Barcelona (BCN) Checkpoint existed as a community organisation for men who have sex with men (MSM) living with HIV before it became a community HIV-testing centre. Cofounders Michael Meulbroek, from the Netherlands, and his husband Ferran Pujol, from Barcelona, Spain, saw the need for community-based testing and opened the centre in 2006. Checkpoint clinics have since opened elsewhere in Spain and Europe, including Athens, Greece, and Lisbon, Portugal. “We wanted the centre to be run by gay men who themselves were living with HIV and could talk positively about sexuality and how they were managing their condition”, explains Meulbroek.
BCN Checkpoint became the first clinic in Spain to use new-generation rapid HIV tests, with trained counsellors on hand to manage any diagnoses. The centre has accelerated from 1000 tests per year to the current figure of around 15 000. “Anyone testing positive is referred to a named doctor or nurse at their local HIV hospital service for prescription of antiretroviral medication and will receive further support from us if needed”, says Meulbroek. In 2023, the centre hopes to begin prescribing antiretrovirals for people living with HIV and is already able to prescribe pre-exposure prophylaxis (PrEP) to around 2500 MSM and transgender men and women across Barcelona. Enhanced funding means that since 2015, the centre has been able to offer syphilis and hepatitis C screening, and, since 2019, has been able to increase capacity further so that clients can request full sexual health screening.
Pep Coll is the chief physician at BCN Checkpoint and is a consultant in infectious diseases at Germans Trias i Pujol Hospital, Badalona, Spain. On top of seeing and treating patients, he oversees the centre's PrEP programme and says that “as more resources become available, we hope to increase [the number of people accessing PrEP] even further”. BCN Checkpoint aims to detect HIV early, and 60% of positive diagnoses are made within 3 months of infection. Barcelona, like other major European centres, has seen new HIV infections drop sharply thanks to PrEP, treatment as prevention, contact tracing, and detecting infections early in those at high risk. Compared with five or more infections per week in 2015, now BCN Checkpoint can see zero in a week.
At the time of writing, BCN Checkpoint is at the forefront of battling the new monkeypox outbreak that affects MSM and often involves a history of group sex and multiple partners over an extended period, combined with recreational drug use (chemsex). In June and July, around ten patients each day were presenting at BCN Checkpoint with monkeypox symptoms, such as anal pain and discharge, fever, and one-to-several genital lesions. Numbers have dropped slightly, partly because the centre and others across Spain are administering vaccines. However, so far this is not close to enough, with only 700 vaccine doses received by BCN Checkpoint in its first delivery. The centre's team is under huge pressure as each case must be dealt with in personal protective equipment and diverts staff from routine STI treatment and surveillance work. Cases must also all be reported to Spain's central ministry of health. Coll believes that “far more vaccines and contact tracing will be key to bringing monkeypox cases down to manageable levels”. The team and two other Spanish centres has published a study of early cases in The Lancet.
Coll is also overseeing BCN Checkpoint's involvement in a number of clinical trials, including DISCOVER for PrEP, the MOSAICO HIV vaccine trial, studies on alternative antibiotics for both syphilis and gonorrhoea, a human papillomavirus vaccine study, and work investigating how many HIV-negative MSM are becoming infected with hepatitis C.
Today, a large part of BCN Checkpoint's resources are dedicated to helping MSM and trans people having problems with chemsex. The problem was first noticed in 2015, when more and more visitors to BCN Checkpoint talked about addiction to methamphetamine (also known as crystal meth or tina) and other party drugs such as GBL/GBH (γ-butyrolactone/γ-hydroxybutyric acid) and mephedrone. BCN Checkpoint set up a dedicated service to help counsel people about chemsex. In 2015, just 30 people were being treated for serious chemsex addiction, but today that number has increased to 170. During this period, the proportion of MSM practising chemsex has doubled, from 5% to 10%, and the average age of first chemsex experience has dropped from around 30 years to the early 20s.
Antonio Gata is the psychologist at BCN Checkpoint who leads the chemsex support services, having initially worked at the centre as a volunteer doing rapid HIV tests. “Visitors to BCN Checkpoint are asked if they are having any chemsex issues, and, if so, an appointment is provided immediately, or no later than 3 days, so we do not lose contact. In therapy, we explore the person's family and work situations, and the issues around loneliness and lack of intimacy that are common to many engaging in chemsex”, explains Gata. “Some MSM are in a deep crisis, feeling alone and isolated. Despite all our interactions through social media today, we have maybe forgotten how to practise intimacy and trust in our relationships. All of these things are connected.”