Public position: "This reversal communicates the policing of other people's sex lives, is a deterrent to screening and will promote the underreporting of STIs"

GAT Grupo de Ativistas em Tratamentos rejects the position of the National Association of Public Health Doctors, which advocates ending the anonymity of those diagnosed with a sexually transmitted infection (STI).

Between 2020 and 2022, GAT diagnosed, treated and notified 3,465 STIs and considers that the social alarmism about the "skyrocketing" incidence of STIs and the recurring proposals for "policing" by public health services are very worrying, ineffective, counterproductive and against the best principles of defending and promoting public health.

Current epidemiological knowledge does not allow us to guarantee that there is in fact an increase in the incidence of STIs, although it is possible.

What we do know is that there has been an increase in the number of notifications, which is positive in an area where underreporting has been a given and contrary to the definition of prevention policies.

We don't know how to quantify the impact of increased notification, to which the TAO has contributed a great deal in recent years.

We don't know the impact of the greater supply, which is still insufficient, and the growing demand for screening to identify and treat asymptomatic infections, which is estimated to be 50% in men and 70% in women.

To quote the motto of the AIDS Activists in 1983: "We need good research and good public health, we don't need hysteria".

GAT argues (and puts into practice) that the systematic offer of support to people with STIs with information and treatment for sexual partners is very important, but it has to be voluntary, led by the people diagnosed and together with the health professionals who offered the screening, and it can be done anonymously or not. This is because, as the WHO states, in the context of managing sexual partnerships with diagnosed people: "these actions must be carried out with sensitivity and taking into account social and cultural factors, in order to avoid ethical and practical problems such as rejection and violence, particularly against women"^[1] .

Since 2012, GAT has developed and promoted an anonymous partner notification system called CheckOUT™ with effective results in detecting STIs, sometimes at an asymptomatic stage.

The anonymization of DNO (Notifiable Diseases) is a communication to the health authority indicating that the person diagnosed with an STI has not consented to partner notification being led by the health professional (external/public health).

Reversing this practice will be seen as a step backwards in the public consent mechanism for public health services to contact people diagnosed with STIs in the context of sexual life. We believe that this reversal communicates the policing of the sexual lives of others, is a deterrent to screening and will promote the underreporting of STIs.

Public health can contribute to reducing STIs with:

• Anonymous notification systems for sexual partners, built by public health professionals but led by the people diagnosed, and enabling automatic delivery to the people notified of an MCDT request for the respective bacterial STIs;
• Extension of the free condom distribution network to the entire public school system (university, secondary school, 3rd cycle of basic education);
• Expansion of the open consultation model for the diagnosis and treatment of STIs in all Local Health Units in the NHS;

Public health policies must solve the problem of free coverage and access to condoms and lubricant gel, access and coverage of screening for bacterial STIs by molecular methods, PrEP for the incurable STI that is HIV, and vaccination against Mpox, hepatitis A and B viruses and HPV in adults, as well as the introduction of new STI prevention technologies such as the gonorrhea vaccine (through cross-protection of the meningococcus B vaccine) and the availability of post-exposure prophylaxis for STIs (doxyPPE).

GAT is available to work with health authorities on these issues, based on the available evidence, the recommendations of the WHO, UNAIDS, ECDC and other international institutions, always respecting human rights.

_{^[1] Guidelines for the management of sexually transmitted infections, World Health Organization, 2003, p.76.}