been experiencing an HIV epidemic

Like many of the settings mentioned during the Consultation, especially those in higher-income countries, Seattle
has been experiencing an HIV epidemic that is highly concentrated among populations of MSM including a smaller
number who are both MSM and injecting drug users.
One objective of the Seattle programme has been to provide “one-stop shops” for the sexual health needs of
MSM; these include integrated services that provide voluntary counselling and testing (VCT), STI evaluation and
treatment, and vaccination for hepatitis A and B. Integrated services face challenges in service delivery related to
lack of resources including the specific problems faced by younger MSM who are often not covered by medical
insurance. This includes problems with integrating medical records alongside the clinical services, and inadequacy
of service staff qualified to provide all the services needed.
Ongoing research is looking at the optimal time for initiating ART based on CD4 count from an individual and
community perspective, and rolling out more specialized diagnostic tests to community-level providers to better
identify the newly infected in the “window” of time before antibodies are detectable with standard enzyme
immunoassay (EIA) tests. An important underlying philosophy of all interventions and programmes is to work with
the MSM community in order to identify what these men themselves want from the services.