Ms Deirdre Seery:

I thank the committee for the invitation to speak to it. I am the CEO of the Sexual Health Centre in Cork and have been there for 25 years, which some might say is a long time. I will discuss the changes that have taken place in terms of HIV in that time. It is nice to see some Deputies and Senators from Cork.

As Mr. Mulligan stated, there were 203 new cases of HIV diagnosed in the first half of 2015, which is more than one person per day. So far this year, there have been 427 new infections, an increase of 85 on 2014. HIV is preventable. We need to reflect on how we can improve our HIV prevention. Why is the incidence of HIV increasing and what can we do about it? We do not have concrete data on why it is increasing. It lacks visibility and we know about the context of stigma.

Regarding visibility, before the current treatments were available and when HIV led to AIDS and, ultimately, death, there was no escaping its reality. People were "outed" when they developed AIDS. They had no choice in the matter - the virus did it. Families and friends had to embrace the news of the diagnosis, often within a short timeframe between knowing the status of the person with HIV and his or her death. Frequently, this was accompanied by the realisation that people not only had a terminal illness, but they were gay and-or men having sex with men. Or maybe they were injecting drugs or it was down to heterosexual transmission. There was a lot with which to cope. People with HIV feared rejection and isolation at their time of greatest need. Families kept things secret, locking themselves away from their own support systems and often blaming themselves, for example, parents wondering whether it was their fault that a son was gay or whether they were good role models.

Today, there are effective treatments for HIV and those on treatment are unlikely to develop AIDS. People living with HIV are no longer "outed" by their condition. They have choices about who and when they tell and even whether they tell. This is a cause of celebration and a basic human right of anyone living with any illness. However, has the lack of visibility made us complacent? Is it a case of someone not knowing anyone with HIV and, therefore, it does not exist? I hear this all of the time. HIV is no longer a death sentence, no longer visible, so can we take risks?

Undeniably, an increase in risky sexual behaviours is increasing the risk of HIV and STIs. To combat complacency, we need to raise the visibility of HIV continually. This year, there is a national campaign around World AIDS Day. We need integrated, joined-up thinking and actions. Awareness raising needs to be sustained and of sufficient scale so that HIV remains visible.

Community-based Rapid HIV testing is also a welcome response. Gender, Orientation, Sexual Health, HIV, or GOSHH, in Limerick and the Sexual Health Centre in Cork undertook one-minute HIV testing at gay venues last week during European HIV testing week. The willingness of people to test shows that we can develop this approach further. Mr. Brady will discuss our joint new initiative further.

Mr. Mulligan has mentioned stigma, so I would like to discuss self-stigma. There is social stigma and self-stigma. With social stigma, people may be judged negatively by the people around them. Mr. Mulligan has given concrete examples of social stigma that our agencies around the country have experienced in our advocacy work. However, there is also self-stigma, where people fear the judgment of others and consequently close themselves off from the possibility of negative judgments. Self-stigma stops people from accessing services and supports. They may even be afraid to enter our buildings in case they are seen, discovered, exposed. This is the reality with which we are dealing.

People may internalise how they believe others perceive them. For one person who spoke about this, it felt like being a human time bomb waiting to go off. It made another feel worthless. Some newly diagnosed people can feel suicidal at first. We have seen people change completely when they receive counselling and support. Their lives can turn around and they can live healthy and fulfilling lives, where HIV is a diagnosis, not their total identities.

We can show solidarity to people living with HIV by challenging stigma and discrimination. This is within our control. We can provide support to individuals so that stigma is not just something that society does to people with HIV. Stigma loses its power over people who have self-confidence and positive self-esteem, people who know that a HIV diagnosis is just that. It is not their whole person. They can lead satisfying lives, including sex lives. Counselling and support helps this process. We provide these. Not only do we need to provide good support services, but we also have to reflect continually upon how to make these services safer and more accessible to people when they feel at their most vulnerable. That requires joined-up thinking and multisectoral partnership between policy makers, implementers and HIV services.

In addition to counselling support, there are effective treatments. These treatments have revolutionised the response to HIV. They not only protect the health of people with HIV, but they decrease the possibility of passing HIV to others because they reduce the amount of the virus - the viral load - in people's systems. Treatment is expensive to the State but, thankfully, extensive and free to individuals.

Before someone can access treatment, though, he or she needs to know his or her HIV status. The greatest challenge now is to increase the level of testing. We are promoting testing with such vigour because it is important that people know their HIV status. Testing has also been revolutionised. Some HIV tests require a wait of one or two weeks for results. However, outreach testing can offer a HIV test that gives the result in one minute. This is indeed Rapid. When the Minister for Health, Deputy Varadkar, launched the national sexual health strategy recently, he announced that funding was being made available for free testing in community settings using targeted outreach. Prior to this, GOSHH and we had to charge for that service. The UK is making free home tests available so that people can send their home tests to a lab and get their results in three days. Scaling up HIV testing is an important step in improving HIV prevention. As they say, we have the technology.

The trials for pre-exposure prophylaxis, PrEP, where drugs are provided that help prevent HIV transmission, were shown to be so successful that they were stopped early. We need to know more about how PrEP can be best applied in the Irish situation to maximum effect. We have a clinical lead for the national sexual health strategy in place to steer this process. We are getting there.

Condoms are old-fashioned, but they are still the most effective way of preventing STIs. They are cost effective. If condom use declines, STIs may increase. As such, we still need to promote condom use. However, we also need to make regular STI screening accessible in community outlets. Hospitals cannot cope with broadening out STI screening to a large extent, but there are increasingly new testing kits being produced that make testing in non-medical settings possible and cost effective. They just need to be more affordable. I have one such kit with me. It is small, easy to use and tests for 12 STIs.

At the moment it is expensive. We hope to be able to use these kits in our agencies to detect sexually transmitted infections, STIs, and therefore reduce onward transmission.

With regard to targeted HIV prevention, surely after the success of the Yes Equality campaign it is okay to be gay. For the majority of Irish people it is okay, especially for younger gay people. There are still many men who have sex with men who do not identify as gay, who may be married, living secret double lives. They are difficult to access. In our community outreach testing, we particularly target men who have sex with men and those hidden populations. I have not yet mentioned talking about sex. How can we negotiate safer sex without being able to talk about sex? Good quality sex education has been shown to be effective and it is imperative to our future HIV and STI prevention programmes. I mean sex education and not just information on reproduction. We are competing with pornography, which is the biggest educator of young people today. It has a major impact on misinformation to people and what is regarded as normal sexual behaviour. We need excellent and proactive sex education.

New and younger generations of people are becoming HIV positive who would not have been exposed to the old safer sex and safer drug use campaigns, so we need to keep those up. What can we do? We are increasing testing that is rapid, community-based and free. We need to continue to promote condom use and safer sex and we need to assess the use of pre-exposure prophylaxis, PrEP, for those most at risk. We have free counselling, support and advocacy, and we must continually challenge stigma in order that people can feel safe in accessing these services. We need targeted outreach to those most at risk of HIV. As service providers, we must continually reflect and improve. We need to work in partnership with all the key actors. We provide great services but it is not enough, however, to do the right things. We need to do the right things right. We have not won the HIV prevention battle yet and we need the committee's continued support to do it.