Schwappach David L B, Bruggmann Philip
Research Institute for Public Health and Addiction, Zurich, Switzerland.
BMC Public Health. 2008 May 27;8:180. doi: 10.1186/1471-2458-8-180.
As other countries, Switzerland experiences a high or even rising incidence of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM). An outpatient clinic for gay men ("Checkpoint") was opened in 2006 in Zurich (Switzerland) in order to provide sexual health services. The clinic provides counselling, testing, medical treatment and follow-up at one location under an "open-door-policy" and with a high level of personal continuity. We describe first experiences with the new service and report the characteristics of the population that utilized it.
During the 6-month evaluation period, individuals who requested counselling, testing or treatment were asked to participate in a survey at their first visit prior to the consultation. The instrument includes questions regarding personal data, reasons for presenting, sexual behaviour, and risk situations. Number and results of HIV/STI tests and treatments for STI were also recorded.
During the evaluation period, 632 consultations were conducted and 247 patients were seen by the physician. 406 HIV tests were performed (3.4% positive). 402 men completed the entry survey (64% of all consultations). The majority of respondents had 4 and more partners during the last 12 months and engaged in either receptive, insertive or both forms of anal intercourse. More than half of the responders used drugs or alcohol to get to know other men or in conjunction with sexual activity (42% infrequently, 10% frequently and 0.5% used drugs always). The main reasons for requesting testing were a prior risk situation (46.3%), followed by routine screening without a prior risk situation (24.1%) and clarification of HIV/STI status due to a new relationship (29.6%). A fifth of men that consulted the service had no history of prior tests for HIV or other STIs.
Since its first months of activity, the service achieved high levels of recognition, acceptance and demand in the MSM community. Contrary to common concepts of "testing clinics", the Checkpoint service provides post-exposure prophylaxis, HIV and STI treatment, psychological support and counselling and general medical care. It thus follows a holistic approach to health in the MSM community with the particular aim to serve as a "door opener" between the established system of care and those men that have no access to, or for any reason hesitate to utilize traditional health care.
与其他国家一样，瑞士男男性行为者（MSM）中艾滋病毒和性传播感染（STI）的发病率很高甚至呈上升趋势。2006年，瑞士苏黎世开设了一家男同性恋者门诊诊所（“检查站”），以提供性健康服务。该诊所根据“开放政策”，在同一地点提供咨询、检测、医疗和随访服务，且个人连续性程度很高。我们描述了这项新服务的初步经验，并报告了使用该服务人群的特征。
在6个月的评估期内，要求寻求咨询、检测或治疗的个人在首次就诊咨询前参与一项调查。该调查问卷包括有关个人数据、就诊原因、性行为和风险情况的问题。还记录了艾滋病毒/性传播感染检测的次数和结果以及性传播感染的治疗情况。
在评估期内，共进行了632次咨询，医生诊治了247名患者。进行了406次艾滋病毒检测（3.4%呈阳性）。402名男性完成了入院调查（占所有咨询的64%）。大多数受访者在过去12个月中有4个及以上性伴侣，并进行过接受式、插入式或两种形式的肛交。超过一半的受访者使用药物或酒精来结识其他男性或与性活动同时进行（42%偶尔使用，10%经常使用，0.5%总是使用药物）。要求检测的主要原因是之前存在风险情况（46.3%），其次是无风险情况的常规筛查（24.1%）以及因新关系而明确艾滋病毒/性传播感染状况（29.6%）。五分之一咨询该服务的男性没有艾滋病毒或其他性传播感染的既往检测史。
自开展活动的最初几个月以来，该服务在男男性行为者社区获得了高度认可、接受和需求。与“检测诊所”的常见概念相反，“检查站”服务提供暴露后预防、艾滋病毒和性传播感染治疗、心理支持和咨询以及一般医疗护理。因此，它采用整体方法关注男男性行为者社区的健康，特别旨在成为现有护理系统与那些无法获得或因任何原因不愿利用传统医疗保健的男性之间的“开门者”。
