This document summarizes community-based HIV testing efforts at an LGBT center in Zagreb, Croatia. It notes that 84% of new HIV diagnoses in Croatia in 2012 were among men who have sex with men (MSM), the highest proportion in Europe. The LGBT center in Zagreb began providing rapid HIV tests in October 2013, and has tested over 200 people so far, identifying 5 people as HIV positive. However, challenges include low rates of HIV testing among MSM in Croatia due to perceptions of low risk and barriers accessing testing. New efforts are exploring how to increase risk perception and engagement to improve testing rates.

1. S
Community based HIV
testing @ LGBT centre
Zagreb, Croatia
Zoran Dominković, Dubravko Pogledić, Hrvoje Fuček
Iskorak
Sexual and gender minorities rights centre

2. Iskorak
Sexual and gender minorities rights centre, NGO
Advocacy
and LGBT
awareness
rising
Cultural,
social and
media
activities
Health
program,
MSM&HIV
Legal and
psychologic
al support

3. MSM & HIV in Croatia
Source: Croatian Institute of Public Health, 2013

4. 84% of new HIV
diagnoses in 2012 were
MSM. Highest
proportion in Europe
Source: HIV/AIDS surveillance in Europe 2012, ECDC

5. HIV prevention program for MSM
Primary prevention
Protection on
individual level
Started by Iskorak in 2003.
Secondary
prevention
Timely detection of
new HIV infections
Tertiary prevention
Treatment and care
Safer sex promotion,
outreach & netreach, and
condom/lube distribution,
workshops, internet, aids.hr
Promotion of regular HIV
testing, community-based
testing
Linkage to care,
support PLHIV to live
positive
Lowering stigma and discrimination, lowering barriers to access health care,
improvement of health system through partnerships, education and advocacy.

6. HIV promotion materials, Iskorak

7. Key issue for prevention: financial
S 5.5% of HIV prevention funds for key affected populations is
for MSM in Croatia (GARP, 2013)
AIDS spending category HRK %
Prevention - Youth in school 69,000 1.2
Prevention of HIV transmission aimed at people living with HIV 551,500 9.8
Prevention programmes for sex workers and their clients 490,000 8.7
Programmes for men who have sex with men 310,000 5.5
Harm-reduction programmes for injecting drug users 3,967,500 70.4
Prevention programmes in the workplace 250,000 4.4
TOTAL 5,638,000 100

8. HIV testing at
LGBT centre Zagreb
S Started in Oct 2013
S Rapid HIV tests
S Free & anonymous
S Centre of the town
S A few minutes from most
gay venues in Zagreb
S Partnership with Public
Health Institute
Promotional leaflet

9. LGBT centre Zagreb
Open since June 2013 - Different social
activities for LGBT

10. HIV testing at LGBT centre

11. Councelors

12. Methods
Rapid HIV testing (Toyo and OraQuick)

13. New online campaign
Visuals similar to Facebook.Changing for summer/fall/winter/spring. Targeting
Facebook, Gay.hr, GayRomeo, Scruff

14. Results
S 53 tested during pilot (22 November – 19
December 2013)
S 3.8% (2) positive
S 186 tested October 2013 – July 2014
S 1.6% (3) positive
S Great feedback
S No issues with linkage to care

15. Challenges
S Financial – project has minimal funding, causing
logistic issues. Continuing support of Public Health
Institute is required.
S Reaching MSM
S Campaigns have high reach, but low response
rate. Problem with risk perception.
S Location shifting? - Preliminary data shows that
fewer MSM go to older VCTs as new locations open

16. S
Why MSM don’t test?
Barriers for HIV testing among MSM in Croatia

17. Current testing rates
S 32% of MSM tested in the last 12 months (MSM
bihevioral surveilance 2012)
S Lower than European average testing rate for MSM
(EMIS 2010)
S Review of 7 bio-bihevioral surveys show growth in
HIV testing rates 2005-2012
S Bio-behavioral surveys have self-selection and
social desiriability bias which overestimate testing
rates

18. Obstacles to testing
If you haven’t been tested in the last 12 months, what was the main reason?
Bihevioral survey 2009 n/N* %
I think I haven’t been at risk of HIV 302/512 59.0%
I don’t want to know the result (afraid) 60/512 11.7%
I don’t know where to get tested 43/512 8.4%
Bihevioral survey 2012 n/N* %
I think I haven’t been at risk of HIV 222/360 61.7%
I didn’t have the will (I was lazy) 43/360 11.9%
I am afraid someone will know I tested 25/360 6.9%
Bio-bihevioral (RDS), Zagreb 2010 n/N* % (adjusted)
I think I haven’t been at risk of HIV 137/238 62.6%
I didn’t have the will (I was lazy) 40/238 15.3%
I didn’t have time 19/238 6.7%

19. Have they been at risk?
S Among those who think they are not under
risk of infection (Bihevioral 2012):
S 82.6% meet recommendation to get tested
every 12 months (sexually active MSM)
S Predictors of HIV testing among MSM (RDS
Zagreb 2010) :
S >3 sexual partners (aOR 2.78)
S Knowing HIV status of current partner
(aOR 2.41)

20. Qualitative study
Currently in progress
S In-depth interviews with MSM in Croatia
S Topics:
S Perception of HIV
S Risk perception
S Reasons for testing
S Barriers to testing
S Living with HIV
S Evaluation of ideas to improve testing rates

21. Way forward
S Raising risk perception? (Involve social marketing experts)
S Be open and honest about HIV prevalence and new infections
rates among MSM
S New methods to reach MSM (Peer-driven intervention proven to
successful in Croatia)
S Community engagement
S One-stop STD clinic
S Advocacy for better epidemic response
S New intervention in preparation

22. Acknowledgments
S Srđan Rogošić, Vesna Višekruna Vučina, Hrvoje
Vinter, Tatjana Nemeth Blažić, Jasmina Pavlić,
Mirjana Lana Kosanović, Sanja Glamočanin, Ivan
Pristaš, Lana Kasumović, Sandra Šević, Anja
Repalust, Marija Kavić, Jegor Modrić, Tea Antolčić,
Josip Begovac, Aleksandar Štulhofer, Ivana
Božičević, and others.

23. Thank you
zoran@iskorak.hr