RESUMEN
There is a lack of institutional and regulatory structure and coordination in the public health care system in Germany. The current reform approaches to the public health service, the establishment of a Federal Institute for Public Health and the amendment of the Prevention Act offer opportunities to lay the foundations for a modern public health structure within the framework of these reforms. In this context, the present study, based on the field of health promotion and primary prevention, outlines the following five task areas 1. gathering socio-epidemiological data, 2. health communication, 3. implementation of interventions, 4. method development, evaluation and quality development and 5. discursivization; all of these are highly relevant both for practical work of all identified actors and for their coordination. Taken together, these open a window of opportunity for a coherent, nationwide infrastructure for public health that is capable of action and has the ability to adapt as needed in Germany.
Asunto(s)
Promoción de la Salud , Salud Pública , Alemania , Programas de Gobierno , Atención a la SaludRESUMEN
The contribution contains the laudation on behalf of the award of the Salomon-Neumann-Medal 2020 of the German Society for Social Medicine and Prevention to Prof. Karl Lauterbach.
Asunto(s)
Distinciones y Premios , Medicina Social , Alemania , Sociedades MédicasRESUMEN
OBJECTIVES: To study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing. DESIGN: Non-randomised evaluation and cost analysis. SETTING: Gay venues in 11 of 26 cantons in Switzerland and national online media campaign. PARTICIPANTS: MSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community. RESULTS: Campaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36-55. The number of HIV tests in the month after the campaign was twice the monthly average. CONCLUSION: Break the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively.