Reaching young and low-income people for sexual healthcare in Zurich, Switzerland: perspectives from healthcare workers - a qualitative study.

Abstract

Free voluntary counselling and testing (VCT) interventions improve access to HIV and sexually transmitted infections prevention, particularly for underserved populations. Financial barriers are widely recognised as a key deterrent to testing uptake in vulnerable populations. In 2023, Zurich (Switzerland) introduced a pilot programme offering free VCT for young people and low-income residents. This study explores healthcare professionals' (HCPs) experiences with implementing the programme, with a focus on perceived benefits, barriers and opportunities for improvement. We conducted a qualitative descriptive study based on semistructured interviews with HCPs. Two clinics participating in a city-wide pilot programme providing free counselling and testing in Zurich, Switzerland. 12 HCPs (60% response rate) from the two participating clinics were interviewed. HCPs' perceived benefits of the programme, barriers to uptake, underserved populations and recommendations for improvement. HCPs viewed the programme as an effective entry point into sexual healthcare for young people and first-time testers, particularly due to the removal of financial barriers. Counselling was seen as its most important component, promoting knowledge-sharing and early engagement in preventative healthcare. While the programme successfully reached well-informed, highly educated individuals, key high-risk groups, including vocational students, conservative individuals, asylum seekers and those under 18, remained underserved. Reported barriers included stigma, misinformation and long appointment waiting times. HCPs recommended improved outreach to vocational schools, more inclusive educational materials and mobile testing initiatives to improve accessibility. HCPs consider free VCT programmes a critical tool for equitable access to sexual healthcare. However, to maximise their reach and impact, targeted, context-sensitive strategies are needed to engage underserved and high-risk populations more effectively.