Dialog Ethik

Gesundheitsokonomische Themen dominieren nicht nur die politische Agenda, sondern auch die Debatte in den Gesundheitsinstitutionen. In diesem Zusammenhang zeichnen sich wachsende Spannungen zwischen den professionellen und ethischen Standards der Medizin auf der einen Seite und den okonomischen Gesichtspunkten auf der anderen Seite ab. Wie wir dieses Verhaltnis ausbalancieren, hangt in hohem Mase davon ab, ob wir das Gut der Gesundheit, das fur uns eine existenzielle Bedeutung hat, als ein privates oder als ein offentliches Gut qualifizieren. Dies erschliest sich erst, indem wir die Konditionen der Gesundheit betrachten. Gesundheit erweist sich als ein offentliches Gut. Im Anschluss daran kann die Frage beantwortet werden, wie wir Gesundheit deuten: Gekoppelt an die Umstande, worin wir leben, unterliegt unsere Gesundheit einem Gradualismus. Daruber hinaus schwanken im Laufe der Zeit die Bewertungen, die wir der Gesundheit zukommen lassen. Die stark positive Wertung, die sie in modernen Gesellschaften hat, zwingt uns, nach gerechten Gesundheitsinstitutionen zu streben. Ausschlieslich marktwirtschaftliche Mechanismen sind dazu nicht in der Lage.

Current Swiss politics concerning age and ageing are orientated towards the principle "out-patient before in-patient". As part of new regulations, in 2011 all communities were required to set up information offices to answer questions about out-patient and in-patient care. The aim of this qualitative study was to analyse in which form and under which conditions such information offices are run. A qualitative study was conducted which consisted of semistructured interviews with managers of information offices. They were analysed using qualitative content analysis. The analysis shows that on the one hand the information offices have the potential to serve an important role in the communities and that they have a highly complex, demanding and responsible function. On the other hand the results illustrate that in organisational respects the situation is highly heterogeneous and unregulated. For the running of the information offices, there is need for action such as the definition of general framework, quality standards, qualifications and values profiles, objectives, mission, responsibility and legitimation, instruments for networking and cooperations.

BackgroundAn increase in new HIV cases among men who have sex with men (MSM) has been reported in Switzerland since 2001. A rapid result HIV testing for MSM through voluntary counselling and testing (VCT) facility (“Checkpoint”) was opened in Geneva in 2005. This gay-friendly facility, the first to open in Switzerland, provides testing for sexually transmitted infections (STI) and rapid result HIV testing and counselling. Our objective was to analyze Checkpoint’s activity over its first five years of activity and its ability to attract at-risk MSM.MethodsWe used routine data collected anonymously about the facility activity (number of clients, number of tests, and test results) and about the characteristics of the clientele (sociodemographic data, sexual risk behaviour, and reasons for testing) from 2005 to 2009.ResultsThe yearly number of HIV tests performed increased from 249 in 2005 to 561 in 2009. The annual proportion of positive tests among tests performed varied between 2% and 3%. Among MSM clients, the median annual number of anal intercourse (AI) partners was three. Roughly 30% of all MSM clients had at least one unprotected anal intercourse (UAI) experience in the previous 12 months with a partner of different/unknown HIV status.The main reason for testing in 2007, 2008, and 2009 was “sexual risk exposure” (~40%), followed by “routine” testing (~30%) and “condom stopping in the beginning of a new steady relationship” (~10%). Clients who came to the facility after a sexual risk exposure, compared to clients who came for "routine testing" or "condom stopping" reasons, had the highest number of AI partners in the previous 12 months, were more likely to have had UAI with a partner of different/unknown HIV status in the previous 12 months (respectively 57.3%, 12.5%, 23.5%), more likely to have had an STI diagnosed in the past (41.6%, 32.2%, 22.9%), and more likely to report recent feelings of sadness or depression (42.6%; 32.8%, 18.5%).ConclusionMany of Checkpoint's clients reported elevated sexual risk exposure and risk factors, and the annual proportion of new HIV cases in the facility is stable. This VCT facility attracts the intended population and appears to be a useful tool contributing to the fight against the HIV epidemic among MSM in Switzerland.