Despite recent progress, the spatialisation of LGBTQIA+ health reveals a history of discrimination and stigma that is at risk of resurfacing Checkpoint Zürich, one of Switzerland’s largest centres for HIV and sexually transmitted infection (STI) care, moved to its new purpose‑built premises on Limmatstrasse in 2023, just steps from the city’s main station. Designed internally by architects Skop under the lead of Basil Spiess, the facility occupies half of the ground floor and the entire first floor of a new six‑storey mixed‑use building. Two large street‑level windows reveal glimpses of administrative and laboratory work, making a quiet statement: sexual healthcare should be as open and transparent as any other form of medical service. Once inside, the space feels nothing like a conventional STI clinic – and indeed, it is far more than that. The double‑height atrium, where clients check in for their appointment, instantly sets the tone; six large, glittering disco balls echo queer nightlife and inject a sense of joy. The interior, accommodating a 40‑person team, is designed to be open and inviting rather than clinical and intimidating. Over the past three decades, attitudes towards sexual health and access to related services have changed significantly across several European countries. Along with the advancement of sexual rights, the focus of sexual and reproductive health has shifted from control, policing and stigma to emphasising self‑determination, personal responsibility and overall wellbeing. Growing up gay in East Germany in the 1990s, there was a pervasive sense of fear around sexual health. Even though HIV had become a manageable chronic condition, shame and anxiety prevailed. Regular testing for HIV and other STIs was hard to access, and obtaining unbiased, holistic advice on sex and intimate life felt nearly impossible. You either braved the judgement of your doctor or had to visit a specialist, risking forced outing. Only after moving to London in the mid‑2000s did I experience genuinely LGBTQIA+‑centred care at places like the sexual health clinic 56 Dean Street in Soho.  Switzerland has long been a leader in HIV prevention and destigmatisation: this poster from 1997 was part of a bold campaign advocating condom use. (Bundesamt für Gesundheit BAG) Checkpoint Zürich has been redefining access and dignity in sexual healthcare in my hometown since 2013. The central waiting area on the first floor is a quiet inward‑looking space that follows the centre’s overall club aesthetics. Exposed concrete ceilings, dark walls and painted structural elements create an industrial atmosphere, while plush rugs, upholstered poufs and greenery provide warmth and comfort. Iridescent glass panels shift in colour depending on the angle of view, representing the fluidity of queer identities while avoiding overt rainbow symbolism. Privacy has been carefully considered, with acoustically and visually sheltered spaces for those in need of a moment of retreat. Together, these elements create an atmosphere that radically differs from typical healthcare settings, which often feel cold, utilitarian and impersonal due to their dull mix of white or pastel‑coloured wall coverings, uniform antibacterial flooring, glaring fluorescent lighting and unwelcoming, wipe‑clean furniture.  The architects’ goal was to create a ‘queer space without any prejudice’; the resulting space is safe, hassle‑free and judgement‑free, offering a full spectrum of medical, psychological and preventive services, alongside mobile testing, campaigning, community and cultural events. These services include counselling about gender identity and access to gender‑affirming care, advice on mental health, drug use and addiction, HIV treatment and prescription of PrEP (pre‑exposure prophylaxis), as well as STI testing regardless of sexual orientation. ‘Self‑organised sexual healthcare has historically been a necessity rather than a choice for the LGBTQIA+ community’ Historically, sexual health clinics – known since the late 19th century as venereal disease clinics – were largely driven by state concerns about public health, crime control and eugenic thinking rather than individual wellbeing. These institutions primarily targeted working‑class and racialised populations, soldiers, sex workers and those whose sexual behaviours were considered ‘deviant’. Doing so, they not only reinforced class‑based and moralistic ideas about sexuality but also policed bodies and ways of life beyond heteronormative, bourgeois standards of respectability. Sexual health was intrinsically linked to the growth of the metropolis, where rising urban populations and shifting social norms heightened anxieties over public morality.  