Dr. Tony Holohan:

I thank the Chairman and the committee for providing the time. I am joined by my colleague, Dr. Kate O'Flaherty, who is now heading up the health and well-being programme in the Department which, as the committee will be aware, is a new unit established to drive the implementation of Healthy Ireland which was approved by Government in the early part of this year. Kate comes to us from the Pharmaceutical Society of Ireland, PSI. She is both a pharmacist and a journalist and she has responsibility for sexual health.

On behalf of the Department, I welcome the opportunity to be here today, in particular, to brief the committee on the development of the national sexual health strategy, which is the context in policy terms for our consideration of the issues this morning and which is currently being finalised.

The implementation of that strategy will be undertaken by the health and well-being division of the HSE, and Dr. Stephanie O'Keeffe and her team from the HSE will speak to that. They will be supported by the key stakeholders in the area. The strategy and its implementation are underpinned by the goals and principles of the Healthy Ireland framework which I have mentioned already.

This new strategy is the first time that a nationally co-ordinated approach has been developed to address sexual health and well-being and to reduce negative health outcomes, including in the specific area of HIV. The strategy's vision is that everyone in Ireland experiences positive sexual health and well-being, and has access to high quality sexual health information, education and services throughout the life course. The strategy takes a life course approach, which is consistent with the underpinning concept in the Healthy Ireland framework, and acknowledges the importance of developing healthy sexuality throughout childhood and adolescence and builds on that foundation for positive sexual health and well-being into adult hood and older age.

Sexual health is an important part of overall health. It means in the first place the absence of disease and infection but also covers well-being, the ability to control fertility and to have children and the ability to enjoy fulfilling relationships free from discrimination.

Worldwide, sexually transmitted infections, STIs, are among the most common causes of disease and are an increasing cause of ill health. Apart from the initial symptoms and discomfort, they may result in long-term health problems such as infertility, ectopic pregnancies and genital cancers. In Ireland, rising STI rates have increased the level of concern in this area among health professionals, the Government and the public, and are something we are certainly concerned about.

Sexual health infections prevention and treatment services include a broad range of health care at different levels, both public and private, throughout the health care system. The main elements include: prevention of sexually transmitted infections and clinical care for those with STIs; contraception; screening for diseases such as genital chlamydia; psychosexual counselling and support; and specialised services for high-risk groups and diseases.

HSE public STI screening services are almost exclusively based in hospitals and special community clinic settings around Ireland and they are free at the point of access. In places, some GP practices and family planning services may provide STI services for a fee.

The national AIDS strategy committee, NASC, was established in 1992 by the Government as a response to the HIV crisis. It comprised a wide range of stakeholders, including academia, the health sector, the health boards, Dublin Aids Alliance, and other NGOs, and I would like to acknowledge the commitment and effort over the past 20 years by all the stakeholders in the implementation of that strategy.

Ireland has experienced many changes regarding sexual behaviour and sexuality in recent decades. This changing landscape is evident in legislation introduced in recent years and more openness generally in attitudes and culture around sexuality and sexual health issues.

In the area of treatment, and specifically in the area of HIV, the treatment of HIV has been revolutionised with the introduction of highly active antiretroviral therapy, HAART, which is a special drug therapy which is effective in managing HIV. However, it is equally recognised that the culture can be further improved and that consequences such as non-disclosure of HIV status or late diagnosis continue to be issues that require further efforts and that the fear of stigma or discrimination may prevent people accessing the medical assistance or counselling supports they need. It is also recognised that a broad range of non-health determinants all impact on sexual health and well-being, and sexual health inequalities - the extent to which they are unevenly distributed throughout society - and this is a key feature of the approach taken under the Healthy Ireland framework.

For many individuals, their sexual health service needs are not complex and they can and should be delivered, as with all other health services, at the lowest level of complexity appropriate within our health services, which is within primary care. Notwithstanding this, there are people at greater risk of and-or vulnerable to experiencing negative health outcomes and who, therefore, require specific interventions to achieve and maintain positive sexual health and well-being. The development and implementation of a national sexual health strategy emanates from recommendations of the 2009 review of NASC report. It is in the process of being finalised. A steering group to oversee the drafting of a strategy was established in May 2012. Its terms of reference set out that the strategy would provide a strategic direction for the delivery of sexual health services and a focus on improving sexual health and well-being in addition to addressing issues such as surveillance, testing, prevention and treatment of STIs and HIV, crisis pregnancy, and sexual health education and promotion. The strategy was intended to be in line with the Healthy Ireland framework, which was in development also at the time. The drafting of the strategy has been supported helpfully by our colleagues in the Institute of Public Health. More broadly, the steering group and working groups referred to a number of existing policy documents, including excellent work done by the college of physicians as well as the crisis pregnancy programme, during their deliberations.

The work of developing the strategy is in its final stages, with a final draft to be circulated to the steering group shortly, with a view to the document progressing for Government approval and publication early in 2014. The group was chaired by the Department of Health and comprised representatives of key agencies and stakeholders involved in delivering sexual health services, including a significant number of those who sat on the NASC. The steering group did its work through three working group on education and prevention working group, services working group and health intelligence, which is surveillance and monitoring.

The health and well-being division of the health service directorate will take responsibility for leading the implementation of this strategy, operating with the overall parameters of the Healthy Ireland framework. The implementation will include the appointment of a national lead on sexual health and the establishment of a national advisory group, drawn from key stakeholders, to support and oversee the development and roll-out of the implementation plan. Among the key first steps for the implementation of the strategy will be exercises to map current services and assess needs, and develop an evidence informed approach to target those most at risk of negative sexual health outcomes. Ongoing monitoring and evaluation of the implementation plan and outcomes, including the use of specific indicators to monitor its progress will be facilitated by through an outcomes framework, which will include a research and data dimension as part of our overall work on Healthy Ireland. In addition, in line with the principles of Healthy Ireland, opportunities to improve co-ordination and communication and maximise synergies between other strategies and polices in health and education, as well as other sectors, will be identified and pursued.