There
are many social enterprises we need to get to know, learn from, and work with. Together, we can see afuture where anyone and everyone can take part in combating HIV/AIDS and other STIs. As the worldcontinues to evolve, together we can build a future where youth must lead the way forward.
With determination and heartfelt optimism,

Mechai Viraivaidya
Founder and Chairman
Population and Community Development Association* UNAIDS. (2007). The Positive Partnerships Program in Thailand: Empowering People Living with HIV. UNAIDS Best
Practice Collection (UNAIDS/07.22E / JC1260E). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Preface
On behalf of the Yunus Thailand team, it is a pleasure to introduce this social business guide. Drawing
deeply upon insights from community stakeholders, which add significantly to the specialised knowledge
contributed by its authors, it outlines how to visualise and implement empathetic, client-centred screening
and counselling services as entrepreneurial ventures.
Particularly satisfying about this effort is that it addresses a segment of healthcare clients who remain
vulnerable, but not often visible. This guide represents an open call for self-sustaining, inclusive andfriendly healthcare for a particularly vulnerable population group. The enterprise-led approach proposed for
HIV/STI management in this guide aligns with the community-leadership theme of the 2023 UNAIDS
World AIDS Awareness Day.
In my years as a community health physician, grassroots development worker, and educator, I have beenable to see up-close the profound impact community-grounded service models can have in boosting
healthcare access and quality. Engaging with under-served populations has underscored for me theimportance of financially self-sustaining healthcare delivery approaches that can guarantee the continued
well-being of communities, and in turn, measurably reduce the overall burden of disease.
The fight against HIV and STIs continues. Experts point to a greater need to scale up HIV/STI screening
and counselling in Thailand. Self-testing and digital technologies have been identified to this end. We all
agree, but are also aware that effective outreach requires a multifaceted approach that seamlessly blends
clinical expertise with a grasp of social and economic realities.
In the case of persons with HIV/STIs, healthcare delivery services must integrate risk-awareness, healtheducation, early detection, affordable treatment, and prolonged, compassionate care. Very often,
conventional mass healthcare systems, designed to deliver emergent services within specialised clinicalareas, are not equipped or resourced to deal with persons with HIV/STI requiring long-term care. Setting
up parallel delivery for outlier groups is not always cost-effective within the constraints of government
budgets. This gap in conventional healthcare for persons with HIV/STIs demands a greater focus on selfsustaining, community-centred delivery models. Such innovative models can be effective multipliers, rather
than a substitute for conventional delivery systems. And, they are as much a sustainability strategy as they
are a client-friendly outreach service.
The social business approach pioneered by Nobel Laureate Muhammad Yunus, and successfully
demonstrated in 52 countries over the last three decades, is one such innovation. Social businessenterprises are purpose-designed to solve a social problem leveraging a market-based solution that offers
a competitive, cost-effective value proposition for at-risk, low-income, and marginalised populations that
C.K. Prahalad refers to as “the bottom of the pyramid”.
Users of this guide are already conscious of the critical significance of building trust within communities
they serve, helping dismantle stigmas associated with HIV and STIs, and fostering a care environment
where individuals feel welcome regardless of background or circumstance. Trust is the social collateral thatis also the foundation on which community businesses are built. And business is by definition focused only
on meeting client demand, and therefore, unaffected by stigma or any form of social discrimination.
This guide proposes to its users a way to engage individuals actively in their own journey to health andwell-being, because the nature of the conditions associated with HIV/STIs requires a greater focus on
assisted self-management approaches. By using this guide, service providers for clients opting for thevalue proposition offered, would enable them to benefit from screening andcounselling programs that prioritise their needs, with discreteness and empathy.
The Yunus Thailand team and I are confident this guide will serve to reinforce
the steadfast commitment healthcare advocates and practitioners continue todemonstrate, weaving compassion, inclusivity, and empowerment into
efficient and cost-effective outreach services for a particularly vulnerable
section of society.
All power,
Faiz H. ShahFounding President, Yunus Thailand

Contents
07 ......... How to Read This Guide
08 ......... Background and Introduction
09 ......... The Role of Testing and Counseling
10 ......... Counseling and Communications
11 ......... The Napneung Model
12 ......... Social Business17 ......... Toward People Centered Approaches
18 ......... People Centered Service Delivery
18 ......... Crafting and Communicating your Value Proposition
19 ......... Innovation Opportunities
20 ......... Lean Operations: Establishing a Monthly Operating Cost Profile
22 ......... Balancing Cash Inflows and Outflows
23 ......... Leveraging Private Finance
25 ......... Zero HIV Social Impact Bonds in the United Kingdom
26 ......... Non-Financial Support
27 ......... Self-Testing and Self-Sampling Technologies
28 ......... Leveraging Public Partnerships
29 ......... National Health Security Office (NHSO) Medical Reimbursements
30 ......... Leveraging Private Partnerships
31 ......... Educational Partnerships
32 ......... Expanding Product and Service Offerings
33 ......... Conducting Market Research
35 ......... Recommendations
35 ......... Conclusion
36 ......... Stakeholders Engaged
37 ......... Further Reading
37 ......... ReferencesAbbreviations
AFD
AIDS
AMS
ART
CBO
CD4
CDC
CT
EpiC
FDA
HBV
HCV
HIV
HIVST
HPV
KPL
NG
NHSO
MoPH
MoPH-TUC
MSM
PDA
PLHIV
PrEP
PWID
RRTTR
STI
SW
SWING
SY
TB
TG
U=U
UNAIDS
USAID

Agence Française de Développement
Acquired Immunodeficiency Syndrome
Faculty of Associated Medical Sciences, Chiang Mai University
Anti-retroviral Treatment
Community-Based Organizations
Clusters of Differentiation 4
Center for Disease Control
Chlamydia trachomatis
Meeting Targets and Maintaining HIV Epidemic Control Project
Food and Drug Administration
Hepatitis B Virus
Hepatitis C Virus
Human Immunodeficiency Virus
HIV Self Test
Human Papillomavirus
Key Population-Led
Neisseria gonorrhoeae
National Health Security Office, Thailand
Ministry of Public Health of Thailand
Thai MoPH - US CDC Collaboration
Men Who Have Sex With Men
Population and Community Development Association
People Living With HIV
Pre-Exposure Prophylaxis
People Who Inject Drugs
Reach-Recruit-Test-Treat-Retain Program
Sexually Transmitted Infection
Sex Worker
Servise Workers In Group Foundation
Syphilis
Tuberculosis
Trans Gender
Undetectable = Untransmittable
Joint United Nations Programme on HIV/AIDS
United States Agency for International Development

How to readthis Guide

This guide intends to provide an overview of
key considerations, insights, opportunities,
and recommendations for innovation indeveloping and following social businessapproaches that can deliver access toadequate screening and counseling for HIV
and other Sexually Transmitted Infections(STIs) in Thailand. The guide focuses ondelivering relevant health services to at-riskand bottom of the pyramid populations in a
Thai context, while noting that insights andrecommendations may be adaptable tocontexts beyond Thai borders.
The guide is based on the premise thatalternative approaches to sustain
interventions to end the AIDS epidemic is
possible beyond non-revenue-generating
charitable initiatives and traditional for-profit
business models. While reading this guide, we
encourage a shift of mindset that support
exploration of social business approaches thatenable revenue generation to avoid financial
losses, and can further address existing gaps
in access to HIV and other STI-related healthservices through reinvestment of surplus
revenue. In doing so, the guide does notintend to question nor discredit existingmodels for providing HIV and other STI testing
and counseling services. Understanding theneed to adapt to ever-changing social andfunding conditions, we recognize that atransition towards diversification and pluralityof approaches can complement and sustain
efforts to overcome the threats of STIs to thewellbeing of people and society are needed.
Whereas this guide introduces opportunities
for social and financial innovation, it should beviewed as a non-exhaustive starting reference
for existing stakeholders and innovators toconsider adopting social business principles inoperations for the purpose of achieving
financial sustainability and maintaining publichealth interests as its primary objective.

We encourage critical and continuous
consideration of the specific conditions andrequirements of existing initiatives to adapt
and1 apply the opportunities presented in thisguide.

The Seven principles ofSocial Business by
Muhammad Yunus 1

1
2
3
4
5
6
7

Business objective will be to overcome
poverty, or one or more problems(such as education, health, technology
access, and environment) which
threaten people and society; not profit
maximization.
Financial and economic
sustainability.
Investors get back their investment
amount only. No dividend is given
beyond investment money.
When investment amount is paid
back, company profit stays with thecompany for expansion andimprovement.
Gender sensitive andenvironmentally conscious.
Workforce gets market wage with
better working conditions.

...do it with Joy!

