01.05.2012 HIV and STIs are unevenly distributed – priorities need to be set
The National Programme on HIV and Other Sexually Transmitted Infections 2011–2017. For the first time, the National Programme is focusing on the prevention not only of new HIV infections but, explicitly, of other sexually transmitted infections (STIs) as well.
On 1 December 2010, World AIDS Day, Swiss government minister Didier Burkhalter introduced the National Programme on HIV and Other Sexually Transmitted Infections 2011–2017 (NPHS) to the public. STIs such as syphilis, gonorrhoea or chlamydia are on the increase and are regarded as a motor of the HIV epidemic: infection with an STI increases the likelihood of contracting HIV and raises the infectiousness of an HIV carrier.
Uneven distribution of the infectious agents in the population – prioritisation will help
In the run-up to the development of the NPHS programme, international experts (Rosenbrock et al. 2009) had been mandated by the Federal Office of Public Health (FOPH) to analyse the Swiss approach to HIV prevention and draw up recommendations. One key recommendation was to increase efforts wherever there is a high incidence of the virus or a higher incidence than elsewhere (“put the effort where the virus is”). This recommendation requires the setting of priorities on various levels.
Prioritisation 1: target groups
Men who have sex with men are particularly at risk
Target groups have been allocated to different intervention axes, depending on the extent to which they are at risk of becoming infected with HIV or another STI. The target group of axis 1 is the general population. In this group, successful prevention efforts had stopped an HIV epidemic from occurring. To maintain this situation, the LOVE LIFE campaign is being continued – it reaches all sexually active people in Switzerland and is the cornerstone of prevention efforts.
Intervention axis 2 targets groups particularly affected by, or at risk of, infection with HIV or another STI: men who have sex with men (MSM), male and female sex workers, migrants from countries with an epidemic in the general population (e.g. in sub-Saharan Africa) and injecting drug users (IDUs). Male inmates of prisons are also at greater risk of contracting HIV or another STI than other men Intervention axis 3 addresses people with HIV or an STI, and their partners. The aim is to ensure that HIV and STIs are identified and properly treated as early as possible. The FOPH therefore promotes voluntary partner information.
Prioritisation 2: cantons
Zurich and Geneva are the cantons worst affected by HIV
For prioritisation to work, it is essential to take into account the areas in which infections occur. Over 98% of MSM and over 80% of heterosexuals who contract an HIV infection do so in cities. The worst affected cantons are Zurich, Geneva, Vaud, Basel-Stadt and Berne. It makes sense to focus financial resources primarily on the cantons in which HIV infections actually occur and where they can be successfully prevented.
A third of all HIV infections diagnosed in Switzerland occur in the canton of Zurich, with unprotected sex between men accounting for about 70% of them. The reason for this is simple: Zurich has a lively and active gay scene and functions as a centre for the surrounding cantons and neighbouring countries. Prevention of HIV and other STIs is therefore important not only for the city itself but also for the German-speaking part of Switzerland as a whole.
Geneva, on the other hand, is home to large numbers of migrants from countries in which the general population is affected by an HIV epidemic, and it therefore reports a correspondingly large number of diagnoses in this particular population group. Many cantons have, with support from the FOPH, commissioned an external evaluation of their healthcare systems to enable them to address the specific challenges facing them even more effectively and to deploy financial resources selectively.
“Break the Chain” project
When someone has been newly infected with HIV, their viral load increases rapidly in the first few weeks and they become 20–100 times more at risk of passing on the infection than in the later course of the disease – usually without being aware of it. About half of the gay men diagnosed with a new HIV infection have contracted the virus from a man who was currently in this primary infection phase. To interrupt such chains of transmission, the “Break the Chain” project proposes that as many MSM as possible should avoid infection risks for one month (April) and then have themselves tested along with partners with whom they do not want to practice safer sex. This would break the chains of transmission and, with no new infections occurring in April, would reduce the viral load in the community as a whole. This in turn would somewhat reduce the risk of being infected with HIV during individual episodes of unprotected sex.
The NPHS lays down the key focuses of the various players involved
The NPHS was drawn up in a participative process and is today accepted as the basis for the activities of the organisations working in the field of HIV and STI prevention. The SGS (SEXUAL HEALTH Switzerland) and the AHS (Swiss AIDS Federation) are important partners of the FOPH in the realisation of the LOVE LIFE campaign. The efforts of the SGS, the umbrella organisation of advice centres for family planning, pregnancy, sexuality and sexual health education, are focused on the general population as well as on the campaign. It is therefore essential for the work of the SGS that the promotion of sexual rights, and efforts to achieve sexual health as defined by the WHO, are enshrined in the NPHS. The SGS attaches particular importance to the extension of the NPHS to other sexually transmitted infections. Using the NPHS as the basis, the AHS is concentrating its work even more intensively on prevention activities aimed at the target groups particularly at risk, i.e. MSM, migrants and sex workers, and on combating discrimination of people with HIV.
Mini-series The National Prevention Programmes
What’s happening in tobacco, alcohol, drug and HIV/STI prevention, what’s new in nutrition and physical activity?
spectra has been highlighting the achievements in the major national prevention programmes organised by the Federal Office of Public Health:
spectra 88 – September 2011
National Tobacco Programme, 2008–2012
spectra 89 – November 2011
National Programme on Diet and Physical Activity, 2008–2012
spectra 90 – January 2012
National Alcohol Programme, 2008–2012
spectra 91 – March 2012
Third package of drug-related measures, 2007–2011
spectra 92 – May 2012
National HIV and STI Programme, 2011–2017
Roger Staub, head of Prevention and Promotion Section, firstname.lastname@example.org