Ms Deirdre Seery:

I thank the Chairman and committee for the invitation.

When I started working in the sexual health centre, then Cork AIDS Alliance, many years ago, HIV was basically almost a death sentence. Since then, we have witnessed many changes. When I started work there, homosexual acts were illegal and condoms were not freely available. I suppose the context I want to give is that HIV allows us to look at how we need different strategies over the years.

Since we have effective treatments for HIV, people with HIV can lead a healthy life. The treatments also reduce the amount of virus in people's systems and, therefore, they are less likely to pass it on to others. The effect of the treatments means that we can really promote testing and look at the opportunities for testing in community sectors and different types of testing. Essentially, that is what we will talk about today. It gives us the possibility of reducing infections.

The context of HIV is fear and stigma. There is a still a huge stigma around HIV and a denial of the risk. I am constantly asked why are there still people getting HIV. There is almost one person per day in Ireland newly infected with HIV. It is preventable. We know how people get it and still the new infections are basically the same. That is why we are focusing on the effectiveness of prevention, both human and financial.

There are three aspects to this that I will outline in my brief contribution: promotion, access and outreach. Promotion has to be targeted at the communities that we feel are most at risk of HIV without losing the focus on the heterosexual population, who still make up a large number of those with HIV. It is a matter of achieving that combination. This is EU testing week. We have got Irish AIDS Day, World AIDS Day and, of course, St. Valentine's week as well. These are all big focal points where the media is interested in promoting testing and we have to ensure that we get as much free publicity as we can out of those.

On access, there are STI clinics in most of the major parts of the country. They offer free and specialist services. They are busy, they have waiting times but they are very good services, and we work hand in hand with those. They give full STI screening.

On top of that, one of the aspects that will be highlighted in the national sexual health strategy is looking at other ways, including community testing. At Sexual Health Centre and Gender, Orientation Sexual, Health, HIV, GOSHH, in Limerick, we have rapid HIV testing - a simply finger-prick or saliva test with results in 20 minutes. It is an opportunity to get people to come in and talk. They feel relief when they can come in and talk about their risks, or sometimes they have not been at risk at all and they are just anxious about the fact that they might have put themselves at risk. Then there is the link that we can have in to the STI screening. If people have put themselves at risk, we can refer them to the STI clinic for full screening. Dublin AIDS Alliance works with St. James's Hospital and, therefore, has a different outreach service where St. James's Hospital does it in the Dublin AIDS Alliance's building. Those are examples of community testing. In the United Kingdom, they are exploring the opportunity of testing for migrant communities in churches.

Community testing offers a huge opportunity. We have got out-of-hours services because our research showed that people want out-of-hours services as well as nine-to-five services. It is a safe and non-clinical environment. People can talk. They can get their relief.

It is cost effective. We have to charge for it at present because we had to prove that people would do it. We have to charge €50, on a sliding scale to free. If people need a repeat test, that is always free. We know that the times when we offer it free, we get more people coming for testing and the next stage is how to improve access to free community testing.

It is very simple. There is rapid turnaround and people do not have to wait a week for the results. They know that if they come, they will know within 20 minutes whether they have HIV or not, so long as they are not in the window period.

The other opportunity that it gives us is for early diagnosis. When people are newly infected with HIV, they are more infectious.

If we can catch people quite early, they can be referred on. We have very good referral routes onto the specialists in the hospitals and they can go on the treatment route. If they know their status and know they are highly infectious, they are less likely to pass on the infection to other people. It is a win-win situation. Mr. Foley will talk about the home testing.

The other aspect we can offer in the NGO sector is outreach work. In our case the outreach work is targeted at men who have sex with men and hidden populations. Many of the men who have sex with men do not identify as gay. So we have to be creative in how we access people who are in risk behaviours. We have to know our populations. We have a very good health intelligence service now from the Health Protection Surveillance Centre. It now has a system whereby it gives us accurate and up-to-date statistics so that we can understand the diversity of populations affected and apply them.

I am also involved in the European Joint Action on Improving Quality in HIV Prevention. That is looking at applying tools so that we are really structured in how we improve quality in HIV prevention. So there are many initiatives going on.

Where do we go from here and how? We still have almost one person a day newly affected with HIV. Over half the people are diagnosed late, which is not good from a health point of view. We have to increase promotion and access. We have the opportunity for leadership. The national sexual health strategy has been sitting in the Department of Health for more than a year. It offers the opportunity to get us all together to work across sectors. It is being modelled on the national HIV strategy committee and we really need to get that out. That is something members of the committee can do. We need to get the national sexual health strategy launched, which will give us the opportunity to work together to develop an implementation plan.

The way HIV has developed is a really good model for responding to a health problem. It involves reflection, focused on continual improvement, strategic work, working across sectors, and effective use of scarce resources. Essentially we focus on doing the right thing at the right time in the right way, constantly reflecting and constantly responding to the needs of HIV prevention.