"Hein & Fiete" is an HIV prevention project for gay and bisexual men with an information shop in Hamburg's St. Georg district, just five minutes from the main railway station. In addition to HIV, you can also get tested for other sexually transmitted infections (STIs) in the info shop. Christine Höpfner interviewed Kai Ecksteinthe Infoladen coordinator and prevention advisor from Hein & Fiete.
Kai, how long has your trial offer been available and what exactly does it look like?
Hein & Fiete has been offering HIV and STI tests since 2004, together with CASA blanca, a counselling centre of the Hanseatic City of Hamburg in the Altona district. We started with tests for HIV, syphilis and hepatitis A, B and C. Since May 2011, we have also been offering tests for gonorrhoea and chlamydia. Counselling and testing is available every Tuesday and Thursday from 4 to 6 pm. The service is free, anonymous and there is no need to register in advance.
The info shop is at the centre of the scene
As far as HIV is concerned, we offer all test procedures, usually the "Combo-ELISA" as a screening test plus "Immunoblot" as a confirmation test, but optionally also the rapid test and the PCR test for direct virus detection. Here too, the result is available after just two days, so you no longer have to wait a whole week for it, as was previously the case. We use a rapid test, for example, if the test consultation shows that the user was at high risk and is unable to wait two days for the result.
What prompted Hein & Fiete to offer tests? This is actually a task of the public health service ...
What we are talking about here is an offer from CASA blanca, i.e. a public health service - only on the premises of Hein & Fiete. And that has clear advantages: Our project is firmly anchored in the gay scene and can therefore reach men better than a public authority. The Infoladen is located in the centre of Hamburg's gay scene, and we have many gay volunteers who work in the Infoladen and are also out and about in the various scenes with our on-site team. We also reach gay and bisexual men via gay magazines, the internet and social networks such as Facebook. Hein & Fiete is also present everywhere with its own campaigns focussing on the topic of "HIV and STI testing". And then we are also involved in the nationwide DAH campaign I KNOW WHAT I AM DOING and took part in their test weeks.
Nevertheless, you have a co-operation partner...
The prevention counselling is well received
We need this because Hein & Fiete does not have a doctor on staff. Wherever HIV and STI tests are offered, there has to be a doctor on site. The advantage of cooperating with a health authority is that the tests are free of charge for users. In our case, a doctor from CASA blanca is responsible for taking the blood sample and providing medical advice, while I and two other gay colleagues carry out the prevention counselling. The test result is then communicated by the doctor and myself.
Like many other prevention projects, Hein & Fiete also contributed to the DAH standards for HIV and STI tests published in 2011. Has this changed anything for you?
No, because what we have jointly formulated here as a standard is nothing new for Hein & Fiete, as we have always attached great importance to providing a high-quality service. It is particularly important for us to embed the HIV test in a consultation that also includes other STIs and focuses on individual risk and protective behaviour. This "prevention counselling" is well received - some men come to Hein & Fiete for precisely this reason.
How do you go about prevention counselling?
Anyone who would like to take an HIV test with us is first asked to complete a questionnaire as the basis for the subsequent counselling session. The aim here is to work with the user to assess their personal risk and consider together how they can protect themselves. It is also discussed whether other risk minimisation strategies can be considered in addition to the usual protective measures such as condom use. As we neither advise nor discourage testing, it is quite possible that the prospective client will come to the conclusion at the end of the consultation that they will not be tested.
You can also get advice from to the test...
A catch-up meeting can be very helpful
Sure, when the test result is communicated. If the result is negative, we discuss with the person tested what this finding means for them and their future safer sex behaviour. If the diagnosis is "HIV-positive", the person concerned can of course get rid of all their questions first. It is true that the information that a long and relatively healthy life is possible with HIV has largely reached our target group. However, finding out that you are affected yourself still triggers anxiety - hardly anyone can simply shrug it off. For most people, the diagnosis is associated with uncertainty and the anxious question of what will happen now. The "catch-up talk" with the doctor and us counsellors can be very helpful here. At the same time, we offer to refer those affected to facilities such as AIDS-Hilfe Hamburg, the AIDS counselling service or another psychosocial counselling centre. And if they wish, we can also tell them where they can find HIV-focussed doctors.
What about the use of the trial offer at Hein & Fiete?
In 2010, we carried out 1,344 prevention consultations - including counselling on notification of findings - and 638 HIV tests, 30 of which were positive. We also diagnosed eight acute syphilis infections. The number of users has risen even further in the meantime, which is partly due to our advertising and partly due to the expansion of the STI test programme. From May to July 2011, 135 rectal and 160 throat swabs were taken at Hein & Fiete; ten acute gonorrhoea and ten acute chlamydia infections were diagnosed. Overall, we found that the vast majority of men not only want to be tested for HIV, but also for other STIs.
And which men take advantage of the test offer?
Over 90 per cent of all those tested are gay and bisexual men from very different social groups and classes. Our service is obviously also attractive to men who cannot easily come out as gay in their social environment. Our users increasingly include men with a migration background, which applies to around a fifth of them. They mainly come from Arabic and English-speaking countries. Occasionally, tourists also visit, but these are mostly men from the Hamburg area. We don't know exactly where they come from, as we don't ask them.
Are you planning to offer the test directly in the scenes?
Hein & Fiete is itself a trendy meeting place and is so well used that we don't need to be present at other locations. We also test for various STIs, and it's not easy to do this in every neighbourhood. But because STIs are playing an increasingly important role in HIV prevention - some of them increase the risk of transmission and there are special treatment recommendations for HIV-positive people -, we could imagine extending the range of tests to other STIs such as genital warts and then perhaps even offering tests every day.
This video shows what counselling at Hein & Fiete looks like: http://www.youtube.com/user/HeinFieteTV
