Dear Manuela, thank you very much for taking the time for this interview. To start with: what are SwissPrEPared and TravelPrEPared, briefly explained?

SwissPrEPared is a program with an integrated study developed within our department (Department Public & Global Health at University of Zurich). Its aim is to improve medical care for people using or interested in PrEP, most of whom are men who have sex with men (MSM), as well as trans people.

TravelPrEPared builds on the experience gained through SwissPrEPared and is a program for integrated sexual health counseling in travel consultations. The focus is on the prevention of HIV and other sexually transmitted infections (STIs), and it also includes specific counseling on HIV pre-exposure prophylaxis (PrEP) for travelers. In addition, a training program for travel medicine professionals is being developed to strengthen the competent discussion of sexual risks and HIV in consultations.

Why was TravelPrEPared established at ZRM?

MSM account for around half of new HIV infections in Switzerland. TravelPrEPared aims to address the other half of the population. Since a relevant proportion of HIV infections are associated with travel, sexual health should be more strongly integrated into travel consultations, and access to PrEP and other effective prevention strategies should be promoted.

Why, in your view, is it important to integrate sexual health not only into a specialized consultation, but also into traditional pre-travel medical consultations?

Sexual behavior often changes during travel, which can increase the risk of HIV and other sexually transmitted infections.

Open sexual health counseling before travel can help raise awareness of potential risks and promote effective prevention measures. However, this topic is still addressed too rarely in travel consultations, and modern prevention options such as HIV PrEP are not yet widely known or used.

How does addressing sexual health in a pre-travel medical consultation differ from a dedicated consultation in the Sexual Health Consultation?

Unlike in the Sexual Health Consultation, customers in travel medicine usually focus on other topics, such as malaria or vaccinations. Although people are asked about sexuality during travel before their appointment, counseling on the topic is not expected. This is also because sexual contacts during travel often arise spontaneously, meaning that people do not necessarily see a specific need for counseling in advance. As a result, it is easier for professionals in the Sexual Health Consultation to address the topic, as customers expect this and are usually more open to it. In addition, the professionals in the Sexual Health Consultation are much more experienced in dealing with these topics.

TravelPrEPared builds on the experience gained through SwissPrEPared. Looking again at PrEP in Switzerland: how has access developed in recent years from your perspective?

A lot has changed in recent years. I received the first inquiries about HIV PrEP in 2016. At that time, PrEP was not yet approved in Switzerland, and the original medication was unaffordable at several hundred francs per month. People who wanted to use PrEP often had to rely on cheaper medications from abroad. Today, PrEP is approved in Switzerland, generics are available, and for people with an increased risk of contracting HIV, treatment at SwissPrEPared-associated centers can be billed through health insurance.

What challenges remain despite this progress, for example in terms of knowledge about PrEP, access, or reducing barriers?

In the queer community, knowledge about HIV PrEP is now much more widespread than in the general population. In my view, there is still a considerable need for information, especially outside of this community. The topic is also not yet established everywhere in the medical field, which means that it is not always easy for interested people to receive competent and non-judgmental counseling. Specialized PrEP consultations can play an important role here by providing low-threshold and trustworthy access to information and care.

This brings us to the service offered at ZRM: how did the Sexual Health Consultation come about? What need became apparent?

Since our department not only coordinates the SwissPrEPared program, but our clinic is also a SwissPrEPared-associated center that cares for PrEP users, establishing a Sexual Health Consultation was an important step. In addition to prevention and testing services, diagnostics, counseling and treatment must also be ensured. Furthermore, we see this service as a valuable addition for travel medicine customers, as questions related to sexual health are also becoming increasingly important in the context of travel. In addition, our testing services are used by many members of the university community, which further highlights the need for a low-threshold and competent service.

What role did you play in setting up the Sexual Health Consultation at ZRM and in project management?

Together with the medical director, I took on project management. My responsibilities included project management in particular, as well as operational and personnel leadership, including organizational decisions and coordinating implementation.

What was particularly important when setting up the Sexual Health Consultation at ZRM, professionally, organizationally and in dealing with customers?

Numerous processes had to be newly defined and implemented for the consultation, including, for example, customer flow, counseling and laboratory processes, pricing and billing processes. In addition, a favorable flat rate for STI testing was agreed with our partner laboratory Analytica. At the same time, the new service had to be seamlessly integrated into existing structures. Another focus was staff training to ensure professional competence. It was especially important to us to communicate and model an open, respectful and non-judgmental attitude toward sexual health and toward the people who use our services.

You described an open, respectful and non-judgmental attitude as particularly important. Where do you think barriers or uncertainties still exist today when it comes to STI testing, PrEP or sexual health?

Sexual health is still associated with taboos and uncertainties. In addition, the cost of an STI check can be a barrier, meaning that some people do not get tested even though they would like to, or simply cannot afford the examination.

What is needed, in your view, so that customers can speak openly about sexual health and feel well cared for?

Customers should feel welcome and comfortable from the moment they register and enter the clinic. During counseling, it is important that the professional is open, non-judgmental and friendly, so that conversations about sexual health are experienced as something completely normal, just like any other medical consultation.

What are you particularly proud of when you look at the service at ZRM today?

The responsibilities we had during the pandemic significantly delayed our plans for setting up the service. That makes it all the more rewarding to see today how the Sexual Health Consultation continues to develop and is being used more and more. In my opinion, the successful establishment of such a service is only possible thanks to a committed and diverse team with different professional skills and perspectives. It is also especially nice to see the strong commitment of the professionals, who support the further development of the service with great motivation and enthusiasm.

What would you like to see for the further development of the Sexual Health Consultation and TravelPrEPared?

For the future, I hope that the Sexual Health Consultation will become even better known and be perceived and used by people from all population groups as a natural health service. It would also be important to continue making access as low-threshold as possible, to integrate sexual health even more strongly into other areas such as travel medicine, and to continuously advance the professional development of the service. In the long term, it would be desirable for competent, non-judgmental counseling as well as prevention, testing and treatment services to be easily accessible to everyone, regardless of origin, gender, sexual orientation or financial means.

Thank you very much for this interesting interview, Manuela!