The early 20th century, however, saw advances in sexual health being reclaimed by those who were controlled by such measures. Magnus Hirschfeld’s Institut für Sexualwissenschaft (Institute for Sexual Science), which opened in Berlin in 1919, was one of the first centres dedicated to LGBTQIA+ health and gender‑affirming care before it was brutally attacked and destroyed by Nazi students and paramilitaries in 1933, with Hirschfeld’s extensive research library set on fire. The institute occupied two adjacent late‑19th‑century buildings, one a three‑storey villa and the other an apartment building with a ground‑floor restaurant. As the Institut für Sexualwissenschaft, the buildings served, in Hirschfeld’s words, as ‘a research institution, a place of learning, a healthcare centre and a place of refuge’. The large rooms of the villa housed the world’s first gay rights organisation, the Wissenschaftlich‑humanitäres Komitee (the Scientific‑Humanitarian Committee), as well as consultation rooms, a sitting room and dining room for visitors, and a scientific archive. Located on the attic floor were guest bedrooms for clients of the institute (counting 3,500 in the first year), some of whom also worked there. The former restaurant on the ground floor was converted into a library and lecture hall, where events such as costume balls were held. Self‑organised sexual healthcare has historically been a necessity rather than a choice for the LGBTQIA+ community due to discrimination and systemic exclusion from medical services. In Toronto, the Hassle Free Clinic began operating in 1973, open 24 hours, seven days a week, in the city centre on Yonge Street; once the city’s hub for commerce and entertainment, strip clubs, porn theatres, body‑rub parlours, gay bars, clubs and bathhouses began to populate the street in the late 1960s. Initially focused on drug crisis counselling and treatment, the Hassle Free Clinic provided discreet, non‑judgemental care under the government’s Local Initiatives Project. In the following years, the clinic shifted to offering STI and birth control services. Similarly, the Gay Men’s Health Crisis (GMHC) was launched in 1982 in New York City, offering life‑saving services during the early AIDS crisis when governments failed to respond. Prevention efforts often emerged in spaces linked to casual sex, such as saunas and bathhouses, where community outreach programmes provided education, condoms and, later, HIV testing.  Checkpoint Zürich’s origin story echoes these efforts to establish community‑centred sexual health services to counter the cultural competence that was lacking in LGBTQIA+ issues within traditional healthcare settings. Established in 2005 in response to the rising rates of HIV and other STIs among men who have sex with men, it created a space where testing, prevention and treatment could happen without stigma. The initiative stemmed from a collaboration between the Zürcher AIDS‑Hilfe (now Sexuelle Gesundheit Zürich, SeGZ), founded in 1985, and Arbeitsgemeinschaft für risikoarmen Umgang mit Drogen (ARUD). The latter was instrumental in addressing Switzerland’s heroin crisis in the early 1990s, advocating harm‑reduction strategies at a time when the city’s central Platzspitz park had become an open drug scene. ARUD’s expertise in tackling addiction provided a crucial foundation for Checkpoint Zürich’s integrated approach to sexual health, harm reduction and community outreach. Off‑site, mobile STI testing, for instance, remains a core aspect to this day. The first incarnation of Checkpoint Zürich occupied a former apartment on the upper floors of a late‑19th‑century residential building that fronted onto Sihlquai, an area known for street prostitution until 2013 when it was banned. Due to the successive expansion of services over its near 20‑year history, significantly to include care and advice for trans and non‑binary people, and the resultant increase in client numbers, Checkpoint Zürich outgrew its former premises. The new Checkpoint Zürich clinic joins other recent purpose‑built sexual health clinics, such as the Burrell Street Clinic (designed in 2012 by Urban Salon, now Mowat & Company) in London and Family Tree Clinic (designed in 2021 by Perkins & Will) in Minneapolis. Burrell Street Clinic, London’s largest sexual health centre, provides a stigma‑free environment open seven days a week in one of London’s youngest, as well as most ethnically and sexually diverse, boroughs – also ranking among those with the greatest sexual health need in the country. Featuring a large glass facade and non‑clinical interior, the facility that occupies two railway arches in Southwark was designed to be as welcoming as possible to encourage people to walk in for check‑ups. The Family Tree Clinic in Minneapolis, dating back to the 1970s, likewise serves a broad range of communities, including LGBTQIA+ individuals, people of colour and those on low incomes. Its new‑built clinic prioritises accessibility and safety, incorporating warm, inviting spaces, discreet entrances and a design that fosters both privacy and inclusivity. The expansion of Checkpoint Zürich has greatly improved regional availability of sexual healthcare, yet challenges persist in ensuring nationwide, equitable access. Other centres, albeit smaller and less modern, exist in Basel, Bern, Geneva, Lausanne and Lucerne, creating a network of queer‑friendly sexual health services. Nevertheless, accessibility remains uneven – rural areas and certain cantons lack comparable facilities, leaving many without easy access to specialised STI care. Sexual health services have made tremendous strides, but recent political shifts threaten to undo decades of progress. The closure of clinics, cuts to public health funding and erosion of LGBTQIA+ health protections disproportionately impact marginalised communities. Numerous studies have shown that queer people already face significant health disparities, making these setbacks even more damaging. Without urgent action, hard‑won advances in sexual health equity, represented by clinics such as Checkpoint Zürich, risk being reversed. 2025-04-10 Reuben J Brown Share