Checkpoint was the name of the first rapidHIV testing facility in the Netherlands.[1] This project, run on a voluntary basis, was based in Amsterdam. From 21 June 2002 until its closure on 27 June 2008, almost 5000 people opted for a Checkpoint HIV test.
The rapid HIV testing employed by Checkpoint was new for the Netherlands, because it was at that time not used by the various local health authorities. Such authorities and physicians employed the regular HIVantibody test and clients had to wait 1 or 2 weeks for the result. When an increasing number of local health authorities began using the rapid HIV test, Checkpoint had served its purpose and could be closed down.
The rapid HIV test enabled a reliable outcome to be generated within 15 to 20 minutes, which in practice lowered the threshold for such testing. Because in this way more people opted for testing, more HIV-positive people could be reached. A clear advantage was that the diagnosis was made at the earliest possible stage of the infection, facilitating adequate treatment. In addition, through successful early treatment, the infectious period for HIV-positive people was reduced.
Background
Research conducted in 2000 revealed that in the Netherlands only 42% of men who had sex with men (MSM) had ever in their lives been tested for HIV,[2] so the Dutch HIV Association (HVN) wanted to introduce a rapid test in the Netherlands to lower the threshold to get tested.[3]GlaxoSmithKline provided financial assistance.
Aim
The rapid HIV test had to be on offer to everyone who had incurred a risk of HIV infection, irrespective of gender or sexual orientation. The testing procedure had to include comprehensive pre-test and post-test counselling. Knowledge gained from this form of testing had to be analyzed and eventually be communicated in a structured manner.[3]
History
Initially, the mainstream bodies in this field, such as SOA Aids Nederland and the Municipal Health Services (GGD), were not immediately enthusiastic and regarded the initiative with some scepticism. The following initial objections had to be overcome:
Checkpoint had chosen the Determine rapid HIV test, then the only reliable rapid HIV test available in the Netherlands. The reliability of this test had already been established but was not known to everyone.[1]
Another criticism was that a positive result from a rapid HIV test was first confirmed by a Western blot (gold standard) and was, therefore, provisional. The CDC had observed around that time that 31% of positive results were not being collected.[2]
More questionable was the conviction that having to wait seven highly worrying days for the result of an HIV test would have a preventive effect, something for which no scientific basis was ever established. In practice, it turned out to be a matter of logistics. Testing a large number of blood samples simultaneously was cheaper: the cost per test was lower. Once the laboratory had initiated the testing procedure, the results from all blood samples were known within an hour. Additionally, the laboratories would suffer a loss in income if the testing localities required only the Western blots.
Clients quickly learned about Checkpoint, which meant that the low-threshold walk-in clinic soon had to be abandoned. During the first 26 Friday surgeries, demand was 20% higher than the then available 375 test spots. Clients regularly declared that they had been waiting years for such rapid testing.[3]
Recognition came in 2004 when, at the 15th World AIDS Conference in Bangkok, Checkpoint demonstrated that the rapid HIV test in the Netherlands lowered the threshold for MSM to have themselves tested, which meant that the second of Checkpoint's two aims had been realized.[4]
As of 2005, the Amsterdam City Council's public health service (the GGD) started offering rapid HIV tests to high-risk visitors to the STD outpatient clinic. At this moment, the first of Checkpoint's goals was also realized.
In 2006 the RIVM (Netherlands National Institute for Public Health and the Environment) advised the Ministry of Health to encourage the use of rapid HIV testing, to make an inventory of all obstacles to this, and to eliminate these obstacles.[5]
When 60% of the local health authorities appeared to be using rapid HIV testing as part of their standard screening method or were busy implementing it, this project could be successfully wound up. During an extensive farewell party on 27 June 2008, the then Mayor of Amsterdam, Job Cohen, thanked all volunteers for their results.