1 Professor Muhammad Yunus, a Nobel Laureate, is renowned as the pioneer of Social Business and Microcredit. He is the esteemed founder of Grameen Bank and has established07

over 50 other companies in Bangladesh. Professor Yunus has been recognized by Fortune Magazine as "one of the greatest entrepreneurs of our time" due to his unwavering
innovation and entrepreneurial spirit. He has been awarded multiple honorary degrees from universities around the globe, and awards and recognitions including the UnitedStates Presidential Medal of Freedom, US Congressional Gold Medal, and featured in covers of renowned publications such as Time, Newsweek, and Forbes Magazines.

Background &Introduction
Nearly a quarter of new HIV infections in theworld occur in Asia and the Pacific (UNAIDS
Global AIDS Update 2023), a region with thesecond-highest number of people living with HIV.
Other infections including some sexuallytransmitted (STIs), such as syphilis, hepatitis B
virus (HBV), hepatitis C virus (HCV), Chlamydia
trachomatis (CT), Neisseria gonorrhoeae (NG),
Mpox, Human Papillomavirus (HPV), andtuberculosis (TB) are of concern from a publichealth perspective. At-risk populations andgroups at the bottom of the socioeconomic
pyramid face a range of challenges to access HIV
and other health services including stigma anddiscrimination. The prevalence of HIV among atrisk populations globally ranges from four tofourteen times higher than other sexually active
groups in 2022. With the aim of ending the AIDS
epidemic by 2030, a global effort has focused onscreening and testing for HIV as a core component
in diagnosing people living with HIV, providing
timely treatment and prevention, and suppressing
HIV viral loads to undetectable levels.

Financing
HIV/AIDS
initiatives
in Thailand

Public (Domestic)

International

USD 286M(2021)

Data: UNAIDS (2022) Global AIDS
Monitoring GARPR Reports.

Private (domestic) financefor HIV/AIDS in Thailand
represents less than 1% of total available
finance. At a global scale, total available
financing for HIV based on current
spending falls approximately 29% short ofresource needs for 2025, according to
UNAIDS. Social business approaches todeliver HIV and other STI screening andcounseling can help bridge the finance gap
by leveraging private resources.
2

Whereas Thailand has made significant
advancements to reduce HIV infections and reach2
the 95-95-95 targets, there were an estimated6500 new HIV infections in 2021. Critically, half of
all new infections occur among young people
between ages 15 and 24, most of them amongpeople in key population communities (UNAIDS
report on 1 December 2022). A combination of
public health initiatives from government,
community and key-population led organizations,and private sector clinics providing screening andtesting for HIV and other STIs has been at theforefront of Thailand’s success in diagnosing
approximately 90% of people living with HIV(PLHIV). These initiatives have relied significantly
on international finance such as from the Global
Fund to fight AIDS, Tuberculosis, and Malaria, andThailand’s National Health Security Office (NHSO),
among others, while also many for-profit private
sector clinics have exclusionary pricing structures
for many key populations.
The incidence of HIV is significantly higher amonggroups that also face stigma and discrimination bysociety. Bottom of the pyramid and risk
populations such as undocumented migrants,
LGBTQ+, sex workers, and people who use drugs
often face particular difficulties in accessing healthservices that meet their needs in a safe
environment. A series of community-based andkey-population led interventions have beendeveloped both in Thailand and elsewhere, as a
successful model to reach and recruit at-risk
groups for HIV and STIs testing while confronting
stigma and discrimination. These initiatives include
informing and counseling in testing service
delivery approaches. Analysis by the Institute for
HIV Research and Innovation (IHRI) reports thatover a third of HIV preventative treatment inThailand in 2022 was provided via key populationled initiatives.
In the race to end AIDS by 2030, identifying andimplementing innovative approaches to financeand scale the provision of HIV and STIs testing,treatment and prevention, and counseling services
in Thailand is needed. This guide aims tocontextualize and present practical innovations
and opportunities to do so from a social businessperspective, which strive to follow the principles of
non-loss to ensure financial independence andsustainability, and non-dividend to enablefinancing the expansion to scale long-term impact.
Whereas this guide hones into the Thai context, it
may also inform others.

The 95-95-95 targets represent a global initiative to combat the HIV epidemic and improve the health and wellbeing of PLHIV (see next page).

08

The Role of Screening andCounseling to Combat HIV andOther STIs
Screening and counseling are at the core of
the reach, recruit, test, treat, and retain
strategy (RRTTR) to end the AIDS epidemic
and applies to other STIs as well. Targeted
outreach and marketing interventions to reachand recruit at-risk populations involve anelement of educational counseling. Screening
and testing to identify positive cases of HIV
and other STIs requires technical counselingfor collection and diagnosis. Navigating theprocess for adequate treatment, preventive
medication, and patient wellbeing requires
guidance and emotional counseling, ensuringcontinuity for retention in care throughongoing support, including follow up with atrisk individuals to retest regularly, while also
providing support for vulnerable
individuals.

RRTTR helps ensure early detection andprompt treatment or prevention, with
continuous engagement. Throughout anindividual’s journey, counseling support
ensures access to comprehensive informationand guidance to take ownership of theirhealth by adopting preventive measures,
adhering to treatment and prevention regimes,
overcoming stigma, and fostering emotional
wellbeing, among other benefits.
Screening and counseling services areprovided by the public health system, private
health service providers, and civil society andcommunity-based initiatives. In the case ofThailand, the Ministry of Public Health sets out
specific guidelines for country-specificrequirements on HIV and other STIs.
Undetectable

R
RE

R

IT
RECRU

T
TEST

Untransmittable

T

TRE

+

AT

-

ACH

Treatment
Prevention

PLHIV are diagnosed
95% ofand know their status.
of diagnosed PLHIV receive
95%antiretroviraltreatment (ART).
PLHIV on ART
95% ofsuppress
theirviral load toundetectablelevels.

RE

R
TA

IN

09

Counseling & Communications
Counseling services are essential to ensure
the provision of health services in a peopleoriented and effective manner. Different
types of counseling require various levels ofknowledge and skills.

Individuals often seek guidance and support
from peers and on digital platforms before
approaching on-site counseling service
centers. Digital counseling can help delivercertain information in a cost-effective waythat can also bridge language and otherbarriers of access.

Education and Awareness on

Leveraging Digital Technology
for Marketing andCommunications

Existing risks and safety measures
Existing products, services, andprocedures

Techical Guidance on
Adequate methods for sample collection
and testing
Details, risks, and safeguards for available
treatment and prevention measures
Details on medical procedures

Mental Health Support on
Emotional orientation, guidance, andsupportConfronting stigma and discrimination
Identifying symptoms of concern for
mental health
Identifying and referringcases for psychologic
attention
Identifying and referringcases for psychiatricattention
Identifying and referringcases for otherprofessional attention

In Thailand, community-based organizations reporta tendency of individuals, including youth, to seek
counseling, guidance and support from peers andonline sources via social media and other channels.
Marketing and communication strategies for HIV
and STI screening and counseling may leverage
multiple channels to maximize reach to a broader
audience. With an aim of guiding the audience
toward ordering or booking an appointment, theseadvertisements may include videos, multimedia, or
physical advertisement including referrals for peers
or volunteers to distribute a link to existingproducts and services. Videos on risks,
testimonials from previous users, and explanation
videos, and promotions can help build an effective
marketing strategy. These strategies often include
a strong component of advocacy to combat stigma
and discrimination.
Social business models may seek to explore online
marketing and e-commerce channels to advertiseand reach a wider market. These may complement
referrals (word-of-mouth) and physical or eventbased advertisements. Based on available
resources and tools, information technologies canhelp achieve higher conversion rates.

The Marketing Funnel
Awareness Raising

EducateOffer & Benefit

Transaction
10

The Napneung Model
A Simple Approach to DeliverSelf-Screening With Integrated
Counseling at Scale
The initiatives spearheaded under the Napneungproject provides an innovative service delivery
approach that helps service providers reduce
operating expenses and open opportunities to scale
the delivery of screening and counseling for HIV andother STIs. Napneung screening and counseling sites
across Northern Thailand have focused on delivering
services to at-risk, marginalized, and low-income
populations with a focus on HIV and three additional
STIs: Syphilis, HBV, and HCV.

The Napneung simple model for service
delivery at a location-based screening
and counseling site is modular andadaptable. Setup of operations requirea small private and clean space withinternet connection linked to a separate
small and simple counseling room for ahealth service provider to assist andcounsel visitors as needed.

