Mr. Tiernan Brady:

I thank the members of the committee for putting this on the agenda. Unfortunately the trends in HIV diagnosis picture have not changed since last year. Today we are calling for a new approach to this so that we can try to achieve the goals of having zero new infections and zero discrimination against people who are living with HIV in Ireland.

The statistics that have been published clearly show that the trend is not good. In 2005 we had 60 cases of new diagnoses of gay and bisexual men and this had moved up to 159 cases in 2013. This week the figures for the first six months of 2014 were released. Unfortunately they mirror those problems. We have gone from 82 cases in the first six months of 2013 up to 94 in the first six months of 2014. So there is a significant problem here. Especially for gay and bisexual men this is an issue that needs real attention and needs a new set of thinking on how we engage with people and how we get people to engage on their own sexual health. That is one of the key targets here. Ultimately we want to empower people to make the right decisions for themselves.

HIV is an easily preventable condition, as are many sexually transmitted infections. However, we have to be able to equip people with the confidence and awareness they need so that they can engage with their own sexual health. We need to do that, starting from the basis of being honest about sexual health. Nobody looks forward to an encounter with a doctor, an NGO or anybody about their sexual health. Nobody wakes up in the morning with a smile on their face, thinking, "I'm having my syphilis test today"; that is not how the world works. Far too often our services are built on the idea that is how the world works with the notion that if we provide the service, of course, people will come to it. In reality there are so many significant barriers - social and stigma barriers - to engaging on sexual health for the entire population. A whole additional level goes in on top for LGBT people and in the case of HIV in particular for gay and bisexual men.

In Ireland the most common point of call for people engaging with their health is with their GP at primary care. However, based on the most up-to-date Irish research, 54% of LGBT people are not out to their doctors. If they are not out to their GPs about their sexual orientation, then there is no chance they will be able to get to their next step, which is their sexual health in general and that is important information for their doctors to know.

We have been working with the Irish College of General Practitioners and health-care providers in sexually transmitted infection clinics to build their capacity to understand, first, that they have LGBT patients who look like everybody else and, second, that those patients face significant additional barriers when engaging with health services. Those themes represent a two-step approach. We have to be able to build up the capacity of the service provider before telling the service user it is okay to proceed. We have had a very positive relationship with the Irish College of General Practitioners. We have a new set of guidelines there. We are working with St. James's and the Mater hospitals to help equip doctors through training seminars, increasing their awareness that there are issues and that there are lesbian and gay patients in their clinics.

Once we know of the barriers we need to ask how we can be inventive about trying to create a service that is easy for people to use based on the original principle that we know people would prefer not to use the service at all. We need services that are convenient, accessible, inclusive and understanding of those challenges. Ms Seery's rapid testing service in Cork addresses that fear of the long delay before the result. Mr. Foley's home testing uses new technologies to get people to engage more on their sexual health, while at the same time building up the capacity of primary care to deliver effectively for their lesbian and gay patients and more specifically for their gay and bisexual men patients.

We need strategies that are targeted and tailored, and that recognise that one size does not fit all the population, given that we are dealing with an issue that people are very reluctant to engage in.

Mr. Goulding will talk more about this. We need to get to a point where there is zero discrimination against people living with HIV. It is very real and has not gone away. Stigma still exists. To anyone who believes it does not exist I would ask them, "If you were diagnosed with HIV tomorrow, whom would you tell?" I am pretty sure the answer is "Nobody". Would such people tell their boss, their friends or their family? Why would they not tell them? Regardless of whether we want to concede it, stigma is very real and Mr. Goulding will refer to that.

Some key recommendations arise from this. On testing, we need to develop programmes that are resourced and recognise that we need to make testing accessible in many different ways because of the significant barriers to sexual health engagement for everybody and the additional barriers for gay and bisexual men in particular. As Ms Seery has said, this is important because the vast majority of HIV cases are passed on by people who do not know they have HIV. So we need people to know their status, whether negative or positive. There is peace of mind for those who realise they have a negative status. In additional the quicker those with a positive status get into treatment the better it is for their long-term health outcomes. So we want to drive in as many people as possible.

There needs to be a new focus on stigma and we need to invest money to raise awareness with the general population.

We all remember huge advertising campaigns about HIV when it was in the public consciousness but these no longer exist. We are not unrealistic about budgetary requirements and they will not suddenly started to exist again, but we need to find ways to target messaging to raise awareness that HIV exists, that people live with it and that stigma is unacceptable. The prevention messages must be equally targeted because within the HIV figures we can see the diagnosis age is getting younger and younger. It has gone from 37 years in 2005 to 32 years now. Part of the reason is this generation did not have exposure to the type of information and heavy-duty campaigning that was out there.

We want to sign off on the national sexual health strategy. We know it is nearly completed, or ready to be signed off, but the quicker the better so we can start to implement it. It needs tough implementation guidelines and real targets and goals.