Dr. Derval Igoe:

I will speak about two aspects of primary prevention, namely, behaviour change and harm reduction and pre-exposure vaccination or prophylaxis. Regarding primary prevention and communicating risk, this disease has been overwhelmingly within the gay, bisexual and men who have sex with men, gbMSM, community. We have worked hard from the beginning to work in partnership with gbMSM representatives, including the Gay Health Network, GHN, and the MPOWER programme. Initially the focus was awareness of this disease, the symptoms and the need to present early for treatment. The next step focused not only providing treatment for the patients, in terms of care, but also identifying others who may be at risk having been exposed to them and providing post-exposure vaccination. That has been happening for quite a while.

More recently the focus is not only on awareness of the disease but also on some changes in behaviour that people might make to reduce their personal risk of infection pending vaccination. Quite a systematic campaign was outlined in the opening statement, using a variety of media channels, outreach in venues etc. employing an approach adopted from America which is like a traffic light approach that indicates behaviours according to higher or lower risk in order for people to be able to avoid certain behaviours that might put them at increased risk. That has been rolled out comprehensively within the community.

The second part is pre-exposure prophylactic vaccination that is now the focus of the vaccination programme. There are two focuses: the post-exposure vaccination which started as soon as was possible when we first got cases in Ireland and we are now planning for the roll-out of the pre-exposure vaccination. It has been taken in a couple of phases. First, we focused on people with a history of early infectious syphilis, identified them quickly and tried to vaccinate them and now we have widened the criteria. With regard to-----