Innovating to Simplify Service Delivery
and Reducing Operating Expenses
The Napneung model provides a lean yet
comprehensive approach that simplifies the deliveryof fast and user-friendly services by leveraging digital
tools throughout the process and self testing andsampling technologies. Appointments are booked
online based on the availability of counselors, withvisits lasting no-more than 60 minutes. In doing so,
the time of on-site health service providers is
optimized. One counselor can comfortably assist
three visitors within one hour slot.
In this way, the operating expenses of location-based
screening and counseling can be reduced given thatthe time of health workers is optimized. With asimple digital interface, the privacy of users issafeguarded and users can opt to access informationin regional languages, review instructions andeducational information at their own pace, andrequest support as needed. In the event of a positive
result, counselors receive results directly and are able
to inform and follow up with users for any necessary
additional procedures including confirmatory testing,counseling, and referral for treatment. Information
about preventive options such as PrEP is also madeavailable to at-risk, HIV-negative, individuals. An
important element of the service delivery model isthat treatment and prevention products and services
are delivered on a referral basis that leverages
existing initiatives that have identified financing
mechanisms to cover costs.

11

PATIENTCOUNSELOR

Napneung (นับหนึ่ง) translates literally to“count from one” and signifies starting
over from the beginning, thereby alluding
to the importance of recurring testing,treatment and prevention for PLHIV andthose at-risk of infection of HIV and other
STIs. To date, the Napneung project has
location-based screening and counselingsites in Northern Thailand in collaboration
with partners including educational,
community-based, and civil society
organizations. The initiative was led by ateam of medical scientists at Chiang Mai
University’s Faculty of Associated Medical
Sciences, with financial support from theL’initiative-Expertise France(14SANIN204 and 18SANIN210,
December 2025 - January 2024).

Leveraging Digital Tools
Reach and recruit at-risk individuals
via digital marketing.
Book appointments based oncounselor availability and operating
hours.
Collect user behavior and result data
for screening.
Provide instructions for self-sampling
and testing.
Deliver educational information
Link users to counseling support asneeded.
Remind users to retest or request
treatment.

Social Business

Beyond the Binary of Financing
and Operating Interventions for
HIV and other STIs
Social business, as conceptualized by Nobel Peace Laureate Muhammad Yunus,
refers to a business model driven by social objectives rather than profit
maximization. Breaking away from traditional profit-seeking business models
and financially dependent non-profit interventions, social business seeks toaddress societal issues by offering products or services and generating income
streams. Driven by a social mission to create positive impact, financial andbusiness innovation can help eliminate financial losses while reinvesting
revenues to further scale interventions and foster lasting change.
NOT FOR PROFITSOCIAL ENTERPRISESTRADITIONALCHARITY

SOCIAL
BUSINESS

Financialdependence on
external sources:
Donations
GrantsEndowments

Some market
revenues

No dividends.
Some financial
dependence on
external sources.
Most revenues
from market(>75%)

No-dividends
all profits
reinvested

FOR PROFIT

TRADITIONAL
BUSINESS

Some revenues
Somefor corporate
dividends.
socialMission driven
responsibility
enterpriseand philanthropy(B-corp)

Traditional profit
and investment
modelsAdapted from J. Kingston Venturesome, CAF Venturesome and EVPA

“Social business is a bet infavor of life instead of profit” Prof. Muhammad Yunus
0% DIVIDENDS

to invest in expanding
activities and scaling
impact100% SOCIALMISSION DRIVEN

as the primaryobjective of operating

0% LOSSES
to achieve financial
independence andsustainability

Strategies to increase revenues in social business models may include:
Expanding into new markets and customers;
Expanding the products and service offerings; andDiversifying prices and payment to different markets while
enabling the ability to pay.

REVENUES
EXPENSES
Strategies to reduce expenses in social business models may include:
Streamlining and optimizing processes;
Eliminating unnecessary expenses while preserving access andquality of provision;
Negotiating with suppliers and partners; andLeveraging incentives, subsidies, and in-kind support.

12

Toward People-Centered
Approaches
Understanding Market
Segments

From a public health standpoint, providing
equitable access to health services to at-risk
populations, including those at the bottom of
the pyramid, is key to reaching the95-95-95 targets. At the core of this effort isensuring that health services follow acustomer-oriented approach to tailor theservice delivery mechanisms to meet the needs
and preferences of at-risk populations as key
beneficiaries of a social business approach.
Identifying and understanding at-risk groups isnecessary in the design and delivery of suitable
and appropriate mechanisms to deliver
screening and testing.

This guide was drafted following a
consultative process with representatives from
community based organizations with direct
experience in delivering HIV and other STI
screening, counseling, treatment, andprevention among other health services inThailand. Community-based initiatives, often
led by key, at-risk populations, help deliver
screening and counseling services that
respond to the specific needs of sub-groups.
Whereas the operating and service-delivery
models may vary, there is extensive evidence
on the benefits of CBOs to reach and recruit
at-risk individuals. Some of these point tohigher rates of early diagnosis of new
infections by measuring CD4 viral loads.

Engaging and Educating
Adolescents & YouthThailand’s Ministry of Public Health’s Division of AIDS and STIs reports that among newly
diagnosed HIV infections in 2022, nearly half are adolescents and youth (15-24 years).
Whereas younger individuals have longer term risks for acquiring new infections, awarenessand knowledge levels are a function of varied access to sexual health education. Many youth
turn to peers and digital sources for information and counseling. Youth are generally
perceived to have limited purchasing power and an overall preference to low-cost sexual
health services; however, willingness and ability to pay increases with age, particularly
among employed early-career youth.
infections in Thailand in 2022 were in
47% of new HIV people
under 24 years old.

13

Eliminating Stigma andDiscrimination Against Sex
Workers for Public Health
Stigma, legal barriers, and marginalizationof the sex industry often hinder sex worker
access to adequate healthcare. In Thailand,a significant number of sex workers are also
economic migrants from neighboring
countries, who face multiple access barriers
and layers of discrimination, particularly incases where they are undocumented. Given
the demands of clients, risk factors, andother factors, many sex workers report awillingness to pay for sexual health services
including testing. In order to reach, recruit,and safeguard the needs of sex workers,
health services should ensure
confidentiality, non-judgmental care,flexible schedules, regular screenings,
certification of diagnosis, and access totechnical and emotional counselingservices.

Enabling Access to
Health Services for
Migrants
Whereas HIV infection rates may be relatively low
overall, Hepatitis B, Hepatitis C and Tuberculosis
have high prevalence among economic migrants in
Thailand, particularly from Myanmar, Cambodia,
and Lao PDR. Many of these migrants are
undocumented, do not speak the local language,
and are not aware of existing support mechanisms
for health. In response to discrimination, lack ofaccess to public health services, and limited
purchasing power, a range of social enterprises
and civil society organizations in Thailand haveongoing programmes and initiatives to bridge
access gaps to health services, including insurance
schemes such as the M-Fund by Dreamlopments,
and campaigns by the World Vision Foundation ofThailand to provide remote access to testing,treatment, and prevention for HIV and extending
to Hepatitis and Tuberculosis.
14

Unlocking Regular Screening andCounseling for Prisoners
The incidence of HIV and other STIs among
inmates in Thai correctional facilities is higher
than in the general population. Thailand has atotal of 142 correctional facilities nationwide
that conduct HIV and STIs screening uponadmission, along with other screening
processes for substance abuse and physicalexaminations including blood tests, chest Xrays for Tuberculosis, COVID-19 screening,
while assessing the risk of communicablediseases including Tuberculosis, HIV/AIDS,
and HCV. Positive cases are followed bytreatment plans.
Informing inmates for health promotion
includes Tuberculosis counseling during
prison entry, weekly dissemination of video
clips before TV programming, placement of
informative materials in reading corners, andtraining of volunteer health workers within
facilities.

As of May 2023, Thailand reports 15,875
inmate volunteer health workers, with anaverage health volunteer to inmate ratio of
1:50. Volunteers support health-related
activities, disseminate knowledge, andprovide advice to fellow inmates including
sexual health information following
guidelines of the Global Fund to fight HIV,
Tuberculosis, and Malaria. Existing avenues
for engagement of external organizations
with correctional facilities include donations
and the delivery of training sessions with
opportunities for further social businessinterventions.
May 2023 Snapshot of Number ofDiagnosed Infections Among Inmates inThai Correctional Facilities (n=268,621)
HIV/AIDS

5342

Tuberculosis

1668

Hepatitis C

1489

Syphilis
Influenza

1131
323

Male
FemaleData Source: Department of Corrections

Inmates wait for X-ray testing at correctional facility.
Source: Department of Corrections

15

Mainstreaming Sexual
Health Among Male
Populations
Thailand’s Ministry of Public Health reports that
whereas nearly 60% of PLHIV in 2020 are men,
approximately 80% of new HIV cases are amongmen. Risk groups include Gay men or other men who
have sex with men (MSM) and male sex workers(MSW). A wide range of community initiatives inThailand, as in other parts of the world, have opted tofocus on bridging access to screening, treatment, andprevention to male populations regardless of sexual
orientation, gender identity and expression, andoccupation. More recently, the prevalence of Hepatitis
C has been observed to increase, especially among
MSM groups and particularly those infected withsyphilis, engaging in chemsex, having multiple sex
partners, and inmates in prisons.

