SUMMARY BRIEF

SOCIAL
BUSINESSGUIDE

Screening &Counseling for HIV
and Other SexuallyTransmitted Infections

Social Business Guide: Screening and Counselingfor HIV and Other Sexually Transmitted Infections.
2023
The development of this guide was completed by theYunus Foundation in Thailand (Yunus Thailand) incollaboration with the AMS-PHPT Research
Collaboration, Faculty of Associated MedicalSciences, Chiang Mai University. The researchleading to this guide was conducted in consultation
with stakeholder organizations and innovators inThailand. 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.

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 thespread 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.* Thisprogram 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 theHIV/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. Thereare 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.

Abbreviations
AFD
AIDSAMSART
CBO
CD4CDCCT
EpiC
FDA
HBVHCVHIV
HIVST
HPV
KPL
NG
NHSO
MoPH
MoPH-TUC
MSM
PDA
PLHIV
PrEP
PWID
RRTTR
STISW
SWING
SY
TB
TG
U=U
UNAIDS
USAID

03

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
Service Workers In Group Foundation
Syphilis
Tuberculosis
Trans Gender
Undetectable = Untransmittable
Joint United Nations Programme on HIV/AIDS
United States Agency for International Development

SUMMARY
BRIEF

Public (Domestic)

Nearly a quarter of new HIV infections in the world
occur in Asia and the Pacific (UNAIDS Global AIDS
Update 2023), a region with the second-highest
number of people living with HIV. Other infections
are of concern in the region, several of them thatcan be sexually transmitted (STIs), including
syphilis, hepatitis B virus (HBV), hepatitis C virus(HCV), Chlamydia trachomatis (CT), Neisseria
gonorrhoeae (NG), Mpox, Human Papillomavirus(HPV), and tuberculosis (TB). At-risk, marginalized,and groups at the bottom of the socioeconomic
pyramid face a range of challenges to access HIV
and other sexual and reproductive health-related
services, in part due to stigma and discrimination.
The prevalence of HIV among at-risk populations
globally ranges from four to fourteen times higher
than other sexually active groups based on 2022
estimates. With the aim of ending the AIDS
epidemic by 2030, a global effort with screening
and testing as a core component aims to reach 9595-95 targets by diagnosing at least 95% ofpeople living with HIV, provide timely treatment topositive cases, link at-risk individuals toprevention, and suppress HIV viral loads toundetectable levels. Counseling services are also
key in order to provide education and awareness,technical guidance, and mental health support.
However, from an estimated 6500 new HIV
infections in 2021, almost half were among youth

USD 286M(2021)
International

Private (domestic) financefor HIV/AIDS in Thailand
represents less than 1% of total available
finance. Globally, available financing falls
short of resource need estimates byUNAIDS.
Data: UNAIDS (2022) Global AIDSMonitoring GARPR Reports.

under 24 years old and most of all new cases
among people in key at-risk population, according
to a UNAIDS report (2022). At the time of writing
this report, Thailand has made significant
advancements in diagnosing approximately 90% ofPLHIV. A combination of public health initiatives
from government, community and key-population
led organizations, and private clinics providing
screening and testing for HIV and other STIs has
been at the forefront of Thailand’s success indiagnosing. Analysis by the Institute for HIV
Research and Innovation (IHRI) reports that over athird of HIV preventative treatment in Thailand in2022 was provided via key population-led
initiatives.
Undetectable

RREACHRRECRUITTTESTSELF TESTING AND
SAMPLING

UntransmittableThailand’s MinisterialRegulation No. 1/2015 on+Treatment
HIV self tests (HIVST) wasTRE
approved to promote
AT
Prevention
people knowing their HIV
status by increasing accessto HIVST. Self-samplingproducts for STIs include
95% of PLHIV are diagnosed
and know their status.
HPV, NG, and CT which
95% of diagnosed PLHIV receive are widely accepted andantiretroviral treatment (ART).
deemed as safe and withofPLHIV
onhigh relative accuracy. Self95%
ART suppress
testing and sampling fortheir viral load
HIV and other STIs
to undetectablelevels.
provides an opportunity toincrease the coverage andfrequency of testing forearly detection.

