A characteristic building due to the art deco style sgraffito on its facades stands on the corner of Sandoval and Ruiz streets. Otherwise it doesn’t attract attention. But inside, the battle for health is fought every day: more than 88,000 people entered last year, and they all came out with their tests done and their diagnosis: 7,000 had a sexually transmitted infection. A figure that has skyrocketed over the last decade, explain those responsible for this center, a benchmark in Spain and Europe.
Jorge del Romero arrived at the Sandoval Center 40 years ago; “I came to do my doctoral thesis at a time when HIV didn’t even have a name,” he explains. He is today medical director of this health establishment, specializing in sexually transmitted diseases (STDs), which has been operating for almost a hundred years: since June 1928. “It was originally created to treat young soldiers, heavily affected by syphilis. Then there was no treatment, no antibiotics… there were only some ‘syphilimonies,'” says Del Romero.
When he arrived in Sandoval, “there was even a space for rabbits, which we worked with, infiltrating them to treat syphilis.” If at the time of its opening, and for many decades afterwards, it mainly catered to women, today its users have changed: “They are men, many sex workers and trans people”, explains Del Romero.
In Sandoval, everyone who comes is served, whether or not they have a health card, with and without an appointment. And anyone who enters is guaranteed absolute confidentiality. In fact, there was a time when nothing was asked, which gave rise to more than one anecdote: “There were days when we had eight or nine Felipes González; “We already had to say to someone: ‘dude, if you can tell me another name…'”, says the director of the center. They are now asked for an official document that identifies them, but those who do not have a health card receive a provisional number to seek treatment.
In recent years, managers and workers at the center have witnessed the explosion of cases of sexually transmitted diseases: the figure of 2,258 gonorrhea infections reached in 2023 “we have already exceeded it and it is September”, deplores Del Romero. This increase in demand has also led to the extension of the hours of the center, which since last year has also been open in the afternoon, from eight in the morning to 10 p.m. Fourteen hours at a time, where 60 professionals – including doctors, nurses, pharmacists and other staff – care for those who come. With a particular burden lately, they say, on social workers.
Sometimes people who come to the Sandoval center do so after a rapid HIV test done at an outpatient clinic, or because they suspect they have it. Here they are tested for HIV and other sexually transmitted diseases, many of whom show no symptoms. The quality of care is maximum: “The tests are analyzed in our laboratory and in two hours, they come out with everything confirmed and with a referral to your hospital.”
Facade of the Sandoval center, Madrid
In addition, vaccines are also administered: papilloma, hepatitis, varicella-zoster virus or monkeypox. “It’s a sentinel center: it alerts others when cases increase.” This happened, for example, with monkeypox, in 2022: “The first seven cases in Spain were diagnosed here; and since then, we have had more than 600.
First in HIV
But without a doubt, one of the great milestones of Sandoval is its role in relation to HIV, an area in which it is the first center in Europe that concentrates the most cases treated. Since 2020, it is the first healthcare device to deliver pre-exposure prophylaxis, PrEP, a medication taken to reduce the risks of contracting infection by people at risk of being exposed to HIV through sexual relations, the use of injection drugs or other means. means such as professional exposure.
In Sandoval, they created a hospital pharmacy consultation, linked to the pharmaceutical department of the clinical hospital – to which this center is attached. “PrEP prevents you from taking it,” explains Del Romero, who even remembers the day it was launched at Sandoval: “January 20, 2020; and since then, more than 4,000 people have followed it. This involves undergoing four checks per year and “it is such an effective tool that people who take it do not become infected.”
In his four decades at the Sandoval Center, Jorge del Romero has seen it all. And he is still surprised every day, he says. The evolution of this dispensary specializing in STDs has gone hand in hand with that of the company. His summary is that “the fear of AIDS has been lost; Treatment ensures that sufferers experience it as something chronic; The life expectancy of those treated is similar to that of others, and they die of other things, not this.
But the statistics are grim: “The only thing going down is HIV”; All other sexually transmitted diseases have been on the rise for years. “Gonorrhea and others continue to increase,” explains the director of the center, who links this increase to two factors: “The enormous ease of consuming substances that promote sexual relations and of finding contacts on the Internet. If you put all that in the shaker…”
Very addictive
Here come into play substances used to facilitate, prolong or enhance the sexual experience, such as amphetamine, methamphetamine or ‘tina’, speed, MDMA, ketamine, cocaine or mephedrone (mefe), GHB or the ‘chorri’… “They are very addictive drugs, which begin to be taken in relation to sex and end up being consumed without sexual intercourse,” explains Del Romero. In his experience, “tina” is the most consumed in Barcelona, while in Madrid the one that prevails is mephedrone. “Addictions not only generate physical and mental problems, but also absences from work… we see it a lot here at the center,” underlines its director.
Sandoval’s user profile is “male, young but of age.” Sometimes patients have suffered a form of sexual violence. “This is not something new; “We’ve been talking about male-on-male sexual violence for years,” Del Romero says. Often this is linked to the use of GHB or other drugs. “It does exist, and it’s not something trivial, although it’s not usually reported. “Some told us they had a worse time during the trial when the case was being heard than when they were raped.” It’s not a phenomenon I can quantify, but it exists: “And people tell you they don’t know where to go” when it happens.
Dr. Del Romero is clear that in this area “health education is lacking”; proposes that teachers train students, according to their age, “and not only in the sexual area, but also by informing them about drugs and their effects.” Ask for this and that “sexual orientation without stigma” be respected.
The Sandoval center also works by maintaining contacts with NGOs “to access people who otherwise would not have access to a health center; “We went after vulnerable groups, and that’s how suspicion of infection is handled.” At the center, they also do teaching and research. In this last aspect, they carried out studies on heterosexual couples where one of them was HIV positive. In 2002, they launched a reproductive counseling program for those couples wishing to have children, a unique program in Europe.
Two new centers
The demand for the center is so great that even with the extension of hours, it is not possible to access everything. It is for this reason that the regional government will open two more, one on Andrés Mellado Street and another in the city of Alcorcón. Elena Andradas, general director of Public Health of the Community of Madrid, assures that one will be launched this year and the other in 2025. “With the significant increase in sexually transmitted infections over the last decade, the The goal has been to “always expand” the service, he emphasizes.
At the Sandoval center, he emphasizes, “a diagnosis can be made in real time.” But next to this center, many people go directly to hospital emergency rooms: “Younger people, in particular, generally go there: 9.4 percent of sexually transmitted infections diagnoses made in emergency rooms among minors under 19 years old. years. And in 67% of cases, they are between 20 and 39 years old. There are also older people: 3 percent are between 60 and 79 years old, says Andradas.
He agrees with Del Romero on the significant decline in HIV: “It is controlled and transformed into a chronic disease, but now we see that less condoms are used”, which they intend to counter with campaigns that will use social networks. . “Pre-exposure prophylaxis to prevent HIV could have a negative impact on the use of barrier methods in the young population,” he emphasizes. This is why he insists on the message: “Respectful and conscious sexuality”.
Data on the increase in STDs also agrees, “especially gonorrhea, which is increasingly common, with more than 4,000 cases per year.” It occurs mainly in men, but also in young women, “between 18 and 24 years old”. An additional problem because this infection can degenerate into pelvic inflammatory disease and even “lead the affected person to infertility”.
Public Health currently has 45 rapid testing services for the detection and diagnosis of STDs. In addition to the health centers where they are manufactured, there is also a bus that “goes where the most vulnerable population is”.