Ensuring
Friendly andJudgment Free
Services for
People Who
Use Drugs
Activist t-shirt calls to decriminalise people who use drug harm reduction(World Bank/Trinn Suwannapha)People who inject drugs (PWID) are at highrisk of STI infections such as HIV and Hepatitis
C. UNAIDS reports estimate that in 2018-22
there are approximately 57 600 adults in
Thailand who inject drugs. Other forms of risk
sexual behavior while under the influence ofdrug and substance abuse, also referred to as
chemsex, are also of concern for new
transmissions. According to health volunteers
from the Thailand Drug User Network,
location-based test services are often
preferred by people who inject drugs given the
direct availability of counseling and careservices, particularly for

immediate response in the event of a need fortreatment.
Willingness and ability to pay is perceived to
be low among PWID, and issues linked tostigma and discrimination are reported as a
key barrier, including health workers denying
access to health care facilities and services.
Thailand has various community-based
initiatives providing judgment-free, friendly,
and fast health services and often integratingharm-reduction support.

16

Transforming Health Services
for Transgender Inclusion
Transgender women and men in
Thailand, as in other countries, report a
range of issues linked to social stigma
and discrimination, which extends toexperiences in accessing and navigating
health care systems. Transgenderinclusive health services, including sexual
health support, gender affirming care, andcounseling are often out of reach in partsof Thailand and neighboring countries.
Thailand’s Tangerine Clinic– a one-stop
health center in Bangkok operated bytrained trans personnel for trans men andwomen– reports a 15% rate ofunemployment among visitors, 16% rateof visitors opting for sex work, 11%
opting to use drugs, and a third showing
symptoms of depression. Beyond externalbarriers to access transgender inclusive
health services, internalized stigma, lowlevels of awareness, knowledge and data,
and misconceptions about genderaffirming treatment and its interactions
with ART or PrEP drugs have been
known contributing factors to poor healthamong trans populations.
Gender-affirming health services
require specific screening
and counseling support
including lipid profilingand hormone
monitoring tests. For
Thailand has reached the triple elimination criteria for HIV mother-to-childthose that opt fortransmission (MTCT), but some cases of transmission still occur. There is still
gender affirming
an incidence of congenital transmission of syphilis and Hepatitis B. Throughhormonal treatment
accessible antenatal care, HIV testing aims to follow WHO recommendations
or surgery, additional
to conduct testing for HIV, Syphilis, and HBV. Effective interventions on HIV
services are needed.
diagnosis have reduced rates of transmission to less than 2%. Streamlined
testing methods and swift diagnosis and initiation of treatment are also part
Integrating HIV andof Thailand's success in providing comprehensive care to ensure the health ofother STI screening
both mothers and their children. Whereas this guide focuses less on MTCT, it
and counseling canis also important to note the ongoing efforts to enhance access to sexual andhelp with early
reproductive health services and education to reduce teen pregnancies indetection and
Thailand and ensure safe and accessible support for family planning among
optimize operations.
women and girls, while comprehensively engaging men and boys.

Sexual and Reproductive HealthServices for Women and Girls17

Five Aspects ofPeople-Centered
Service Deliveryof Screening andCounselingSocial business approaches can deliver universal access to
HIV and STI health services for groups unable or unwillingto seek access through existing service delivery
mechanisms. Following a people-centered approach thattakes into consideration the different challenges of at-risk,
marginalized, and low-income populations, social business
innovations can focus on improving the products, services,and delivery mechanism for screening, testing, counseling,treatment, and prevention of positive cases.

ACCESSIBLE
Enabling the availability of products
and services at all times andincluding remote or difficult to reachlocations or populations. Delivery
measures ensure that screening andcounseling are available to anyone
regardless of risk behaviors, sexual
orientation, gender identity andexpression, language or legal
barriers, operating schedules,
disabilities, religious affiliation, etc.

AFFORDABLE

AGILE
Ensuring fast services
and establishing mechanisms to
respond to sensitiveor unexpectedcircumstances.

Meeting the purchasing powerof users and customers for
products and services, including
via access to support withexisting insurance mechanisms,
finance from alternative sources,and other cross-subsidization
methods.

ADAPTABLE
Screening and counseling can adapt product andservice delivery based on the needs andpreferences of beneficiaries or partners, available
resources, and existing conditions on the ground.

ANONYMOUS
Respecting and ensuring the privacy of
individuals by providing solutions for discrete andfriendly screening and counseling regardless ofidentity, risk behaviors, and other factors thatmay prevent unwilling individuals from disclosing
personal information.

Crafting and CommunicatingYour Value Proposition
Human-centered design principles aim to deliver
solutions that respond to user pain-points and customer
demands. Most often, the uptake of these solutions go
hand in hand with a marketing and communication
strategy that clearly communicates the value propositionof the products and services of your social business. To
help this process, it is useful to develop customer profiles,
or personas, that clearly detail the pain-points, desired
gains, and personal priorities of different users or
customers. In order to tailor your value proposition
message to fit your customer, focus on answering thequestion: “why should I opt for this product or service?”

What are the products
and services yourproposition is built
around?

Gain Creators

Pain Relievers

How do yourproducts andservices create
gains for yourcustomer?

How do yourproducts andservices alleviate
the pains of yourcustomer?

18

Innovation
opportunities

Price and ValueHow can quality solutions be delivered while
minimizing the price of products and services?

Scalable Solutions

Technology Innovation
How can solutions be improved by integrating
features from existing and emerging
technologies?

Resource Efficiency

How can solutions and offerings be designed tofacilitate scaling up?

How can products, services, and operations
avoid wasting resources and be produced
sustainably?

Redesign for Functionality

Streamline Operations

How can the functions of existing solutions be
redesigned to work better for users?

How can processes, logistics, manufacturing,sourcing, and other aspects of product andservice delivery be streamlined?

Task Shifting

Educate Consumers

How can staff roles be designed for
optimization and reducing skill requirements todeliver health services?

How can awareness be raised, knowledge
increased, and demand stimulated among key
populations?

Difficulty Proofing

Simple Interface

How can products and services be delivered inplaces with difficult conditions and limited
infrastructure?

How can the customer experience be intuitiveand easy to use? This may be online and offline.

Distribution and Reach
What are innovative methods to distributeproducts and services, including for both ruraland urban markets?

19

People-centered social business
innovation for inclusion and accessibility indelivering HIV and other STIs screening,counseling, and related solutions may also
benefit from considering areas to improveexisting service delivery and operation
models following the twelve principles forbottom of the pyramid (BoP) innovation by
C. K. Prahalad, which aim to reach lowincome markets.

Challenge Assumptions
Old roads lead to old destinations. How can you
invert existing beliefs in your organization andthe sector to innovate value?

Lean Operations
Establishing a Monthly Operating
Cost Profile for Location-Based
Screening and Counseling
A monthly cost profile for screening andtesting locations can help decision making by
providing a reference cost that can becompared with cash flow forecasts todetermine minimal income streams to breakeven and avoid financial losses. It can also
help indicate cost reduction opportunities.
The table below provides a non-exhaustive
list of costs that can help establish a baseline.
profile for operational expenses.

Defining Key Assumptions
The following questions can help define a list of
key assumptions that can be used to develop a
cost profile for a screening and counseling site.
How many hours does the site operate(monthly)?
How many staff are on site?
How many visitors can one staff attend
simultaneously?
What is the average number of visits perhour? Month?
What percentage of visits test positive for
infections?

