🛡️ The Situation

Spain has 17 Autonomous Communities, and sexual healthcare is entirely decentralized. There is no single "Spanish" system. What is fast, digital, and efficient in Barcelona or Madrid might be a labyrinth of paperwork and waitlists in Andalusia or Galicia.

PrEP ACCESS CRISIS (2025–2026)

Spain's PrEP program is currently bottlenecked. The medication is legally free, but the system cannot keep up with demand because PrEP can only be dispensed through hospital pharmacies, not community pharmacies. Waitlists in some regions exceed 6 to 12 months. Do not arrive in Spain expecting immediate PrEP initiation on the public system.

⚖️ The Golden Rules

  • Get your TSI: Your Tarjeta Sanitaria Individual (TSI) unlocks free care. Without it, you pay. Getting one requires empadronamiento (formal registration at your local town hall).
  • Regions rule everything: Every Autonomous Community runs its own show. Madrid and Barcelona have fast-tracks; other regions move slowly. Check local rules.
  • NGOs are the fast lane: Don't rely solely on public clinics. BCN Checkpoint (Barcelona) and Sandoval (Madrid) bypass bureaucratic nightmares. Go to them first.

⚖️ The Reality of the System

  • It is free: HIV treatment, PrEP, and STI testing are legally free at the point of access via the public system.
  • NGO infrastructure: Major cities have exceptional, gay-led health NGOs that offer world-class, fast-tracked care.
  • Undocumented access: Emergency care and HIV treatment are usually guaranteed regardless of immigration status.
  • Extreme decentralization: Moving regions means starting your paperwork over. There is no unified system.
  • PrEP gridlock: Waitlists for PrEP can be over 6 months because it must be dispensed by hospital pharmacies.
  • Bureaucracy: Getting into the system requires navigating local town halls and strict residency proofs (empadronamiento).

💬 Anonymous Partner Notification

If you test positive for an STI, you can notify your partners completely anonymously. You do not need to face a difficult conversation if you feel unsafe or anxious.

  • Aviso ITS: A free, Spanish-developed service (avisoits.com) specifically designed for anonymous partner notification. Enter a partner's phone number or email to send them an anonymous message alerting them of a potential STI exposure.
  • Public Clinics and NGOs: Centers in the CESIDA network, BCN Checkpoint, or Apoyo Positivo provide counseling. Mediators can guide you on partner notification or help contact them safely and confidentially.
  • Private Portals: If you use private sexual health services, networks like Better2Know offer built-in anonymous partner notification tools.

🗺️ Guide Map

System & Setup

Testing & Clinics

Prevention

Emergencies & Support

Result Management