Problem: Rising prevalence of HIV among MSM population in Lisbon; limited HIV/AIDS health promotion targeted to the MSM community; low rates of care-seeking behaviour by the MSM population linked to care access barriers.
Solution highlights: A community centre was opened in Lisbon to provide free, anonymous and peer-delivered HIV testing and prevention services targeted to the MSM community; generating political buy-in took considerable time and was described as a “long and persuasive process” with a need to “repeat the message endless times”; strong grassroots advocacy and persistent lobbying efforts by a patient organization were essential for securing funding; incorporating the target population in the provision of services helped ensure wider community engagement and trust; absence of a formal legislative framework and financial incentives required partnerships with self-motivated health professionals to be sought out.
Description of practice
Men who have sex with men (MSM) are an at-risk group for HIV/AIDS in Portugal. In 2005, prevalence of HIV/AIDS was estimated to be 10% among MSM in Portugal, compared to a population average of 0.6%. Furthermore, the incidence rate of HIV/AIDS doubled over the last decade in the MSM population. In Lisbon, new diagnoses of HIV within the MSM population showed a 6% annual increase between 2005 and 2011. Limited health promotion services targeted to the MSM community contributed to observed trends and the MSM population was described as exhibiting low rates of care-seeking behaviour and poor treatment compliance, likely linked to barriers faced in accessing care, such as stigma and confidentiality concerns.
Discussions among members of Grupo de Ativistas em Tratamentos (GAT), an NGO working on HIV/AIDS-related issues, led to the idea to establish a community centre in Lisbon to provide free, anonymous and peer-delivered HIV testing and prevention services targeted to the MSM community. After extensive government advocacy efforts, funding for the initiative was eventually approved by the Ministry of Health. The centre, known as CheckpointLX, opened in 2011 in a well-known gay district. A team of eight trained peers deliver HIV rapid testing and prevention services to the MSM community at CheckpointLX, supported and supervised by health professionals. If a patient tests HIV-positive, a referral protocol between CheckpointLX and local hospitals guarantees patients an appointment to receive treatment within two weeks of diagnosis. As laws require HIV/AIDS treatment be delivered in hospitals, but hospital providers had no incentive to participate and did not understand the importance of accepting patients referred from a community initiative rather than a general practitioner, CheckpointLX’s leadership had to seek out motivated hospital providers who would take referrals to secure follow-up care for CheckpointLX patients. Peers from CheckpointLX offer to accompany patients to hospital appointments, helping to increase continuity of care. While austerity measures temporarily halted CheckpointLX funding in 2013, advocacy efforts were successful in restoring funding in 2014 and CheckpointLX continues to deliver services today.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
The initial momentum for CheckpointLX was led by grassroots community advocates within GAT. Already closely connected to the HIV/AIDS community, GAT members were aware of the growing issues within the MSM population and felt it was important to expand their work to fill observed gaps in HIV/AIDS care. A motivated group of individuals within GAT led the design and implementation of the initiative, supported more generally by the organization for advocacy and outreach efforts. Successful implementation of the initiative rests on the motivation of GAT members, CheckpointLX staff and community volunteers. GAT oversees the running of CheckpointLX with direct support from the MSM community. The high level of peer engagement helps involve and gain buy-in from the MSM community and support from health professionals, from both the centre and local hospitals, is critical for ensuring effective care delivery.
CheckpointLX has provided the MSM community in Lisbon with a confidential service they can trust. Over 5000 HIV tests were performed between 2011 and 2014 and, as a result of the initiative, the MSM community reports better access to HIV/AIDS-related services. University researchers are currently following a cohort of CheckpointLX patients and will analyse information collected through a standardized patient questionnaire to give greater insight into the initiative’s impact.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Maria José Campos
- Civil society representative