VARIABLE COSTS

Operating costs that depend on the number of visits and positive cases
Health Staff (i.e., counselor, nurse, doctor, etc.)
Determine whether counselor and medical staff costs are linked to visitors or
considered part of central, fixed, costs. Establish average fees if linked to visits andestimate an average monthly cost based on historical or existing data. Note thatcosts may be reduced or eliminated by leveraging in-kind support,
reimbursements, or other methods.
Screening Test Products
What are the total costs of screening test products? Note that these may be
reduced in collaboration with suppliers, and possible reimbursement from thepublic health sector may be attainable for some in the case of nationals.
Products and Services for Positive Cases
What are the additional procedures followed on site by your operations when avisitor is diagnosed positive for an STI? (i.e., One step anti-hiv (1&2), viral load, and
CD4). Note that some sites may reduce costs by refering positive cases to publichealthcare providers. Estimate the total cost for screening packages offered tovisitors, and calculate estimates based on available data on the rate of positive
cases.
Other
Depending on the setting, clinics may incur other variable costs including different
medical, nursing, and other fees.
Total Variable Costs

20
18

FIXED COSTS

Operating costs that need to be paid regularly and regardless of visits*
Facilities
Does the clinic location incur monthly rental, lease, or purchase fees?
Note that location specific expenses may be reduced or eliminated by leveraging inkind support from partners.
Utilities
What are the average monthly costs for electricity, internet, water, and other utilities?
Note that costs may vary by location and can be reduced or eliminated by leveraging
partnerships and in-kind support.
Cleaning and Maintenance
What are the average monthly maintenance costs? Note that costs may vary bylocation and can be reduced or eliminated with in-kind support,
Operation staff
Determine which staff are central to operations and calculate a monthly cost.
Consider whether finance outside of social business revenue streams can be
expected to cover any of these costs. Note that costs can be optimized by scaling
and centralizing operations, leveraging partnerships, and outsourcing certain
elements of operations (i.e., accounting, audits)
Training and certifications
Determine the number of counseling and other staff that require onboarding, training
and certifications to support your operations and calculate a monthly depreciation
cost. Determine whether these costs are borne by the social business, shared withstaff or partners, or expected as entry requirements.
Information technologies and maintenance
Determine any fixed IT cost for minimum reliable services, and estimate a monthly
cost. Note that these can be reduced by scaling and centralizing operations, andleveraging in-kind contributions by IT product and service suppliers.
Outreach, Marketing, and Communications
Estimate any costs and consider linking these to the recruitment of new customers or
beneficiaries. Establish a baseline monthly spending that also considers content
development costs. Note that these costs can be reduced or eliminated by leveraging
partnerships, in-kind contributions, and centralizing operations.
Operation Outsourcing
Determine what activities are to be outsourced from operations and calculate amonthly cost based on fees. Note that these may be optimized by leveraging in-kind
support and centralizing operations, among others.

Total fixed costs

Factoring in “Sunk” Costs

The capital expenses or upfront investments to start new operations are also referred
to as “sunk” costs. Depending on the type of finance used to cover these costs,
monthly cost profiles may need to factor in a monthly sunk cost value. In the case of
location-based screening and counseling sites, these may include:
Medical technology and equipment
Furniture and appliances

21

Administrative and registration fees
Certifications* It is worth noting that, for simplicity, this template does not consider nor reflect the depreciation of assets into
operating cost estimations.

Balancing cash

inflows & outflows

1
2
3
4
5

When designing social business models andconsidering different options for financial
sustainability, it is imperative to estimate required
expenses and consider these in relation to thetime when revenues will be received. Below are
five questions to consider.

Capital Expenses (CAPEX)

How much money is needed at first to
establish what I want to do?
This may be to buy equipment or infrastructure,
cover license fees, etc.

Operational Expenses (OPEX)

How much money is needed to cover thecosts of doing what I want to do?
Remember that there are fixed costs which areconstant each month (e.g., rental fees, salaries,
internet bills); variable costs which change
depending on sales (e.g., buying testing kits,
packaging, delivery costs of products); and thedepreciation of assets (e.g., if you need to buy a
computer, how will it lose value over time andwhen will you need to buy a new one?)

Cash Inflows

How many units of my products andservices do I project to sell on a daily,
weekly, monthly, and annual basis?

The most important factor is what you base yourassumptions on. Try to define assumptions asevidence-based as possible using comparable
examples and market studies. This is also based
upon the pricing of your products and services.
Prices should be based upon the market realities
and what is affordable for at-risk populations,determined through market research, the cost
structure of delivering the product and service, anda surplus for contingencies and scaling.

Cash Flow Forecasting
Forecasts are usually produced on a monthly
basis and estimate net cash flow between cash
inflows and outflows. The opening balance is thenet cash amount a business starts with eachmonth.
JAN

FEB

TOTAL

INFLOWS
Investments

Sales

Total
OUTFLOWS
Set up
Wages
Materials
Marketing
MaintenanceTotal

Net cash

Break Even Point

When do I expect to make enoughmoney to cover my operational
expenses and, if needed, recover thecapital expenses?

There is no definitive answer to this question as
we cannot predict the future, but predicting
different scenarios such as a high uptake,moderate uptake, and low uptake can help withpreparation and planning.

Investment AmountHow much money do I need until I canbe self-sufficient?
Consider where you will get the investment fromand if there are costs to getting this money (e.g.,interest payments on a loan). If so, add these to
your cost projections.

These five considerations are not linear and dependon iteration, as changes in one step impacts others.
Getting the data to answer the questions
highlighted is dependent on rigorous market
research, which should include analysis of existing
research and market data as well as interviews andinteractions with potential customers.
It is also important to understand the impact of cash
flows when considering income generated throughstreams such as reimbursements from Thailand´s
National Health Security Office, where expenses are
upfront and reimbursements may be delayed.
Delays present a need for working capital to bridgetime gaps. Innovative financing approaches may beaccessed to smooth cash flows and to enable social
businesses to break even.

22Leveraging Private
Finance
Investment is often needed to develop social business revenue streams as well as to establish
HIV and STI testing facilities in themselves as sustainable entities. In addition to grants,
donations, and endowments, the two main options for investment are debt and equity, while
there are also opportunities to combine philanthropic capital with investment capital, known as
blended finance. Crowdfunding is also an additional opportunity to mobilize investment.

A

Angel Investor FinanceAngel investors are usually individuals with large sums of capital who use personally tosupport emerging businesses in the early stages of business development. These
investors tend to demonstrate a strong personal interest in the businesses they chose toprovide finance to, and often get involved in business development activities. However,social entrepreneurs may also opt to seek investment finance from individual in theirpersonal networks, which may include family and friends, and extend to a wider pool ofindividuals willing to provide seed funding to support business development capital
expenses.

Blended Finance

B

C
23

Blended finance is a suite of financial tools which combines philanthropic capital withprivate capital, enabling risk - return profiles to be managed while also providing accessto significant pools of private capital in circulation. Some blended finance approaches alsoenable donors to pay for the social outcomes they desire, e.g., bringing people living with
HIV into care, rather than the inputs and activities of a project, such as increased HIV
screening.
One example is a social success note, which brings together a donor which is interested
in seeing a social outcome be achieved but doesn’t want to take a risk, a social business
which can potentially deliver that outcome with an injection of capital, and an investor
who is willing to take a risk but wants to profit if it is achieved. An agreement is reachedwhere the investor will provide a loan to the social business to enable it to implement its
solution, for example scaling HIV screening, and if the social outcome is achieved thenthe donor agrees to pay the investor, for example the interest on the loan. There aredifferent variations of social success notes based on specific projects and needs as wellas the level of concessionality available from the donor, while two other key parties
essential to the financing innovation are the intermediary, who structure and manage themechanism, and the evaluation partner who verify the desired outcome has beenachieved. Social success notes are closely related to social or development impact bonds
as outcome-based blended finance tools, such as the Zero HIV Social Impact Bond.

Crowd-Sourced Finance
Crowdfunding involves raising capital from a large number of individual “backers”,
usually in online platforms. Many crowdfunding campaigns seek to support a specificproject or product’s development by pre-selling a particular product or reward, to be
fulfilled when the product or project’s development has been completed. This approach
to fundraising offer entrepreneurs an early opportunity to engage potential customers
to validate interest and get feedback about a product or project or product, whileaccessing a wide range of investors outside of traditional sources of finance.
Crowdfunding campaigns benefit from a strong communication strategy andleveraging existing networks.

Debt Finance
Debt finance consists primarily of loans and is widely available from commercial banks,
government banks, impact investors, and some institutional or individual donors.
However, for many social purpose organizations, taking out a loan may either be adaunting or unattainable prospect. Commercial banks providing a business loan will
require collateral and strong existing financial records that may not be possible formany organizations. Government-owned banks may be more attainable and offer
concessional, or more favorable, rates due to their development mandates, which may
link to willingness to absorb risks to exclude collateral requirements and extend
repayment periods when compared to commercial banks. If social businesses or
projects have philanthropic partners or donors, another possibility is to explore
guarantor agreements which may enable debt financing.

D

Invoice Finance is a form debt finance that consists of allowing organizations toprovide an invoice, or future payment secured, as collateral for a loan, so that capitalcan be provided immediately for the smooth functioning of an organization. Invoicefinance may also be an opportunity for further exploration, considering potencial delays
in receiving government reimbursements. Often used in other contexts, for example thePracharath Rak Samakkee Social Enterprise provided invoice financing to smallholder
organic farming groups to enable them to supply organic vegetables to Ministry of
Public Health Hospitals, despite a 60-day delay in hospital payment processing. Thismechanism may enable smaller, key-population led HIV testing social enterprises, tomake the most of NHSO reimbursement schemes.

