Mr. Tiernan Brady:

The TRUST programme is very good, but it is not being taught. We advised on its development and also prepared a document with the Department of Education and Skills specifically aimed at helping teachers to provide a sexual education and the SPHE programme for lesbian, gay, bisexual and transgender people. However, we know that it is not being taught universally, even though everybody who is 17 years old is in a classroom. If we are discussing marketing and targeting awareness subject to budgetary constraints, we know where a lot of people are at any one moment. We have a curriculum and have to have it taught.

We repeatedly come back to the issue of stigmatisation of sexual health. People do not want to teach this subject for the same reason a person does not want to go to a doctor to discuss his or her sexual health. I agree that mental health and sexual health are twins in terms of the stigma attached to them. People are embarrassed to engage and this has a detrimental impact. As Senator John Crown rightly noted, engaging is the best thing for individual health outcomes, as well as the other issues that arise from people not knowing their own status. Education is key in building awareness. Sexual health education is about giving people the capacity to assess own their sexual health. Once they have confidence, knowledge and capacity, that is the biggest step. It should not be the case that they have to go to a doctor every couple of months. They should know how to take care of themselves and be able to make the make the best decisions for themselves.

On risk, there is a process which we call "othering". People underestimate their risk exposure. HIV is a good example. Everybody thinks it happens to somebody else. Some think it happens to people from Africa. Straight people think it happens to gay people and gay people think it happens to straight people. The result is that nobody thinks it happens to anybody. Younger people form one of the groups most at risk. When it come to the nationality breakdown, the single largest group is Irish people and, within that cohort, young Irish men. However, these are also the ones who think they are not exposed to risk because they consider themselves to be invincible. They take the attitude that they know what somebody with HIV looks like. They make the same presumptions about someone their own age as they make about themselves and, instantly, that othering process increases their exposure to risk.

To respond to Senator Jillian van Turnhout's question, we know from Irish research that most people become aware of their sexual orientation by the age of 11 or 12 years. The average age when someone comes out is 21 years. In the intervening ten years people keep to themselves one of the most important things about who they are. When we say "coming out", we are referring to the first time a person tells a close friend not to inform his or her entire class. This is an area in which people are incredibly susceptible. There is a good chance that a person under the age of 21 years who presents to a doctor is not out to anybody. We have to ensure health care professionals understand they may be the first to be informed by the patient. What can they do to create an environment that makes it easier and more likely to happen?

On the issue of rapid and home testing, one of the reasons we have only started into this process is there has been considerable worry during the years about home testing and, for example, the circumstances in which a person might be if he or she was to test positive. The safeguards being put in place are very good. Our goal is to persuade people to normalise testing and engagement. Sometimes we devise services for others instead of asking ourselves basic questions about what we would do. Would I prefer to sit in a hospital for several hours or have a home testing kit? When we ask ourselves that question, the answer is so obvious that we can design a system flowing from it. Similarly, in respect of rapid testing, do I want to have to wait for ten days for a result when I can have it in 20 minutes? We should be using all of the technologies available to us to build the widest array of services and break down the barriers in order that people will have pathways for engaging.

Education is key not only at second level but also throughout life. Not everybody is in secondary school. However, we have a good curriculum and need to ensure it is taught in an inclusive way for all students in the classroom.

That would be one of my key asks. I am sure everybody else would have a key ask as well. I hope that answers some questions.