BMC Public Health 2008, 8:180 http://www.biomedcentral.com/1471-2458/8/180 Background The incidence of HIV among men who have sex with men (MSM) in Switzerland increases since 2003 [1-3]. Whereas in 2003 159 HIV new infections were detected in MSM this number rose to 289 in 2006. Sexual contacts with other men accounts for about 40% of all HIV transmis- sions in Swiss men. The HIV prevalence in MSM younger than 30 years is 2%, in those aged over 30 years even 12% [4,5]. In sexually highly active MSM in Zurich every sixth is estimated to be HIV positive but only 2 out of 3 HIV positive MSM are aware of their serostatus [5]. As in other Western European countries, a significant increase in sex- ually transmitted infections (STI), e.g., syphilis, gonor- rhoea and chlamydia infection, has been observed in Switzerland during the last years [6,7]. In addition to the burden associated with STIs, they also have a critical role in HIV seroconversion as the risk for transmission increases with the presence of mucosal lesions [8-11]. A not yet published on-site testing study in Zurich con- firmed a clear rise in syphilis prevalence amongst gay men. Besides infectious diseases it is also the general health status of MSM that raises concerns. In a recent study conducted in the French part of Switzerland, gay men reported significantly more and particularly severe physical symptoms, short-term disability, mental disor- ders, and a higher prevalence of risk factors for chronic disease (high cholesterol, high blood pressure, high glu- cose, smoking), even after adjustment for differences in socio-demographic characteristics [12,13]. Elevated levels of tobacco smoking, alcohol consumption and use of illicit drugs amongst gay men have been reported in vari- ous studies throughout the world [14-20]. Finally, there is evidence that gay men are less likely to be satisfied with the health care they receive, in particular with respect to sexual health issues, and often do not disclose their sexual orientation to their providers [12,21-23]. However, a con- fidential and respectful relationship between providers and patients including open communication about sexual behaviour is essential in order to estimate STI and HIV risk and to provide adequate care to patients. The serious health situation of MSM has led practitioners, researchers and decision-makers to discuss and develop alternative, low-threshold models of care for MSM at the community level. Such specialized health community clinics serving the lesbian, gay, bisexual and transgender population (LGBT) have a long tradition in the U.S. For example, the Fenway Community Health Centre was founded in 1971 [24]. There is, however, little experience with similar services in Europe. As Zurich has the largest gay community in Switzerland with a wide spectrum of gay specific venues, e.g., clubs and dark rooms, a large fraction of new HIV and STI infections amongst MSM occur there. With the aim to reduce rates of new HIV and STI infections and to provide comprehensive health serv- ices for MSM, an outpatient clinic for gay men was opened in June 2006: Checkpoint Zurich. Service description The clinic is run jointly by the Zurich AIDS Federation and ARUD Zurich, a private organisation specialised in the care of drug addicts and experienced in treatment of their common health problems, such as infectious and psychi- atric diseases. Checkpoint Zurich is very centrally located next to the main station, in walking distance from many bars, clubs, and dark rooms. Opening hours were initially on two evenings during the week (4 p.m. to 8 p.m.), but have been expanded to three evenings in 2007. Counsel- ling and testing can be obtained anonymously. No appointments have to be fixed in advance and patients just can drop in for a consultation. All tests and treatments are reimbursed by the Swiss basic health insurance but if clients prefer anonymous testing they have to pay on their own. Services provided to male sex workers are being paid for by the local government. The service was announced to MSM in gay bars and clubs, saunas, and gay media in Zurich. In addition, all regis- tered general practitioners were sent an information leaf- let. Many existing HIV/STI testing centres across Europe are organised according to the VCT (Voluntary Counselling and Testing) principle. As they usually do not offer ther- apy or services unrelated to infectious diseases, referrals to other institutions or providers are often necessary. This transfer between two or even more institutions is time- consuming and requires patients to disclose intimate information repeatedly to new providers. Hence the risk of insufficient follow-up is high. In contrast, Checkpoint Zurich is an outpatient clinic managed by physicians. It provides the opportunity to obtain comprehensive care including counselling, testing, treatment and medical fol- low-up at one location and with a high level of personal continuity. Male nurses with a profound knowledge of and an accepting attitude towards gay sexual practices pro- vide professional counselling. Physicians working at Checkpoint Zurich can draw on experiences gathered in the treatment of infectious diseases in drug addicts. Based on a patient's history and symptoms, clinical examinations, diagnosis of STIs, HIV tests (combination or rapid), and hepatitis A and B vaccinations are provided. Men with a history of sexual risk situation are offered tests for HIV and syphilis. Checkpoint offers tests for all other STIs, accord- ing to the patient's symptoms and history. Diagnostic pro- cedures for Chlamydia and Gonorrhoea testing are based on the patient's presentation and symptoms. Patients with a recent risk of HIV infection are evaluated for post-expo- sure prophylaxis (PEP). Page 2 of 9 (page number not for citation purposes)