For one more year, foreign rapid HIV testing projects were supported. All source documentation was made available in digital form. The Checkpoint formula was adopted not only in the Netherlands but in many other cities: Aarhus, Athens, Barcelona, Basel, Cologne, Copenhagen, Dublin, Geneva, Helsinki, Lisbon, Ludwigshafen, Malmö, Mannheim, Munich, Nuremberg, Odense, Paris, Riga, Thessaloniki, Zagreb, and Zürich. The Checkpoints in Denmark, France, Sweden, and Switzerland received extensive support from Checkpoint Amsterdam. The Swiss Checkpoints have gone further, developing into Gay Health Centres. Not only do they perform tests for STDs and HIV, but they also offer support for HIV-positive persons and in general for coming out, general psychological care for gay men, training in safe drug usage, and assistance with smoking cessation and excessive alcohol use. In 2012 Checkpoints opened in Bern and Lausanne.[6]
Features of the Checkpoint formula
Determine Hiv-1/2 Rapid Test
Checkpoint positioned itself as a facility which shares the client's point of view.
The rapid HIV test was used (the Amsterdam Checkpoint employed the Determine rapid HIV test (third generation), with a 100% sensitivity and 99.75% specificity)
Positive or dubious results were checked using a Western blot test
When an appointment is being made over the telephone, the client was asked whether he belongs to a high-risk group, what the reason is for wanting an HIV test and whether he is still in the window period for testing
Outside office hours
Gay-friendly, aimed at high-risk groups and anonymous if so desired
Preferably with the knowledge of and in the presence of the partner, friends and family, who can give effective support in the case of testing positive
Effective pre- and post-test counselling
Information regarding safe sex, condom usage and sexual techniques
Clients testing positive were immediately referred to a support project run by HIV-positive volunteers who, in various languages, offer support during the 48 hours after testing positive
After testing, the Dutch HIV Association (HVN) Service Centre was available for advice or questions
Modus operandi of the Amsterdam Checkpoint
When the service began, everyone could attend without an appointment. However, demand exceeded supply, so it became necessary to work by appointment. HVN volunteers maintained the appointment schedule. When making an appointment over the phone, clients were asked whether or not they belonged to a high-risk group and about the risk they had experienced; they were informed about the window period. This information enabled a better match to be made between a doctor or nurse and the client for the Friday evening.
A volunteer trained in the paramedical field registered the client, talked about safe sex, and gave a condom demonstration.
After this, a nurse or doctor gave pre-test counselling, conducted the HIV test, and communicated the outcome 15 minutes later.
If the client tested positive or the result was ambiguous, a blood sample was taken for a Western blot and an appointment was made for receipt of the confirmatory result a week later.
In 79% of cases, the confirmatory result was received in person a week later. In contrast to the previous week, clients were noticeably less emotional at this second talk and had highly specific and practical questions to ask. Although initially a point of criticism, this second post-test talk was in fact regarded by the doctors, nurses, and clients as having added value.
Volunteers
This project was run by 43 volunteers. Once selected, volunteers followed an internal training programme, depending on their experience and duties, before being allowed to operate independently. In 2007 Checkpoint became the second voluntary organization in Amsterdam and the 25th in the Netherlands to receive the Goed Geregeld [well organized] award from the Dutch Association of Voluntary Organizations (NOV): an award reflecting the high quality achieved.[4]
Consultations and diagnoses
Content can be sorted per column using the arrows in the headings. GGD Amsterdam refers to the local public health authority Gemeentelijke Gezondheidsdienst
Number of HIV tests
Group
2002
2003
2004
2005
2006
2007
2008
Checkpoint
MSM
213
477
531
438
360
397
174
Checkpoint
Hetero men
129
