Reaching young and low-income people for sexual healthcare -- perspectives from healthcare workers: a qualitative study

BackgroundFree voluntary counselling and testing (VCT) interventions improve access to HIV and sexually transmitted infections (STI) prevention, particularly for underserved 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 implementing the programme, focusing on perceived benefits, barriers, and opportunities for improvement. MethodsWe conducted a qualitative descriptive study with 12 HCPs from two participating clinics. Data collection included semi-structured interviews and semi-quantitative ranking activities to prioritise perceived barriers and hardly reached population groups were analysed using inductive thematic analysis and data frame comparison. Standards for reporting qualitative research guidelines (SRQR) informed reporting. ResultsHCPs 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. The programme successfully reached well-informed, highly educated individuals. However, key high-risk groups - including vocational students, conservative individuals, asylum seekers, and those under 18 - were not well reached. 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. ConclusionHCPs 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. WHAT IS ALREADY KNOWN ON THIS TOPICFinancial barriers reduce uptake of HIV and STI testing, particularly among young and low-income populations in high-income countries. WHAT THIS STUDY ADDSRemoving cost improves uptake and visibility of voluntary counselling and testing (VCT) services, especially among socially connected youth. However, high-need groups such as vocational students, asylum seekers, and individuals from conservative backgrounds remain underreached without targeted outreach. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYFindings highlight the need for policies that combine free testing initiatives with inclusive sexual health education and outreach to improve equity and programme effectiveness.