TRER
TAIN04

“Social business is a bet infavor of life instead of profit” Prof. Muhammad Yunus
Identifying and implementing innovative approaches to finance and scale the provision of HIV and STIs
testing, treatment and prevention, and counseling services to at-risk and marginalized populations isneeded in the race to end AIDS by 2030. This guide aims to contextualize and present practicalinnovations and opportunities from a people-centered and social business perspective, which strive tofollow the principles of models with no financial losses to ensure financial independence andsustainability, and no financial dividends to finance the expansion and scaling of activities for longterm impact. Whereas this guide focuses on the context of Thailand, it may also inform others andrequires critical and careful consideration of local conditions.
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 EVPASOCIAL BUSINESS
Beyond the binaryof financing andoperatinginterventions for
HIV and other STIs
0% DIVIDENDS

to invest in expanding
activities and scaling
impact100% SOCIALMISSION DRIVEN

as the primaryobjective of operating

Five Aspects of People-Centered Service
Delivery of Screening and Counseling
ACCESSIBLE

AGILE

Availability to all regardless Speed and ability to respondof risk behavior, sexual
to sensitive or unexpectedorientation, gender identity circumstances.
and expression, language orlegal barriers, operatingschedules, nationality,
disabilities, religious
affiliation, etc.

AFFORDABLE
Meeting thepurchasing power ofusers and customers.

ADAPTABLE
Meet needs and preferencesof beneficiaries, partners,
and existing conditions on
the ground.

ANONYMOUS

0% LOSSES
to achieve financial
independence andsustainability

05

Respecting and ensuring theprivacy of individuals unwillingto disclose personal information
during screening andcounseling events.

16

Addressing the needs of at-risk and marginalized
populations
This guide was drafted following a consultative process with community based organizations (CBOs)
delivering HIV and other STI related health services in Thailand. There is extensive evidence on thebenefits of CBOs to reach and recruit at-risk individuals. Some of these point to higher rates of early
diagnosis of new infections.

Sexual and Reproductive HealthServices for Women and GirlsEngaging and Educating
Adolescents & Youth
Despite longer risks of infection, awareness andknowledge levels among youth are a function ofvaried access to sexual health education. Many
youth turn to peers and digital sources for
information and counseling.

47%of new HIV infections in Thailand in 2022
were in people under 24 years old.

Eliminating Stigma andDiscrimination Against Sex Workers
Stigma, legal barriers, and marginalization of thesex industry often hinder sex worker access toadequate 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.

Mainstreaming Sexual Health Among
Men
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 sexworkers (MSW). More recently, the prevalence ofHepatitis C has been observed to increase,especially among MSM groups and particularly
those infected with syphilis, engaging in chemsex,
having multiple sex partners, and prisoners.

Ensuring Friendly and Judgment
Free Services for People Who Use
Drugs
People who inject drugs (PWID) are at high risk of
HIV and Hepatitis C and yet some reportexperiencing discrimination including healthworkers denying access to health care facilities
and services. Other forms of risk behavior while
under the influence of drug and substance abuse,also referred to as chemsex, increase risk oftransmission. Location-based test services areoften preferred by PWID given the direct
availability of counseling, care, and treatment.
According to estimates by UNAIDS, there areapproximately 57 600 adults who inject drugs inThailand.

Whereas this guide focuses less on mother-tochild HIV and STI transmissions, it is important tonote ongoing efforts to enhance access to sexualand reproductive health services and education toreduce teen pregnancies in Thailand and ensure
safe and accessible support for family planning
among women and girls while also engaging menand boys.

Enabling Access to Health Services
for Migrants
Whereas HIV infection rates may be relatively lowoverall, Hepatitis B, Hepatitis C and Tuberculosis
have high prevalence among economic migrants inThailand, particularly from Myanmar, Cambodia,
and Lao PDR. Many of these migrants areundocumented, do not speak the local language,
and are not aware of existing support mechanisms
for health.

Transforming Health Services forTransgender Inclusion
Transgender women and men in Thailand report arange of issues linked to stigma and discrimination.
These affect their experience in accessing andnavigating healthcare, including for sexual health,gender-affirming care, and counseling. The transoriented Tangerine Clinic in Bangkok reports thatapproximately 15% of visitors are unemployed anda third show symptoms of depression. Beyond
external access barriers, internal factors affecting
the health and wellbeing of trans individuals
include internalized stigma, low levels ofawareness, and misconceptions drug interactions.

Unlocking Regular Screening andCounseling for Prisoners
In Thailand, inmate volunteer health workers help
disseminate knowledge and advice to fellowinmates.

Diagnosed Infections Among Inmates in Thai
Correctional Facilities (May 2023; n=268,621)
5342

HIV/AIDS
Tuberculosis

1668

Hepatitis C

1489
1131

Syphilis
Influenza

323

MaleFemale

Data Source: Department of Corrections

1106

Innovation Opportunities
for Social business
Adapted from the twelve principles for bottom of
the pyramid (BoP) innovation by C. K. Prahalad.