Equity Finance
Equity finance is where a percentage of ownership in a company is sold to an investor inorder to inject capital into the business for startup, growth, or sustainability ofoperations. Equity finance is the cornerstone of conventional investing in early stage forprofit companies, although there are necessary adaptations for its suitability to social
business investing. Firstly, considering the purpose of a social business is to solve asocial problem rather than maximize profit, the motivations of an equity investor andtheir alignment with the social mission is integral. If part ownership of a social businessis sold to an equity investor wanting to maximize profit, then governance challenges willarise. Secondly, a social business should be non-dividend, so that any profit generated isreinvested in scaling the solution it is delivering, therefore the motivation of an equity
investor should be to get back their investment amount only, rather than returns on
investment. This may deem mainstream equity investing non-applicable, however manysocial business equity investors exist who have philanthropic motivations but are
seeking sustainable ways to use their capital to support social organizations. An
example of this is the Nobin Equity Program, a micro-equity investment approachpioneered by Grameen Trust which integrates equity investing in unproven, early stage
businesses with non-financial support.

E

24

Zero HIV Social Impact Bonds
in the United Kingdom
A Private-Public Partnership to Finance HIV Outcomes
HIV Social Impact Bonds (SIBs) were pioneered in the U.K. in 2018 as an innovative financial
approach leveraging private finance to reduce public spending on HIV/AIDS while focusing on
public health outcomes. The initiative aims to accelerate early detection of HIV, and support
retention of treatment and prevention. The pilot project started by providing HIV health services
to at-risk individuals in marginalized areas of London commissioning the bonds.

Outcome-Based Contracting
A fundamental component of the Social Impact Bonds is the
rigorous measurement of outcomes, which are directly linked to therepayment of investments. The bonds underscore the critical needfor innovative funding models to achieve measurable social
outcomes in the battle against HIV. Health service providers are
given approximately 65% upfront payment of a pre-defined numberof outcomes and then paid on a per-outcome basis. The bonds offer
significantly higher payments for outcomes in comparison torelatively low payment rates per test. As such payments are basedon two outcomes.
1. A new case of HIV that is diagnosed and linked to treatment
and care.
2. A lost case of HIV that is reengaged in treatment and care. This
includes previously-diagnosed PLHIV that have not been issued
ART for at least 12 months or that have been recently released
from an institution (i.e., prison) without regular HIV treatment
and care.

1

The U.K. Zero HIV SIB Model
Simplified
1. Grant funding to support
outcome payments

Outcome Payer

Local Government
Units

1. Loans

5, Outcome-based
payments

4, Evidence ofoutcomes

Investors
6. Repayments(amount varies based on
outcomes achieved)

Zero HIV Social Business
2, Service contract
management & support

4, Evidenceof outcomes

6. Extra payments
based on outcomes

HIV Health Service Providers
3, Activities under RRTTR strategy

4, Outcomesachieved

Beneficiaries

PLHIV who have not been previously diagnosed
or who have discontinued treatment and care

Adapted from Stanworth, N. (2020) Zero HIV Social Impact Bond Insight Report.

25

The benefits ofZero HIV Social
Impact Bonds
For Public Sector: Reduced
public spending. Getting people
into treatment early is much
more effective. £200,000 of
costs are avoided each time aperson living with HIV isengaged into care.
For Private Investors: the capital
invested includes social impact
and financial returns.
For Health Service Providers:Flexible project financing todeliver health services without
concerns on cash flows.

Financing theSocial Impact Bonds
The establishment of the SIBs in the U.K.
was supported by the Commissioning
Better Outcomes (CBO) fund, a SIB
programme funded by The National
Lottery Community Fund of England andalso leverage finance from the Elton
John AIDS Foundation to support theoutcome-based payment scheme.
Private investors to SIBs include a rangeof private initiatives which contribute up
to GBP 1 million as debt finance withvariable rates of return if outcomes are
met or if they exceed a reference
baseline. The funds from SIBs aremanaged by a Zero HIV Community
Interest Company / Social Business,
which mediates contracts and isgoverned by a board of directors that
includes representatives fromcommissioning entities, funders, andinvestors. The CBO Fund commissions
evaluations of the initiative. It is
important to note that SIBs take a longtime to develop given the scale of funds
needed and complex stakeholder
engagement procedures.The U.K. Zero
HIV SIB took 3.5 years from awarding
seed funding to starting the firstoutcome-based contract.

Non-Financial Support

The Role of In-Kind Contributions for
Scaling Public Health Outcomes
Optimizing operations and procedures can benefit
from leveraging non-financial support from external
parties that offer benefits to social entrepreneurs
beyond traditional monetary contributions. Thesemay include training, mentorship, market linkages,
and technical assistance. Moreover, these services
foster connections with industry experts andnetworks, facilitating access to new markets andclientele. Securing these opportunities requires
entrepreneurs to proactively identify and pursue
opportunities, which may be leveraged bystrengthening networks and establishing
relationships with service providers. Ultimately, nonfinancial services can empower entrepreneurs tomake informed decisions, capitalize on existing
programs and opportunities, and optimize
operations toward achieving financial sustainability.

A few examples of in-kind support forsocial entrepreneurs include:

Business Support

Incubators, accelerators, advocacy andpromotion, and other forms of businessdevelopment guidance.

Pro-Bono or Discounted Services
Marketing, accounting, and legal support(i.e., TrustLaw by Thompson Reuters
Foundation).

Technology resources and tools
Examples include TechSoup for
nonprofits, Monday.com project
management, Free Google Suite and
Google Ads.

Building Compassion and Expanding OutreachFaith-Based Contributions to a World of Zero AIDSIn the face of stigma and discrimination faced by at-risk,
marginalized, and low-income groups, leveraging faithbased support for advocacy and community support
can cultivate community support mechanisms to end
the HIV epidemic. Faith-based organizations andnetworks can also provide extensive platforms foroutreach, which can enable services to reach different
key populations and for social businesses to expand
their customer base. In the Mekong region, previous
examples include testing campaigns, HIV-related healthservices in faith-based or affiliated healthcare facilities,
and education and training initiatives for monks as
counselors to provide guidance and spiritual support tothose affected by HIV. The origins of Hope for
Cambodian Children, a community based careorganization supporting children affected by HIV/AIDS,
prevention of mother to child transmission, among otherinitiatives trace back to Wat Norea, which establishedthe Norea Peaceful Children project providing shelterand care to children orphaned by HIV/AIDS related
complications along with other support to PLHIV. Other
examples include Archbishop Desmond Tutu’s lifelong
advocacy for HIV awareness and prevention and theUnited Synagogue Resolution on AIDS.

Buddhist Monk blessing contraception and
STI prevention products for distribution in
Thailand (1974).
Photo courtesy of the People and Community
Development Association (PDA).

26

Self-Testing and
Self-Sampling
Technologies
Thailand has made substantial progress inbuilding access to testing products andservices for HIV and other STIs through a
combination of government initiatives, thedevelopment of healthcare infrastructure, andestablishing partnerships with internationalorganizations. Thailand’s Ministerial Regulation
No. 1/2015 on HIV self tests (HIVST) wasapproved by the National Council for Peace
and Order to promote people knowing their
HIV status by increasing access to HIVST. The
first HIVST kit was listed in Thailand’s Foodand Drug Administration’s notification
announced on 17 September 2019 regarding
the Criteria for the Approval of Test Kits
Related to HIV Screening for individuals.

As of FY 2023, there are four HIVST products
approved by Thailand’s FDA along with selfsampling products for STIs including HPV, NG,
and CT which are widely accepted and deemedas safe and with high relative accuracy. As
demonstrated with COVID-19 Antigen selftests, self-testing and sampling for HIV andother STIs provides an opportunity to increase
the coverage and frequency of testing for early
detection and reduce transmissions, especiallyfor individuals that have difficulty accessing
standard testing services. These individuals
may include people who live far away fromtesting services, sexually active young people
and other key, at-risk, groups that havedifficulty accessing friendly services.

Anonymous Self-Screening:
Taiwan’s Approach to Deliver
HIV Self-Test Kits to All

Coin-operated HIV self test vending machine.
Source: Taiwan AIDS Foundation

27

By combining the delivery streams for anonymous testing,Taiwan has reached the target of testing and diagnosing atleast 95% of people living with HIV. Taiwan’s Center for
Disease Control (CDC) recommends every sexually active
person to test at least once as part of a routine health check,and more frequently for others with risky behaviors such as
needle-sharing, drug use, unprotected sex, and having
multiple sexual partners. To support this goal, Taiwan first
introduced HIV self-testing in 2016, in addition to communityand facility-based testing across all municipalities, cities, andcounties on the island. Self-screening kits are available at a
price of 200 Taiwanese Dollars (Approximately 220 THB) at
multiple points of sale including vending machines, online
ordering and store purchase stations, including a webpage
mapping all locations. CDC provides either mechanical orelectronic vending machines which can be found in university
campuses, pharmacies, religious-affiliated health centers,
community centers, among others. Of all self-test kits sold in
2022, vending machines accounted for 21% and 63% wereordered online. All test kits include a unique QR code anddetails to report results. Those who submit results canrequest an additional HIVST to be collected free after one
month. Approximately 30% of users report their results, witha rate of under 0.5% of positive results.

