The Coimbra Local Health Unit screened 147 people during a free STI testing drive timed to coincide with Queima das Fitas, the city's iconic student festival. Two individuals tested positive and were immediately referred for medical follow-up, underscoring a broader national reality: Portugal now faces one of the highest HIV diagnosis rates in the European Union—triple the continental average—while syphilis cases have surged 140% between 2019 and 2023.
Why This Matters
• Free testing is back: Walk-in STI screening for HIV, syphilis, and hepatitis B and C is available across multiple Portuguese cities, including Lisboa, Porto, and Coimbra. No appointment necessary.
• Syphilis is resurging: Portugal logged 1,153 syphilis cases in 2023, reversing decades of declining infection rates and tracking a worrying pan-European trend.
• Late diagnosis is lethal: Over 53% of new HIV infections in Portugal are diagnosed late, rising to 65% among those aged 50 or older—a gap that directly worsens outcomes and fuels onward transmission.
• Young women dominate screening: The vast majority of participants in Coimbra were women aged 20 to 25, revealing a gendered gap in health-seeking behavior among Portuguese youth.
What Happened in Coimbra
A white testing tent pitched in Praça da República became an impromptu frontline in Portugal's fight against sexually transmitted infections. The Coimbra Local Health Unit's Infectious Diseases Service partnered with the Department of Public Health to deploy rapid blood-prick tests during the opening days of Queima das Fitas, the rowdy week-long student festival that floods the university town each May.
Dr. Cristina Valente, who directs the Infectious Diseases Service, framed the event as both tactical and symbolic. "We chose this moment because it's when thousands of young people gather, many of whom are sexually active but have never been tested," she explained. The initiative was backed by Portugal's Directorate-General of Health under its Viral Hepatitis Priority Health Programme and included free distribution of condoms and other contraceptive supplies.
The demographic breakdown revealed a striking pattern: although the gender split was relatively balanced, women significantly outnumbered men among those who volunteered for screening. The age band of 20 to 25 years old dominated, capturing Portugal's university cohort at a critical juncture in their sexual and reproductive lives.
Portugal's STI Burden in 2026
The Coimbra initiative arrives at a pivotal moment. According to the most recent "HIV Infection in Portugal – 2025" report issued by the Ricardo Jorge National Health Institute and the Directorate-General of Health, the country recorded 997 new HIV infections diagnosed in 2024, of which 951 were identified domestically. This figure marks a 35% reduction in new HIV cases and a 43% drop in AIDS diagnoses since 2015—progress that looks encouraging until placed beside the European baseline.
Portugal's HIV notification rate of 8.8 per 100,000 inhabitants remains roughly three times the EU/EEA average, a stubborn gap that has persisted for over a decade. Heterosexual transmission accounts for just over half of new infections (52.5%), but among men, sex between men drives 60.6% of diagnoses. Critically, more than half of all new cases are detected late, a pattern that amplifies both individual morbidity and community transmission risk.
Bacterial STIs tell an even starker story. Syphilis cases climbed 140% from 2019 to 2023, reaching 1,153 confirmed infections—a rate of 14.8 per 100,000, well above the European median. Gonorrhea surged 80% in 2022, with 2,280 cases logged, while chlamydia infections stood at 1,404 in 2023. Across the continent, the European Centre for Disease Prevention and Control recorded historic highs for gonorrhea (106,331 cases in 2024, up roughly 300% in a decade) and syphilis (45,577 cases, more than doubling over the same span).
Hepatitis A also flared unexpectedly. Between January and May 2025, 504 hepatitis A infections were notified, driven by two concurrent outbreaks: one affecting marginalized children in the Algarve, Alentejo, and Lisbon Valley through person-to-person spread, and another linked to sexual transmission among men who have sex with men, accounting for 122 cases since early 2025.
Why Late Diagnosis Kills
Dr. Valente's message to festival-goers was blunt: "Everyone should test at least once in their lifetime for HIV, hepatitis B and C, and syphilis, because the numbers are climbing again." She emphasized that people who test regularly and are diagnosed early achieve markedly better health outcomes than those who defer screening, a finding borne out by Portuguese epidemiological data.
Late diagnosis—defined as a CD4 count below 350 cells/mm³ or an AIDS-defining condition at first presentation—affects 53.9% of new HIV cases nationally, rising sharply with age. Delayed identification not only accelerates disease progression and complicates treatment but also extends the window during which unknowing carriers can transmit infection to partners.
