Spain

Spain’s 2008 to 2012 multi-sectoral HIV plan1 puts a strong emphasis on the need for earlier diagnosis (40% of the newly diagnosed have less than 200 CD4 cells/mm3). It suggests that all those involved in HIV in the country need to reconsider the way HIV tests are currently offered in a context of HIV-exceptionalism, but without diminishing individual choice or confidentiality.

It recommends that all people attending health facilities and services which are focussed on populations at higher risk should be offered HIV testing on an opt-out basis.

It also recommends:

  • More training for healthcare staff (especially those in primary care).
  • Awareness campaigns to promote testing to anyone who has taken a sexual risk.
  • More anonymous testing services, outreach programmes, rapid testing and home testing.
  • Greater study of late diagnosis and how to reduce it.

In Spain, HIV testing can be performed confidentially and free of charge in primary care, and this is the most common location, accounting for three of every ten tests performed. Greater numbers test at private laboratories and during hospital visits than at the anonymous HIV/STI centres (only 3% of tests), whose facilities may be little known or perceived to only serve higher-risk groups. Testing is also offered at drug treatment centres, contraception clinics, and health clinics for young people.

Antenatal screening is recommended to all pregnant women. 

A number of outreach programmes, often using rapid tests, are being developed in order to reach groups particularly vulnerable to HIV. Moreover, in two regions, pharmacies are offering rapid tests as pilot projects. Target populations are people who have had unprotected sex with multiple partners and injecting drug users (the pharmacies already have experience with methadone or needle exchange schemes).

Four out of every ten people in the general population have been tested sometime in their lives, but the proportion of men who had never had an HIV test, especially those with risk behaviours or lower levels of education, is considered unacceptably high.2

References

  1. Ministerio de Sanidad y Consumo Plan Multisectorial frente a la infección por VIH y el sida. http://www.msc.es/ciudadanos/enfLesiones/enfTransmisibles/sida/docs/PMS200812.pdf, 2008
  2. de la Fuente L et al. HIV testing uptake and risk behaviours in Spain. J Epidemiol Community Health 63:552-8, 2009
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