Leveraging Public Partnerships
Leveraging public finance in social business models involves requesting government-backed
funding and resources to support kick starting or running operations. Leveraging public financemay come in the form of grants, subsidies, tax incentives, equipment or other in-kind resources or
activities. In some cases, public-private partnership (PPP) models can facilitate collaboration,
private investment, and risk-sharing. In others, integrating approaches with public programs canprovide social businesses with competitive advantages to manage interventions efficiently.

Sources of public finance for HIV and other
STI related activities may include:
Relatively low-effort toobtain and high levelsof grant-based secure.

The Global Fund to fight AIDS,
tuberculosis, and malaria
Bilateral HIV/AIDS or broader healthrelated programs or projects
National and international public financefor medical research, research anddevelopment, and innovation
Provincial-level finance for public healthpromotion, education, social inclusion,and related areas

Fund disbursements
may be inconsistent
with spending
schedules. May require
reporting and create
dependencies.

Can subsidize the sourcing Risk of inconsistencyof equipment, materials, or over time due tostaff time, etc. fluctuations in finance.

Collaboration and Centralization
to Reach a Scale of Economy
In order to catalyze the scaling of impact-driven operations to reacheconomies of scale, collaborative approaches can be a pivotal factor to enablesocial business success. Similarly, task-shifting and centralizing certain roles
and functions can amplify the benefits of collaboration by eliminating costinefficiencies and leveraging existing resources. In the case of screening andcounseling initiatives, centralizing marketing and communication roles, digitalsystems and services, and product sourcing and handling can all optimize
operating expenditures as well as increase bargaining power with suppliers.
Collaborative approaches such as establishing federations also can enhance
resilience to external shocks. Effective collaboration, both within institutions
and across sectoral organizations, can help unlock opportunities for social
impact and financial sustainability via a sharing economy approach.
Informationand data

Knowledge andexpertise

Facilities andinfrastructure

Finance andexpenses

Technology,
equipment, andproceduresGroup
Procurement
and logistics

Risk mitigation strategies
and expenses

28

Thailand’s National Health Security Office (NHSO)
Medical Reimbursements
Thailand’s National Health Security Office (NHSO) oversees the country's universal healthcoverage scheme, known as the "Gold Card" program. This program provides access to
medical services for Thai citizens, including medical reimbursements for eligible healthcare
expenses including consultations, testing, treatment, and prescription medications. Medical
reimbursements are typically handled directly by registered health service providers andrequire submission of eligible patients’ ID.

NHSO Medical Reimbursement Rates (FY 2023)
Test

29

THB per
Remarks
Unit

NHSO
Registration

1

Apply for Medical
Technology
Laboratory statusfrom the Provincial
Health Office,
MOPH.

Voluntary Counselingand Testing7

HIV Professional Test

140

HIV Self Test

100

Basic Laboratory CheckUp Tests

Reimbursement rate per test and
25 includes (CBC, FBS, Cr, Chol, TG,
SGPT/ALT)*

CD4 Lymphocyte count

400 For HIV positive cases

Viral Load

1350 For HIV positive cases

HIV Drug Resistance(In-house method)

Only applicable to University
5,500 Hospitals conducting testing for
research purposes

LA: Thai Laboratory
Accreditation (LA) by
Medical Technology Council

HIV drug resistance(Commercial method)

Should include testing forprotease (PR) and reverse
transcriptase (RT) determine HIV
6,000
genetic variability. Testing forintegrase (IN) can be considered
optional.

ISO: 15189:2012 and15190:2020 by Bureau ofLaboratory Quality
Standards, Department ofMedical Sciences, MOPH

To be executed by a licensed
healthcare professional

Regardless of Professional or
Self-Test

HPV DNA280

HBV Antigen

50 Rapid or Automated Test

HCV Antigen

50 Rapid or Automated Test

HCV Core Antigen

400

HCV RNA

1690 Qualitative or quantitative* Complete Blood Count (CBC); Fasting Blood Sugar (FBS); Creatinine (Cr);
Cholesterol (Chol); Triglycerides (TG); Serum Glutamic Pyruvic Transaminase (SGPT);
Alanine Transaminase (ALT)

2

3

Obtain Medical
Laboratory
Accreditation for
quality,competence, andrequirements forsafetySubmit theapplication to the
Regional NHSO
and schedule anevaluation
appointment.

Leveraging Private Partnerships
Leveraging partnerships and private sector
support for HIV and STI screening can help reduce
costs of operation while enabling new revenue
streams. Collaboration with insurance companies
and employers to include HIV and STI screening
and counseling support yield revenue while
contributing to workforce wellbeing. In othercases, leveraging corporate social responsibility
finance to bridge investment needs, purchase of
equipment, and optimize operations can deliver
mutual benefits to social enterprises while
amplifying brand reputation for corporates anddemonstrating commitment to community wellbeing among at-risk and low-income groups. Inkind contributions of equipment, access tofacilities, marketing and communication support,
digital support and other resources and services
can offer opportunities to amplify the reach of
screening initiatives. Preferential rates for the
procurement of products and services can also
contribute to ensuring lean operating costs.

Flexible finance withlow reporting
requirements.

Can build long-term
partnerships
particularly whenconnected with corebusiness interests.
Opportunities more
likely with large
family owned
companies.

May be challenging topresent the businesscase, particularly for
publicly owned
companies focused onshareholder returns on
investment.

Risk of unfavorable
conditions for lean
operations in social
business models.

Trial Services for In Vitro Diagnostic
Medical Devices for Approval by Thailand’s
Food and Drug Administration
Thailand’s Food and Drug Administration(FDA), which operates under the Ministry of
Public Health, is responsible for regulatingand ensuring the safety, efficacy, and qualityof drugs, medical devices, and related
products in Thailand. The FDA also regulates
labeling and packaging of products to ensurethat they provide accurate and clear
information to consumers about ingredients,
proper usage instructions, warnings, andother relevant information. FDA also
regulates, monitors, and enforces import andexport controls, and continuous compliancewith safety and quality requirements.
As part of the approval process for in vitro
diagnostic (IVD) medical devices – which
includes HIV self-testing – the approval
process is required to evaluate their clinicaland usability performance.

Tips to Consider
There is a range of prices for the provisionof evaluation services to manufacturers
and distributors of products undergoing
the FDA approval process. However, a fee
to volunteers to test a given product is
expected.
Leverage other networks and partnerships
during your negotiation process to offer
competitive time frames to meet therequired number of trials.
Consider how a product’s approval may
be integrated into your business
operations and leverage your socialoriented business model and brandposition.
30

Educational Partnerships
Building partnerships with academic institutions
can be pivotal to ensure access to adolescentsand youth. They can ensure comprehensive
sexual and reproductive health education
campaigns, leverage student apprenticeships,
and integrate sexual health programs tostudent life on campus. Though specificavenues may vary depending on institutional
needs and contexts, these initiatives can help
encourage safe practices, promote open
dialogue about sensitive topics, and increase
rates of HIV and STIs screening, treatment, andprevention uptake. Student apprenticeships
enable budding healthcare professionals while
opening opportunities to reduce operation costsin the delivery of screening and counselingservices. On-campus health programs ensure
accessible testing and prevention services,
creating a supportive environment thatempowers students to make informed decisions
and prioritize their sexual well-being.

High impact in reaching
young populations andraising awareness andeducation among key
populations.

May offer mutually
benefitting arrangements
for research andinnovation. Bridges
access for market
expansion of product andservices to institutionalcustomers that may bewilling to pay forscreening products andcounseling services.

May require highefforts to negotiate
and secure contracts or
support.

Unfavorable responseby groups against
integrating sexual
health education orservices into
educational
experiences andinstitutions.

Tips on Liaising With
Educational Institutions
Emphasize your initiative’s contribution to
student wellbeing and institutional public
position in proactively pursuing inclusive andinnovative approaches for public health.
Leverage your networks with faculty andadministrative staff that can advocate for yourprogram and explore opportunities to support
the delivery of mutually benefiting outcomes tothe institution, such as research-related
opportunities. Additionally, in the event of
discussing apprenticeship opportunities forstudents, make sure to critically consider
mechanisms to offer supervision to students
while safeguarding the quality of services
provided. Consider exploring collaborative
approaches to extend certification and credit tostudent interns or volunteers. Refer to any key
academic ranking benefits that may beleveraged by your collaboration, for example theTimes Higher Education SDG Rankings foruniversities with international students. Also
assess whether universities provide students
with group health insurance and whether
enhanced HIV and STI screening on campus
can be used to reduce the insurance costs forthe university, justifying an investment.

