What question did this study set out to answer?

To assess the impact of free voluntary counselling and testing for STIs in a high-income setting and explore barriers to access.

April 3, 2026Open Access

Lowering the barriers to sexual health services: Impacts of free counselling and testing for sexually transmitted infections in Switzerland – an observational study

Key Points

To assess the impact of free voluntary counselling and testing for STIs in a high-income setting and explore barriers to access.
Implemented free VCT for residents under 26 or with low income in Zurich.
Analyzed health data and client feedback questionnaires during the first year of the program.
Used logistic regression models to identify factors associated with first-time HIV and STI testing.
3,475 individuals accessed free testing in the first year.
21% provided feedback via a questionnaire.
Chlamydia had the highest positivity rate (4.5%), followed by gonorrhoea (2.5%).
MSM showed lower likelihood of being first-time testers for both HIV and STIs.

Abstract

Background In Switzerland, tests for HIV and sexually transmitted infections (STIs) are usually not covered by health insurance in asymptomatic people. To improve access, Zurich launched free voluntary counselling and testing (VCT) in June 2023 for residents <26 years or with low income. This study describes the implementation of free VCT for HIV and STIs in a high-income setting where access to testing was previously expensive, along with key barriers and enablers to accessing testing and counselling in the target population. Methods We conducted a study using routine health data, and a client feedback questionnaire (FBQ) collected during the first 12 months of the programme. Logistic regression models were used to assess factors associated with first-time HIV or STI testing, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results In the first year, 3,475 people came for free testing. 83% (n = 2,866) agreed to share their data. 21% (n = 719) completed the FBQ. Median (IQR) age of participants was 24 (23, 26) years. 46% were assigned female at birth. Four HIV diagnoses were confirmed, all of them in MSM. The infection with the highest positivity rate was chlamydia (4.5%), followed by gonorrhoea (2.5%). Men having sex with men (MSM) showed the highest positivity rate in all STIs. 39% of visits were by individuals who had not received prior HIV testing. MSM were significantly less likely to be first-time testers for HIV (OR: 0.28, 95% CI: 0.15–0.48) and also less likely to be first-time testers for STIs (OR: 0.74, 95% CI: 0.44–1.21) compared to women who have sex with men (WSM); however, the latter association was non-significant. Conclusions The free VCT project experienced high demand during the first year. Even in a high-income setting, counselling improved participants’ sexual health knowledge and facilitated many first HIV/STI tests.

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Cite This Study

Arns-Glaser et al. (Wed,) studied this question.

synapsesocial.com/papers/69cf5ea85a333a821460d2e8 https://doi.org/https://doi.org/10.1371/journal.pone.0327114

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