323
251
272
164
202
82
Checkpoint
Women
92
208
194
150
120
99
39
Checkpoint
Total
434
1008
976
860
644
698
295
GGD Amsterdam
MSM
1 537
1 532
1 661
2 238
2 488
3 419
4 230
GGD Amsterdam
Hetero men
2 938
2 954
4 175
4 744
6 398
9 177
9 630
GGD Amsterdam
Women
3 415
3 626
5 039
5 564
7 712
11 340
11 760
GGD Amsterdam
Total
7 890
8 112
10 875
12 546
16 598
23 936
25 620
Number HIV+
Group
2002
2003
2004
2005
2006
2007
2008
Checkpoint
MSM
14
21
21
26
23
11
14
Checkpoint
Hetero men
1
1
1
2
2
0
0
Checkpoint
Women
1
2
1
0
1
1
2
Checkpoint
Total
16
24
23
28
26
12
16
GGD Amsterdam
MSM
56
65
89
126
95
118
148
GGD Amsterdam
Hetero men
14
7
14
16
22
15
19
GGD Amsterdam
Women
12
15
17
21
18
29
11
GGD Amsterdam
Total
82
87
120
163
135
162
178
% HIV+
Group
2002
2003
2004
2005
2006
2007
2008
Checkpoint
MSM
6.8
4.8
5.7
5.7
6.5
2.9
8.1
Checkpoint
Hetero men
0.8
0.3
0.4
0.7
1.2
0.0
0.0
Checkpoint
Women
1.1
1.0
0.5
0.0
0.8
1.0
5.1
GGD Amsterdam
MSM
3.6
4.2
5.4
5.6
3.8
3.5
3.5
GGD Amsterdam
Hetero men
0.5
0.2
0.3
0.3
0.3
0.2
0.2
GGD Amsterdam
Women
0.4
0.4
0.3
0.4
0.2
0.3
0.1
Graphic comparison %hiv+ Checkpoint vs. GGD STI Clinic Amsterdam 2002–2008
It appears that, in the years of its operation as given above, Checkpoint was better able to reach higher-risk groups than was the Amsterdam Public Health Service (GGD).
In 2002 and 2008 Checkpoint was operational for 26 Friday evenings. For comparison, the corresponding results per group are given for the Amsterdam Public Health Service's STD Policlinic.[5] More detailed results (Dutch language) are to be found in '6 jaar Checkpoint, een samenvatting' [6 years of Checkpoint: a summary].[6]
Trials
OraQuick Advance Hiv-1/2 Rapid Test
Detuned ELISA
Until early 2006 a Detuned ELISA test could still be requested in addition to a Western blot. This indicates whether the infections had occurred less than 6 months earlier or longer ago than this. It turned out that 63% of the infections were not recent.
General practitioners (family doctors)
A few GPs used the rapid HIV test in their practice. They noted that this encouraged patients who were otherwise reluctant to face a general STD investigation.
Mister B
In this Amsterdam leather and fetish shop a surgery was held on Sunday afternoons. In this way Checkpoint hoped to reach more effectively the MSM who visited leather bars. This turned out not to be the case, but it was attractive for less well educated men who were taking high risks, regularly experimenting with recreational drugs and not resident in Amsterdam. The incidence rate among these clients was 5.6%.
Oral fluid
In collaboration with OraSure a pilot was conducted with 1000 OraQuick ADVANCE® Rapid HIV-1/2 oral fluid tests.[7] Initially this appeared to form the ideal HIV self-test, but during this pilot two false-negative outcomes were discovered.[8] In a slightly smaller-scale pilot in London a false-negative was noted on three occasions.[9]
Resources
↑ Broekhuizen A. "(14 june 2002) "Checkpoint: een snelle aidstest", Algemeen Dagblad
↑ Hogeweg, J.A. en H.J. Hospers (2000) "Monitoronderzoek 2000", Maastricht, Universiteit Maastricht Capaciteitsgroep Experimentele Psychologie
1 2 Persbericht (14 juni 2002) "Checkpoint, test je betrouwbaar, snel en anoniem op hiv", Amsterdam, Hiv Vereniging Nederland
↑ Rijk, P. de (2007) "De langzame start van een kwaliteitsonderscheiding", Utrecht, Movisie
↑ Loon, C.L.J. Van and W.M. Koevoets (2008) "6 jaar Checkpoint, een samenvatting", Amsterdam, Hiv Vereniging Nederland
↑ Koevoets, W.M. and C.L.J. Van Loon (Augustus 2007) "OraQuick®Advance™, een nieuwe hiv-sneltest…?” Amsterdam, SOAAIDS Magazine Jaargang 4, nummer 3 – Archived 10 November 2013 at the Wayback Machine
↑ Loon, C.L.J. Van and W.M. Koevoets (December 2008) "Foutnegatieve meldingen OraQuick®Advance™ Hiv 1/2" Amsterdam, SOAAIDS Magazine Jaargang 5, nummer 4 – Archived 10 November 2013 at the Wayback Machine
↑ Zelin J. (2008) "An evaluation of the performance of OraQuick®Advance™ Rapid Hiv-1/2 Test in a high-risk population attending genitourinary medicine clinics in East London", International Journal of STD & AIDS Volume 19 pp. 665–667
HIV tests are used to detect the presence of the human immunodeficiency virus (HIV), the virus that causes HIV/AIDS, in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.
