Mr. Tiernan Brady:

I wish to thank the Chairman and other members of the joint committee for deciding to discuss this issue about which awareness needs to be raised. I will examine the figures and talk about some of the trends that are emerging. The most recent full-year data is for 2012. As regard gay and bisexual men and MSM, in recent years we have seen a significant rise in the rates of diagnosis. In 2005 we had 60 cases, while last year we had 161 cases. That represents a 160% increase in diagnosis rates in that time period. It is not a random spike, but a clear trend if one examines the graphs I have included in the document.

In 2010, for the first time, MSM became the largest population group of new HIV diagnosis rates, with 48% of new cases last year. For the first six months of this year we are roughly at 50% again, so unfortunately the trend continues building on previous years.

Figures for the first six months of this year show that the trend is still continuing. We had 72 cases of HIV in MSM diagnosed in that period, which is up to 82 this year.

A key point is that the median age at which people are being diagnosed is getting lower. That trend has been happening consistently in recent years, to the point where for the first six months of this year the median age for young gay and bisexual men being diagnosed is 31. There is also a time lapse between when one gets a condition and when it is diagnosed. We can therefore take it that people are contracting the condition at a slightly lower age than 31.

The figures show that there is a significant issue for a specific group of people - gay and bisexual men. Within that group, that can be targeted down to younger gay and bisexual men. We know that from the statistics which are very good in Ireland. We have a good information gathering service with the HPSC.

Building on the figures, what do we do to address the situation? We can examine two key areas. First, we need to raise awareness about HIV for groups that are most at risk. Second, we need to get people to access sexual health services so that they can make the best possible decisions and get the best sexual health outcomes.

One of the key points about raising awareness is through the kind of campaigns the committee will hear about from other groups. Those must be targeted to groups most in need. We are no longer in the 1980s or 1990s where generations could remember blanket radio and television campaigns about HIV and AIDS. Those resources simply do not exist nowadays. It is now about taking what resources are there and focusing them on groups that are most at risk.

The other key part of raising awareness is through education. There is a good curriculum on sexual health, which is caused the Trust curriculum that was developed in Ireland. One of the challenges, however, is that it is not being taught everywhere. The question, therefore, is how can we address the barriers that prevent it from being taught. Why do people feel uncomfortable teaching the course? Young people in secondary school are a captive audience who can be furnished with the information they need to make the best possible decisions for themselves. No more than in all parts of health, this is about giving people information and the capacity to deliver on their own health outcomes in so far as they can.

Engaging with health services is a critical element. We know that when people contract HIV, they are most contagious in the early stages. It can be passed on more easily in the early stages but, unfortunately, that is the time when one is least likely to know one's status. We need, therefore, to get people to know their status. People must be able to engage with sexual health services and get tested. The quicker people know their status the less likely it is that HIV will be passed on. Most HIV is passed on by people who simply do not know they have it. We must be able to address that problem which is about engaging with services.

Just as we talk about addressing barriers to teaching the curriculum, one of the key things about getting people to engage with sexual health services is by trying to address barriers that stop people from doing so. There are significant social barriers for all people to engage with their sexual health services, but most especially for gay and bisexual men. Many recommendations in previous reports have been developed through NASC and the education prevention committee, discussing how best to engage with those services. Some of them are contained in our document.

The key recommendations we suggest include continuing further campaigns on HIV prevention and raising awareness. These must be targeted to groups at risk. In addition, we need to develop and implement national campaigns to address the stigma and discrimination facing people living with HIV, and the knock-on effect that has in getting people to engage with services.

We also recommend the completion of the national sexual health strategy. I am glad to say that I am on the steering group of that strategy and it is wonderful to know it is coming close to completion. We also need a proper analysis of the barriers preventing teachers from feeling that they can roll out the Trust curriculum to raise awareness.

Ultimately, this is about people making the best decisions to protect their own sexual health.