Price and Value

Delivering quality solutions while
minimizing the price of products andservices.

Scalable Solutions

Designing solutions and offerings tofacilitate scaling up.

Redesign for Functionality
Redesigning the functions of existing
solutions to work better for users.

Task Shifting

Designing staff roles for optimization
including by reducing skill
requirements.

Difficulty Proofing
Delivering products and services inplaces with difficult conditions andlimited infrastructure.

Distribution and Reach

Educate Consumers
Raising awareness and knowledge tostimulate demand among key
populations.

Simple Interface

How can the customer experience beintuitive and easy to use? This may beonline and offline.

Challenge Assumptions
Inverting existing beliefs in yourorganization and the sector to innovate
value.

Balancing Cash Inflows andOutflows

When designing social business models andconsidering different options for financial
sustainability, it is imperative to estimate required
expenses and consider these in relation to the time
when revenues will be received. Establishing amonthly operating cost profile for location-based
screening and counseling can also help identify
opportunities to design lean operations. Below are
five questions to consider.

Distributing products and services,
including for both rural and urban
markets.

Capital Expenses (CAPEX)Technology Innovation

Operational Expenses (OPEX)

Integrating features from existing andemerging technologies into solutions.

Resource Efficiency
Avoiding wasting resources into theproduction and delivery of products,services, and operations.

Streamline
Operations

How much money is needed at first to establish
what I want to do?
How much money is needed to cover the costs ofdoing what I want to do?

Cash Inflows

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

Break Even Point

Streamlining processes, logistics,
manufacturing, sourcing, and otheraspects of product and service
delivery.

Collaboration and Centralization
to Reach a Scale of Economy

When do I expect to make enough money to cover
my operational expenses and, if needed, recover
the capital expenses?

Investment AmountHow much money do I need until I can be selfsufficient?

Collaborative approaches can catalyze the scaling of impact-driven operations to reach economies of scale
via a sharing economy approach. Task-shifting and centralizing certain roles and functions can amplify thebenefits of collaboration by eliminating cost-inefficiencies and leveraging existing resources.

07

Informationand data

Technology,
equipment, andproceduresGroupProcurement
and logistics

Facilities andinfrastructure

Risk mitigation
strategies andexpenses

Knowledge
and expertise

Finance andexpenses

Leveraging Partnerships and Other Support toScale Social Business Approaches
Public Partnerships

Public entities may provide financial and non-financial support forsocial business innovation and operations. In some cases, publicprivate partnership (PPP) models can facilitate collaboration,
private investment, and risk-sharing. In others, integrating
approaches with public programs can provide social businesses
with competitive advantages to manage interventions efficiently.

Private Partnerships

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 other cases, leveraging
corporate social responsibility finance to bridge investment needs,
purchase of equipment, and optimize operations can deliver mutual
benefits. In-kind contributions of equipment, access to facilities,
marketing and communication support, digital support, or favorable
rates for products and services can contribute to lean operationexpenses.

Educational Partnerships

Building partnerships with academic institutions can be pivotal toensure access to adolescents and youth. They can ensurecomprehensive sexual and reproductive health education
campaigns, leverage student apprenticeships, and integrate sexual
health programs to student 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, and prevention uptake.

Sample Financial
Support Opportunities
Thailand’s National Health andSecurity Office (NHSO)
Medical Reimbursements
Trial Services for In Vitro
Diagnostic Medical Devices forApproval by Thailand’s Foodand Drug Administration

Sample Non-financial
Support Opportunities
Business Support
Incubators, accelerators, andother forms of businessdevelopment guidance.

Pro-Bono or
Discounted Services

Marketing, accounting, andlegal 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.

Recommendations to harness social business contributionsto end the HIV/AIDS epidemic and control other STIs.
Research andKnowledge exchange
Conduct analysis of theeconomic case and financial
savings on public spending
derived from social businessinitiatives.

Business Development& Investment
Seek technical assistanceto develop and refine newsocial business models.

Policy and Governance
Develop an enabling
environment to support andintegrate social businessapproaches into policies
and action plans.

Conduct market research on
new products and services.

Mobilize private finance todeliver activities undersocial business models.

Streamline procedures forself testing technologyreview and approval.

Conduct multi stakeholder
dialogues to build
collaborative action plansamong stakeholder
organizations and including
community and key
population actors.

Explore and pilot avenues
to leverage public funds for
additional outcome-driven
finance for social
entrepreneurs.

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

08