Men who have sex with men (MSM) are men who engage in sexual activity with other men, regardless of their sexual orientation or sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay, bisexual, pansexual or various other sexualities, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. The alternative term "males who have sex with males" is sometimes considered more accurate in cases where those described may not be legal adults.
HIV/AIDS in China can be traced to an initial outbreak of the human immunodeficiency virus (HIV) first recognized in 1989 among injecting drug users along China's southern border. Figures from the Chinese Center for Disease Control and Prevention, World Health Organization, and UNAIDS estimate that there were 1.25 million people living with HIV/AIDS in China at the end of 2018, with 135,000 new infections from 2017. The reported incidence of HIV/AIDS in China is relatively low, but the Chinese government anticipates that the number of individuals infected annually will continue to increase.
Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year – in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.
The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.
The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.
The southeast-Asian nation of East Timor has dealt with HIV/AIDS since its first documented case in 2001. It has one of the lowest HIV/AIDS-prevalence rates in the world.
The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.
HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).
Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.
In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).
Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
How to Have Sex in an Epidemic: One Approach is a 1983 manual by Richard Berkowitz and Michael Callen, under the direction of Joseph Sonnabend, to advise men who have sex with men (MSM) about how to avoid contracting the infecting agent which causes AIDS. It was among the first publications to recommend the use of condoms to prevent the transmission of STDs in men having sex with men, and has even been named, along with Play Fair!, as one of the foundational publications in the advent of modern safe sex.
Syphilis is a bacterial infection transmitted by sexual contact and is believed to have infected 12 million people in 1999 with greater than 90% of cases in the developing world. It affects between 700,000 and 1.6 million pregnancies a year, resulting in spontaneous abortions, stillbirths, and congenital syphilis. In Sub-Saharan Africa syphilis contributes to approximately 20% of perinatal deaths.
Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981, and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.
Sheldon D. Fields is a Registered Professional Nurse, Family Nurse Practitioner, educator, researcher, health policy analyst, and nurse entrepreneur who is known for his work in the field of behavioral health research specializing in the area of HIV/AIDS prevention.
With an estimated 120,000 people living with HIV/AIDS, the HIV/AIDS epidemic in Colombia is consistent with the epidemic in much of Latin America as a whole, both in terms of prevalence of infection and characteristics of transmission and affected populations. Colombia has a relatively low rate of HIV infection at 0.4%. Certain groups, particularly men who have sex with men, bear the burden of significantly higher rates of infection than the general population. Colombia's health care system and conception of a "right to health", created by the T-760 decision of 2008, have revolutionized access to HIV treatment. Despite this, the quality of health insurance and treatment for HIV has often been disputed.
In the European Netherlands, a Municipal Health Service is a decentralised public health organisation. Legally, the responsibility for the provision of this service lies with the municipalities. However, in practice, the municipalities work together to provide this service at a regional level, resulting in twenty-five "GGD regions". The borders of the GGD regions largely correspond to the borders of the safety regions.
This page is based on this Wikipedia article Text is available under the CC BY-SA 4.0 license; additional terms may apply. Images, videos and audio are available under their respective licenses.