The problem is compounded by the fact that many STIs, particularly chlamydia, gonorrhea, and early-stage syphilis, often present no symptoms. "People can be infected and never realize it, frequently due to risky behavior during adolescence," Dr. Valente noted. This silent transmission dynamic means that young adults who skip early screening may carry undetected infections for years, eventually facing infertility, chronic liver disease, or advanced HIV.
Where to Get Tested in Portugal
Portugal's public health network now offers multiple avenues for free, confidential STI screening, particularly targeting younger demographics:
Greater Lisbon: Since April 2026, over 50 community pharmacies in Amadora, Sintra, Odivelas, and Loures provide rapid, anonymous tests for HIV, hepatitis B, and hepatitis C under the "Know Yourself" (Saiba de si) campaign, running through March 2027. The service is open to anyone over 18.
National NGOs: Associação Abraço operates walk-in testing centers in Porto, Aveiro, Braga, Lisboa, Setúbal, and Funchal, offering rapid HIV, syphilis, and hepatitis B and C screening at no cost.
University campuses: The University of Coimbra's "Protection+ Screening" (Rastreio Proteção+) program, launched during Queima das Fitas 2024 and continuing into 2026, tests for HIV, hepatitis A/B/C, syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium. Similar initiatives run at the Coimbra School of Nursing, the University of Porto's Faculty of Medicine, and Lusíada University Porto, which held a campus-wide screening drive from May 18 to 22, 2026.
Specialist hubs: The Coimbra Local Health Unit offers direct referrals and follow-up for anyone testing positive during community campaigns, integrating rapid diagnostics with same-day clinical pathways.
What This Means for Residents
The resurgence of bacterial STIs and the persistent HIV burden underscore a critical gap in Portugal's sexual health infrastructure: screening uptake remains far too low, especially among men and older adults. While the healthcare system has made treatment highly effective—hepatitis C cures exceed 97% success rates, and antiretroviral therapy can render HIV undetectable and untransmittable—these interventions depend entirely on diagnosis.
For residents, the takeaway is straightforward: free testing is widely accessible and confidential. If you're sexually active, have had unprotected sex at any point, or belong to a higher-risk group (men who have sex with men, people with multiple partners, anyone over 50 who hasn't been screened), walk-in services across Portugal eliminate both cost and bureaucratic barriers.
From a public health perspective, Portugal's triple-the-EU HIV rate and the 140% syphilis spike signal that behavioral interventions—particularly condom use and partner notification—are failing to keep pace with infection dynamics. The youth-focused approach adopted in Coimbra is a proven model: catching infections early not only saves lives but also severs transmission chains before they amplify.
The Gendered Testing Gap
The Coimbra data point to an uncomfortable reality: men, particularly young heterosexual men, are dramatically underrepresented in voluntary STI screening. This mirrors broader European trends, where men—despite accounting for the majority of new HIV and syphilis cases—are less likely to seek preventive healthcare.
Health authorities attribute this gap to a mix of stigma, perceived invulnerability, and structural factors such as clinic hours that conflict with work schedules. The consequence is predictable: men are diagnosed later, present with more advanced disease, and drive higher transmission rates than women. Expanding pharmacy-based testing and deploying mobile units to workplaces and nightlife zones may help close this dangerous gap.
The Long View
Portugal has achieved measurable progress against HIV since 2015, cutting new infections by over a third. Hepatitis B vaccination coverage among newborns surged from 77% in 2023 to 98% in 2025, placing the country ahead of WHO elimination targets for that age cohort. Antiretroviral therapy is free and universally accessible, and viral hepatitis treatments are state-funded with near-universal cure rates.
Yet these victories are fragile. The explosive growth in syphilis, gonorrhea, and chlamydia—coupled with stubborn late-diagnosis rates—suggests that prevention messaging and testing infrastructure have not kept pace with changing sexual behavior. European health officials point to declining condom use, dating apps that facilitate rapid partner turnover, and inadequate sex education as key drivers of the current surge.
For Portugal, the path forward is clear: sustain the gains against HIV and viral hepatitis while urgently addressing bacterial STIs through expanded screening, faster partner notification, and renewed investment in sexual health literacy. The 147 people tested in Coimbra represent a tiny fraction of the national need—but they also demonstrate that when testing comes to people, people will respond.