31

Expanding Product andService Offerings
By offering comprehensive testing, digitalcounseling services, and educational resources,
social businesses can tap into a growing demand fordiscrete and convenient solutions. The financial
gains align with the ethical imperative of
safeguarding individual well-being, reinforcing thepotent synergy between profitability and publichealth progress. The commercial distribution of selftesting and related products presents a promisingavenue for social enterprises to generate revenues
to cross-subsidize services for low-income and atrisk groups while significantly bolstering HIV andSTI screening rates. Offering self-testing kits andinnovative solutions through commercial online andlocation-based channels expands reach toindividuals that may otherwise opt out of screeningfor HIV and other STIs. This approach also ensuresindividuals’ privacy, reduces stigma, and contributes
to early detection for treatment and prevention.

May require highefforts and upfront
investments for setup,High revenue marketing, andgeneration potential. operations.

May offer mutually
benefitting opportunities
to leverage additional
partnerships for social
business innovation,market expansion, andservice delivery.

Legal or logisticalprocesses may distract
core social business
operations duringinitial stages.

Whereas screening, counseling services, andprevention products can be a starting point,
enterprises can explore expanding to also include:
Sexual and Reproductive health and related
products;
Merchandise for awareness, entertainment, etc.;
Gender-affirming cosmetic products andservices;
Harm reduction and recreational products; andEducation and training products and services.

Cabbages & Condoms:

Sexual and Reproductive Health Awarenessand Prevention in Thailand
The innovative story behind the food and beveragesocial business “Cabbages and Condoms'' and its
sister venture “Coffee and Condoms” has received
national and international recognition for its
contribution to drastically reducing the number ofchildren per family and new HIV infections inThailand since 1974. With daily revenues thatreach an average of THB 500 000, “Cabbages andCondoms” chain of restaurants in the U.K. andThailand channels funds to the Population andCommunity Development Association (PDA),
founded by Mr. Mechai Viravaidya, which has
worked since 1974 to raise awareness about sexualand reproductive health. Reports by the WorldBank estimate that prevention efforts linked to PDA
activities have saved millions of lives and over USD
18 billion in treatment costs in Thailand.

Cabbages & Condoms store in Bangkok
Image source: FHI 360

The stores are creatively decorated with condomthemed artwork, messages about safe sex, imagesof HIV infections globally, quiz games about sexual
health, and also display a range of condom-themed
and artisanal products for sale. Visitors are seen
taking photos of the space and are given freecondoms with bills instead of mints. Linked to its
success, PDA activities have since expanded to avariety of rural development activities with a social
business lens. The social business called “BREAD”
or Business for Rural Education and Development,
sells a variety of community-produced agriculturaland artisanal products, and conducts knowledge
exchange and training activities including on social
enterprise development. To date, “Cabbages andCondoms” and “Coffee and Condoms” have 16
restaurant locations in Thailand and 2 in the U.K.

32

Conducting Market
Research for Social Business
WHY

Defining and understanding the market of social business product and service offerings
is fundamental to achieving both public health outcomes as well as operational andfinancial sustainability. At various stages of social business model development andimplementation, market research can help decision makers discover, describe, or
determine important information about customers, competitors, or the sexual healthsector at large. Research outcomes can help inform business development strategies for
product and service offerings and pricing, marketing and communications, and otheraspects of business operations.

Market research can help social business decision makers to
WHAT

WHO

DiscoverDefineDetermine

Insights and ideas

Trends,preferences, andothercharacteristics orfunctions

Cause and effectrelationships between
variables in social
business activities

about customers, competitors, or the sector and usually at the

WHEN

Early stages of social
business modeling anddecision making
HOW

Case studies

Qualitative research anddata analysis fromsecondary (external) sources
Surveys and interviews

Midterm and laterstages of decision
makingLater stages ofdecision making

Surveys and Interviews
Quantitative research anddata analysis fromsecondary sources
Focus groups and panels

Experiments and trials
Analysis of primary
qualitative and/or
quantitative data

Observational data
i.e.

33

What kind of new sexualand reproductive healthproducts or services areyouth between 18-24
willing to buy?

What are the mostimportant features fromour product or service to
our institutionalcustomers?

Which advertising
campaign will be mosteffective to recruit people
who use drugs in central
Thailand?

Identifying Beneficiaries
and Customers
An important distinction in social business is that oftentimes,
individuals benefiting from social business activities may bedifferent from those paying for products or services. In thiscase, defining and characterizing who are the paying customersof specific products or services within a social business model is
key to developing distinct marketing strategies that can best
meet the needs of both beneficiaries and customers.

The Five Forces
Affecting a Market

Defining the Market

BuyersB
E

How much purchasing andbargaining power and influence doyour customers have?

EVG

Entrants

1. Earlyvangelists

How difficult is it for new players toenter the market?

Competitors

CHow much competition do you haveand how is the market shared withother product or service providers?

SuppliersS

Who are your suppliers and how
much bargaining power do they
have on your operations?

SOM

SAM

TAM

Who are the most likely customers for yourproducts and services?

2. Serviceable Obtainable Market

How many customers can you reach and servewith your current resources?

3. Serviceable Available Market

How big is the customer base that you could reachnow?

4. Total Available Market

How big is the customer base at large?

Substitutes

S

What is the likelihood of yourcustomers opting for alternative
products or services?

Drafting Market Survey
or Interview Questions
Clear
Are questions easy to understand?

ConciseAre there too many questions?

Communicative
Do questions help inform your decisions?

Interview Approaches
Structured
Open and close ended questions to be read nearverbatim with little to no background knowledge
and training by the interviewer.

Semi-structured
Open and close ended questions or prompts forthe interviewer to facilitate the discussion basedon some previous knowledge and training on thesubject.

Unstructured
Open ended questions to facilitate conversation
with the interviewer, who should haveknowledge and training on the subject at hand.

34

Recommendations
Harnessing the power of social business to end the
HIV/AIDS epidemic and control other infections.
Research andKnowledge
exchange

Business
Development &Investment

Policy andGovernanceConduct analysis of theeconomic case andfinancial savings on public
spending derived fromsocial business initiatives.

Seek technicalassistance todevelop and refine
new social businessmodels.

Develop an enabling
environment to supportand integrate social
business approaches into
policies and action plans.

Conduct market researchon new products andservices.

Mobilize private
finance to deliver
activities undersocial businessmodels.

Streamline procedures forself testing technology
review and approval.

Conduct multi stakeholder
dialogues to build
collaborative action plansamong stakeholder
organzations andincluding community andkey population actors,

Explore and pilot
avenues to leverage
public funds for
additional outcomedriven finance forsocial entrepreneurs.

Conclusion

Conduct training andcapacity development
activities among healthservice providers on social
business approaches.

Social business approaches can offer an alternative to support the financial sustainability of impact
oriented interventions focusing on reaching at-risk, marginalized, and low-income populations todiagnose, treat, and prevent HIV and other sexually transmitted infections. Given the complex nature offacing this challenge, social business approaches should be seen as part of a broader, collective effort toreach the goal of Zero HIV, with special attention on existing gaps and careful consideration to policy
developments to determine whether and how social business models can best add value. With an impact
and people-oriented social mission that values social inclusion and combats discrimination, focusing on
models that deliver public health outcomes is paramount. Given the experimental nature ofentrepreneurship, fostering continuous improvement, knowledge exchange, and a collaborative mindset is
key to ascertain and accelerate the adoption of impactful and scalable models.

35

Stakeholders engaged in thedevelopment of this guideCenter for Disease Control (CDC), Taiwan
Dreamlopments
Empower Foundation
Equal Asia Foundation
Expertise France, L’initiative
Faculty of Associated Medical Sciences, Chiang Mai University
FHI 360, Meeting Targets and Maintaining Epidemic Control (EPiC) Project
Institute for HIV Research and Innovation (IHRI)Love Foundation
M Plus Foundation
Medical Service Division, Department of Corrections, Thailand
Population and Community Development Association (PDA)
Public Health Promotion, Research and Training Foundation
Rainbow Sky Association of Thailand
Raks Thai Foundation
Social Business Academia Network, Kyushu University, Japan
Service Workers In Group (SWING) Foundation
Taiwan AIDS Foundation
Thai Drug Users’ Network
Thailand Ministry of Public Health and U.S. Center for Disease Control Coordinating Unit
World Vision Foundation, Thailand
Yunus Center, Asian Institute of Technology

36

Further Reading
Social Enterprise Readiness Assessment Tool: A self-guided decision-making tool for non-profit leaders exploring ifsocial enterprise is right for their organizations.
Social Enterprise Business Planning Workbook: A simple business planning tool, adapted from the lean canvas
methodology, for nonprofit leaders launching social enterprises to impact the HIV response.

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