teSTI - Feasibility of free HIV and STI testing in the population

Sexual health plays an important role for the population of the city of Zurich. The wide range of education, employment and leisure activities attracts young people, who in general are sexually active. Moreover, Zurich has a long tradition of tolerance towards sexual minorities, especially lesbian-, gay-, bisexual- and transgender (LGBT) community. Thus, the proportion of the population of men having sex with men is substantially larger than the national average. Due to the specific population structure, it is not surprising that a substantial number of the national HIV and STI cases are diagnosed in Zurich. Hence, focusing the resources to combat HIV and STIs on larger cities as Zurich might speed up the elimination of HIV. Encouraging people at risk of having contracted HIV or STIs to regularly get tested is an important part of newer prevention efforts such as HIV pre-exposure prophylaxis (PrEP) or “treatment as prevention”. However, asymptomatic testing is not covered by the basic health insurance in Switzerland and outside of special, time-limited campaigns, there is no free or easily affordable HIV or STI testing available in Zurich. Since the most sexually active population often coincides with the young and thus financially less secure population, the costs of getting HIV and STI testing might be a prohibiting factor for a substantial part of the population who should get tested. The city of Zurich has recognized this dilemma and is offering free HIV and STI testing for its youth and young adults, as well as other people living in Zurich with small incomes (KulturLegi holders) during a pilot phase of three years. Since this is a unique situation, as the effectiveness of introducing free or discounted HIV testing has been shown in resource-limited settings but not in industrialized countries, we are following the pilot project with a study. The objective of this observational mixed-methods study is to evaluate the city of Zurich’s pilot project offering free HIV and STI tests to its youth or people having a low income (measured by eligibility for the KulturLegi). Specifically, this study aims to (i) collect data on the demographic and epidemiological characteristics of individuals benefiting from the project, (ii) assess the feasibility of the free testing intervention, (iii) assess changes in the age distribution of people accessing PrEP, (iv) assess whether the most relevant vulnerable populations are being reached, as well as (v) assess the health status in this specific study population, including general and sexual well-being and mental health.

For more information and to participate please klick here: Gratis HIV und STI Test