bcn c heckpoint H I V-A I D S ▪ S T I ▪ S E X U A L I T Y ▪ M E N ▪ H E A L T H

1. 1 bcncheckpoint H I V-A I D S ▪ S T I▪S E X U A L I T Y▪M E N▪H E A L T H How a Community-Based Testing Center for MSM helps detection of HIV recent infections Ferran Pujol Projectedels NOMS-Hispanosida Creative strategies for provision of and increasing access to services for PLHIV XIX International AIDS Conference Washington DC, 25th July 2012

2. 2 Kevin De CockCDC Kenya, Nairobi. CROI 2010

3. 3 Impact of HIV in MSM • The HIV epidemic is not homogeneously distributed among society • MSM living in low- to middle-income countries have a greater risk of HIV infection than the general population of these countries • MSM were found to have a 19.3-times greater chance of being infected with HIV than the general population • In some countries MSM have A 100-times greater chance of being infected (Republic of Georgia: 24-times greater chance; Republic of Senegal: 27-times; China: 45-times; México: 109-times more chance) Stefan Baral et al. Elevated Risk for HIV Infection among Men Who Have Sex with Men in Low- and Middle-Income Countries 2000–2006: A Systematic Review PLoS Medicine, Vol. 4, No. 12. (1 December 2007), e339.

4. 4 Disproportionately high incidence of HIV in MSM in Western Europe Le Vu S., et al. Population-based HIV Incidence in France, 2003 to 2008. Lancet Infect Dis. 2010 Oct; 10 (10): 682-7. Epub 2010 Sep9

5. 5 Does the incidence depend on individual behavior? • No, it also depends on the Community Viral Load (CVL) • Within this context, even modest levels of sexual risk- taking can result in very high transmission rates • It is the context that matters, not just the individual risk-taking behavior “HIV is increasing among MSM not because of greater risk-taking behavior, but simply because HIV is so prevalent among their sex partners that even one or two slip-ups can have devastating consequences.” Susan Buchbinder FDA AdvisoryCommittee forPrEPapproval 10th May 2012

6. 6 The EU Fundamental Rights Agency (FRA) In the health-care area, many LGBT people fear stigma and prejudice from health-care providers The EU Fundamental Rights Agency (FRA). “Homophobia and DiscriminationonGrounds of Sexual Orientation and GenderIdentity in the EU” The Social Situation”, April 1. 2009

7. 7 HOMOPHOBIA and HOMONEGATIVITY The main barriers to HIV prevention among MSM!

8. 8 Background • Hispanosida established in 2004 the 20th of Octoberas the National HIV Testing Day in Spain • BCN Checkpoint was created in 2006 by Hispanosida • BCN Checkpoint introduced the use of HIV rapid tests in non-clinical settings for the first time in Spain

9. 9 Why a Community Based Centre of HIV detection for MSM? • Significant MSM community in Barcelona • High HIV prevalence and incidence in MSM • Key population at risk (Prevalence > 5%) • High Community Viral Load • Group of population traditionally oppressed and marginalized • Denial of sex education and lack of adequate health care • Early detection of HIV (individual and collective impact) • Peer counseling for MSM for an effective risk reduction

10. Impact of rapid HIV tests in Catalan NGO’s 10 Source: CEEISCAT. Departament de Salut – Generalitat de Catalunya

11. Legal issues 11 Problems for HTC in a non-clinical setting: “Only Healthcare Professionals can perform diagnostic tests” • Screening versus Diagnostics • Informed consent (Community Educator, confirmatory test) • Specific training for HTC Community Educators

12. 12 Best Practices “The ultimate goal is not simply to increase access to and uptake of HTC, but to support HIV prevention and provide treatment (including ART), care and support to all who need it.” Scaling up HIV testing and counseling in the WHO European Region (Published: 5th May 2010)

13. 13 Services provided at BCN Checkpoint • Rapid and conventional HIV test • Rapid and conventional Syphilis test • Hepatitis A and B vaccination • Complete STIs screening for MSM within a study (syphilis, chlamydia, gonorrhea, HAV, HBV, HCV, HPV, anal cytology) • Information about other STIs • Information about PEP • Referral to Public Health Centres (HIV hospital units or STIs Clinics)

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15. 15 Characteristics and Methodology (1) • Service is free, anonymous and confidential • Situated in the middle of Barcelona’s gay area • Peer counselors: all are gay and some are HIV+ • VTC takes up around 1 hour in first visits and half an hour in follow-ups: clients are able to talk openly about their sexuality, risk perception and sexual safety without fearing prejudices • Determine TM HIV-1/2 and Determine TM Syphilis TP • Specific outreach to our community through campaigns and presence of our volunteers in clubs, discos, other gay venues and public events

16. 16 BCN Checkpoint Volunteers

17. 17 Characteristics and Methodology (2) HIV Negative: • Counseling for risk perception and reduction • Education to avoid discriminatory attitudes towards HIV positive men within the MSM community • Invitation to repeat the test at least every 12 months (and whenever necessary) HIV Positive: • Western Blot test (confirmatory) • Immediate emotional support • Linkage to care

18. 18 Characteristics and Methodology (3) Linkage to care: • Medical appointment in an HIV unit • Health Card to be able to access the Public Health System • Legal support for obtaining residence in Spain • Post-test peer counseling for further emotional support and treatment issues

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20. 20 Specific campaigns towards youth and non-nationals

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22. 22 Campaigns for events

23. 23 Results * False positives excluded

24. Impact of BCN Checkpoint 24 Proportion of HIV Cases reported in MSM in Catalonia 325 317 295 272 38,77% 41,54% 24,41% 11,67% * www.ceescat.org - June 30th 2011

25. 25 Results – Early HIV detection * Cases with negative test within the last 1,5 year

26. 26 Linkage to Care (2009-2011) 375 persons HIV reactive tests 4 false positives 10 previously HIV positive 361 persons HIV reactive tests 333 persons linkedtocare 28 persons non-linked 92,24% 9 persons lost 12 personsreturnedto country of origin 7 persons self-linkedtocare 2,50% 3,32% 1,94%

27. 27 Community Research First and only HIV negative MSM cohort in Spain

28. 28 Summary (1) • BCN Checkpoint shows high efficiency in HIV detection: • Small number of tests achieve a high positivity rate • Increase in the absolute number of HIV cases over the years • Significant proportion of HIV cases in BCN Checkpoint regarding reported cases among MSM in Catalonia • The intervention model of BCN Checkpoint helps very significantly in the early diagnosis of HIV among MSM and contributes to the prevention of new infections • The experience of BCN Checkpoint can be useful not just for MSM but also for other hard to reach key populations

29. 29 Summary (2) • Quality of the service and the development of Best Practices are very important • A community HTC approach for the key populations gives better results and is more cost/effective than an approach to the general public • Health Authorities should provide adequate funding for CBC, and communities should get involved actively in its development • HIV Testing & Counseling in CBC should be part of national prevention policies

30. 30 Acknowledgements Michael Meulbroek Eduardo Ditzel Jorge Saz Héctor Taboada Félix Pérez Gerard Font Alberto Pérez Antonio Carrillo MassimilianoIngrami PepColl www.bcncheckpoint.com