I am doing free and anonymous HIV and syphilis testing with my colleagues of Alternatíva Alapítvány at a downtown cafe in Budapest this weekend.
Hungary has one of the lowest testing rates in Europe, so scaling up testing and counselling is truly essential in this setting. While we use the usual triple rate for the estimated number of PLHIV in Hungary, many say that a quadruple rate would be more realistic: We can assume that there are four times as many people living with HIV as tested and registered. The MSM population is hardest hit with app. 80% of PLHIV coming from the gay and other MSM communities.
Curiously, while HCV prevalence is very high in the PWID population, the rate of HIV is very low in this group - clearly a disaster in the waiting.
However, the legal environment is far from clear. Low threshold, demedicalised testing is possible only if one can prove that testing and counselling are done in a context where substance use and harm reduction are an issue. Alternatíva Alapítvány is a harm reduction organisation, and the testing procedure is complete with a questionnaire to assess sexual and other (substance use) risk behaviours.
But if we wanted to do testing in an MSM setting that is concerned with safer sex and gay populations, then a doctor is needed to be present at the testing. However, even in this case activists or peer helpers with a proper testing and counselling certificate can perform the tests themselves. This is the argument we use to justify why we can and should move testing into less conventional environments and leave the predictable relative comfort of harm reduction services and gay saunas.
Another issue is the volatility and precariousness of the campaigns. There are no secure funding streams for community based organisations to make sure that there is a safe supply of tests. Also, we have to make do with whatever is available for the money we have. This time combination HIV+syphilis rapid tests are used, but one never knows what donations will be available next, or what the next grant allows one to buy.
HIV is very low priority in low prevalence settings. Testing is also not important for the government or health policy in general, and the civil sector often needs to be creative to the level of guerilla to make sure that testing reaches everyone.