In light of the rising number of cases of sexually transmitted infections, particularly among gay men, the establishment of target group-orientated healthcare facilities is increasingly being discussed in Germany. These low-threshold contact points are primarily intended to reach men who, for example, do not want to come out to their GP with their specific sexual problems and questions.
In Switzerland, centres that offer a comprehensive range of treatment, counselling and testing services for gay men are already a reality. Checkpoint Zurich, the first Swiss health centre for homosexual men and sex workers, was opened in 2006. Axel Schock spoke to Andreas Lehner, Deputy Director of Checkpoint Zurich, about the project.
The checkpoint concept seems to have proved its worth. After Zurich and Geneva, Basel, Bern and Lausanne are now to have a health centre of this kind. Who originally came up with the idea or initiated the project?
Andreas Lehner: It all depends on who you ask. If you ask the Federal Office of Public Health, they invented it; if you ask the Zurich AIDS service organisation, they came up with the idea. But the really crucial thing is that this is an initiative by gay men for gay men.
Away from a pure HIV test centre to a gay health centre
So the Federal Office supported the checkpoint idea right from the start?
The epidemiological data has simply shown that gay men are a target group. And if you want to reduce costs in the health sector, especially in the case of HIV, then you have to start with gay men. In addition, as we know from surveys, the general state of health of gay men is also significantly worse than that of the general population.
Having a good idea is one thing, getting it financed is another.
We are funded directly by the Federal Office of Public Health, but also receive money from the city and canton of Zurich, albeit for different tasks.
How broad is your offering?
We now cover a lot of areas. We started with HIV tests, then added counselling and tests for other sexually transmitted infections (STIs). We now also have doctors in the team who can carry out smear tests or blood tests on HIV-positive people, for example. They can also treat a cough if a client doesn't have a GP. A psychologist is a new addition and this year we will be expanding our services again - depending on the needs of the gay community. We are increasingly moving away from being a pure HIV test centre towards becoming a gay health centre.
Do patients actually have to present their insurance card for these general medical services so that they can be billed via the health insurance companies?
You can take advantage of all these treatments anonymously.
Does this mean that the state and municipal organisations are paying for services that should actually be paid for by the health insurance fund?
As we also carry out prevention tasks, we are not able to cover our costs. The Zurich Checkpoint has ten employees, plus doctors and psychologists. All of this can only be financed if there is also funding.
The clients come from all cantons, some have even travelled from Germany
How many clients come to you?
We carry out around 2,000 HIV tests a year and also provide counselling and treatment for a large number of HIV-positive people. Many people also come to us for psychological problems. We have between 20 and 50 clients a day. We will soon be extending our opening hours to five days a week.
You are also open on Sundays until 8 pm.
Sunday opening is primarily intended for PEP (HIV post-exposure prophylaxis), because the potential cases of infection naturally occur more frequently on Fridays and Saturdays.
The checkpoints are first and foremost a project by gays for gays
How often do men contact you about a possible risk of HIV infection?
People are now well informed that there is a PEP. We certainly have two or three cases every week.
What considerations did you make to find the ideal location for the checkpoint? For example, was proximity to the gay scene or discreet access the deciding factor?
I think we have found a clever mix. We are right next to the railway station. Many people travel from other cantons to visit us. Incidentally, there are also a lot of Germans who travel three or four hours by train to come to us for anonymous advice and treatment. Zurich railway station is also very close to the scene, but not in the middle of it.
In Germany, the idea of checkpoints for gay men is still being discussed critically. The debate is primarily about opening up the service to target groups such as migrants or drug users, who may find themselves in a far more difficult situation than gay men with health insurance. Are you aware of similar discussions?
Of course, but in Switzerland we generally have the option of treating "sans-papiers", people without a residence permit, free of charge even without health insurance. However, the checkpoints are primarily a project by gays for gays. To do more than that is beyond our means. It would therefore make more sense if, for example, migrants or organisations close to them took matters into their own hands and set up a specifically tailored project of this kind. That is possible in principle.
How is the checkpoint perceived among gay men? Do people perhaps shy away from going there because they might be seen and thought to be HIV-positive in the scene?
We are not only perceived as an HIV project, but also as a project for gay health. Moreover, it's not just gay men who come to us, but also heterosexual men and women. Anyone who is generally afraid of coming into contact with us doesn't come to us, but goes somewhere else.
Does that mean that if a straight woman comes to you, she won't be turned away and has the same right to treatment?
In principle, yes. However, if we have an overcrowded waiting room, we reserve the right to turn away heterosexuals and ask them to come back at another time.
So people usually come to you without an appointment?
For longer-term medical treatments, patients are now called in by appointment because they don't want to have to wait for their consultation or treatment every time.
In Germany, as in Switzerland, a medical landscape has developed that is specifically aimed at gay patients, including many HIV-focussed practices. Don't they see the checkpoints as strong competition?
That is definitely the case. However, there are also a lot of misconceptions about what we actually do at the checkpoint. The legend that we offer everything for free naturally frightens a general practitioner in Zurich. However, we also have a lot of non-physicians working here; people who come from conceptual prevention or counselling. We also had to make it clear to our GP colleagues: "People come to us who don't want to go to you". We don't really take clients away from them, but this fear is understandable.
For example, if you diagnose a client with gonorrhoea, an organic disease or high blood pressure: Do you also treat these patients or do you refer them to specialists?
That depends. In the case of syphilis, hepatitis C or chlamydia, for example, we can offer treatment ourselves. However, as soon as major apparatus medicine is necessary, we refer patients to specialists in our network.
What does your on-site work look like?
One very important thing for us is "Checkpoint mobil". We go directly into bars, discos and darkrooms and offer HIV and syphilis tests there. In contrast to Germany, this can be done quite cheaply here, as there is no requirement for medical supervision on site for the diagnosis. However, we do not carry out rapid HIV tests. We don't want the situation to arise where we have to say: "You're HIV-positive, but keep dancing for now and come to us for counselling tomorrow." A bar is not an ideal setting for such conversations, and people are not prepared for such test results. That's why they have to pick them up at our checkpoint. Over 90 per cent actually come by. Syphilis test results, on the other hand, they find out immediately on the spot.
We now have a good STI monitoring system. We immediately recognise who has just come from a short trip from Berlin.
How necessary do you think the tests for STIs are?
The networks among gay men are very small, especially in Switzerland. If someone with fresh syphilis enters the scene, it spreads quickly. That's why there are always waves of such cases.
We now have a good monitoring system for STIs. We immediately recognise who has just returned from a short trip from Berlin or London. That's also easy to explain. In Berlin, for example, there are other opportunities and people feel freer to do certain things. This also increases the opportunities to get something. The trend is that chlamydia infections in particular are on the rise. Basically, our experience has shown that the decision to focus more on sexually transmitted infections in our work was the right one.
Internet presence of the Checkpoint Zurich
