01.01.2011 Global strategy for HIV and other sexually transmitted infections
National HIV and STI Programme 2011–2017 (NPHS). The new NPHS will continue the work undertaken to date and take account of the latest findings: for the first time ever, sexually transmitted infections (STIs) have been integrated into a programme for combating HIV. The strategy is to concentrate on particularly at-risk target groups and on people with HIV and their partners. The main goal is to significantly reduce the number of new infections with HIV and other STIs and to avoid long-term effects that are harmful to health.
STIs have been integrated into the HIV strategy for several reasons. On the one hand, a number of different kinds of infection have increased in Switzerland, resulting in prevalence rates above the average for Western Europe. On the other hand, there is a marked connection between HIV and other STIs: an STI can increase the infectiousness of people with HIV and impair the efficacy of HIV treatment. In addition, STI prevention can be easily integrated into existing HIV prevention structures as the messages are largely identical. Besides, with this holistic strategy Switzerland is following a European trend. The UK, France, Sweden and Norway have already developed strategies that combine efforts to combat both HIV and STIs.
The familiar rules on safer sex still apply:
1. Always use a condom (or a Femidom) in penetrative sex.
2. No semen in the mouth, don’t swallow semen. No menstrual blood in the mouth, don’t swallow menstrual blood.
The integration of STIs in the strategy has resulted in a new rule:
3. In the event of genital itching, secretion or pain, consult a doctor at once.
More prevention funding for at-risk groups
Implementation of this strategy will cost the Federal Government about nine million francs a year – as much as the previous programme. However, there will be a shift in the distribution of the prevention funds to favour target groups that are particularly affected by HIV and STIs. These are men who have sex with men (MSM), migrants from high-prevalence countries, injecting drug users, sex workers and prison populations. There will continue to be basic provision for the population as a whole. For instance, the «LOVE LIFE» campaign will be adapted and continued, as will the «Check Your Love Life» tool. The shift in the distribution of funding is in line with international experts’ recommendation that efforts in areas with a high prevalence of both HIV and other STIs should be stepped up. But other criteria are also to be taken into account: for instance, over 98% of MSM and over 80% of heterosexuals become infected in urban areas.
Informing partners should be a matter of course Another important target group comprises people with HIV or another STI and their partners. People with HIV receive medical support from the time of diagnosis, and the course of the HIV infection is assessed at regular intervals. Thanks to these checks-ups, the doctor can identify the right time for starting treatment. But regular contact with the healthcare system is also important for prevention: people with HIV become sensitised to the risk of passing on the virus. Wherever possible, they receive counselling together with their partners. Consequently, an important goal in the next few years will be to achieve a cultural shift towards voluntarily informing partners. People diagnosed with an infection are to be encouraged to inform their regular and/or casual partners of a positive test result. The partners will then quickly be able to seek counselling, take a test and, if necessary, receive treatment. Voluntarily informing partners is a key prevention element for interrupting the chain of infection. And those affected will not be abandoned to their own devices but will be supported by the medical and counselling system. New methods and communication tools will be tested and deployed for this purpose.
Implementation along three axes of intervention
For the first time, a model with three axes of intervention is being used for structuring and implementing goals and measures. This approach is based on considerations concerning the prevalence of infections and the threat to the at-risk groups. Intervention axis 1 focusing on the «General population» target group is a cornerstone of prevention. Intervention axis 2 is geared to people who engage in high-risk behaviour in an environment characterised by high rates of infection. Intervention axis 3 targets people with HIV or another STI, and their partners. The axis model is designed to be cumulative, i.e. measures from axis 1 also reach the target groups of axis 2 or 3.
Continuing validity of learning strategy
Like the preceding programmes, the NPHS pursues a learning strategy: HIV and STI prevention is based on cooperation with the people affected. Prevention – particularly in such a sensitive area as sexuality – can be successful only if there is a relationship of trust between the state, the service providers, those infected and the groups and individuals at risk. The application of epidemic law-enforcement measures would jeopardise this trust and could result in people concealing their infection or trying to avoid the corresponding tests.
Broadly based strategy
Under the Swiss Law on Epidemics, the Federal Government is obliged to issue regulations for combating transmissible or life-threatening diseases. The NPHS now represents a binding strategy for this purpose. All relevant players have been involved in drawing it up: the Federal Government, cantons, municipalities, NGOs and organisations of people with HIV. The individual players will now decide how the specific measures are to be implemented in their areas of interest and the available resources deployed. The Federal Government has been tasked with coordinating the measures.
Roger Staub, Prevention and Promotion Section, firstname.lastname@example.org