Dr. Stephanie O'Keeffe:

I thank the Chairman for the invitation to attend the meeting to discuss this area.

Under the new governance arrangements of the health services there are five service divisions on the directorate, one of which is the new health and well-being division. The division provides people with knowledge, services and supports to help them live healthier and more fulfilled lives. The division includes public health departments, health protection services, child health, health promotion and improvement services, environmental health services, emergency management and health intelligence. National frameworks and strategies such as Future Health, and Healthy Ireland - A Framework for Improved Health and Wellbeing 2013-2025 underline the commitments at national level and service wide to increasing the proportion of people who are healthy at all stages of life, reducing health inequalities, protecting the public from threats to health and well-being, and creating an environment where individuals and all sectors of society can play their part in achieving a healthy Ireland.

Improved health and well-being, importantly, is one of four pillars of reform outlined in Future Health. This pillar of reform demarcates a shift in policy, service design and practice away from simply treating sick people to also keeping people healthy. The new division will work with the director general and other national directors to ensure health service reforms result in a greater focus on disease prevention, early detection and intervention and self-care.

One of a number of priorities in 2014 for the division is to review the co-ordination, effectiveness and impact of sexual health services and preventive work. We plan to build on the existing capacity and expertise that we have in the area of sexual health, in health promotion and improvement and public health within the division and with our colleagues in primary care, social inclusion and acute hospitals to improve co-ordination in this area. We also plan to identify a clinical lead to look at sexual health services and improve standardisation in this area. This work will be aligned, as appropriate, across the service divisions of the health service. We will continue to take a strong and strategic partnership approach to addressing sexual health issues involving key stakeholders ranging from other Departments, professional bodies, academia, NGOs, the media and all the groups represented at the meeting.

The work of the health service in this area in more recent times has been guided by the NASC and three national strategies dealing with the prevention of crisis pregnancy. As Dr. Holohan pointed out, the Department of Health established a steering committee and we worked closely with the Department and other stakeholders in developing the draft strategy. A significant volume work is undertaken every day across the health service and by a range of partners across the statutory, non-statutory and community sectors in the area of sexual health. This work is focused on preventing negative sexual health outcomes from unplanned pregnancy to STIs and HIV-AIDS. This work is targeted towards at-risk and vulnerable groups and has been informed by a robust research and information agenda over the past ten years.

Surveillance is an essential part of any framework to support and inform the delivery of sexual health services and supports. Surveillance of STIs and HIV, in particular, has improved in recent years due to the work of clinicians, departments of public health and the Health Protection Surveillance Centre, HPSC. I refer to trends in HIV diagnoses. In 2012, 341 newly-diagnosed HIV cases were reported in Ireland, which equates to a rate of 7.4 per 100,000 population and represents a 7% increase on the 2011 figure of 319. This reversed a downward trend since 2008. A total of 6,629 cases of HIV have been reported in Ireland since the early 1980s. This figure does not represent the number of people living with HIV in Ireland, as it does not take into account factors such as migration or death. Among the reported new cases in 2012, the median age is 33, with the majority male. The probable route of HIV acquisition is men having sex with men, MSM, in 48.7% of cases. This is the largest group and this figure has been increasing since 2004. In addition, 38.1% of new cases were acquired heterosexually and 3.8% through intravenous drug use.

The health service has a strategic objective to improve knowledge and awareness of sexual health and relationships through the delivery of targeted communication campaigns, customised information and educational programmes and other initiatives across a range of settings. This is achieved through the ongoing management, funding and evaluation of communication campaigns and education and prevention programmes. It is also achieved through significant partnerships with, for example, the Department of Education and Skills and the out of school sector and service providers.

The health promotion and improvement service has more recently worked with the Gay Health Network , GHN, on a two-year campaign targeting MSM to destigmatise HIV, reduce homophobia, and encourage early testing and taking protective measures to reduce risks. Public health services, through the gonorrhoea control group, are engaged in information campaigns for MSM. A social media campaign for sexually active young heterosexual adults encouraging safer sex is planned to go live on 9 December. In addition, the HSE crisis pregnancy programme launched a new phase of its Think Contraception campaign last month to encourage consistent use of condoms and other forms of contraception among sexually active young adults. This phase of the campaign directly addresses both unplanned pregnancy and STIs.

The health service is involved in a number of education initiatives targeted at specific audiences from parents, teachers, youth workers and young people to improve knowledge and skills around relationships and sexuality as part of its approach to improve sexual health and well-being and to reduce stigma and negative sexual health outcomes. This has involved significant inputs in the area of relationships and sexuality education, RSE, and social personal health education, SPHE, in schools and working very much in partnership with the Department of Education and skills and in out of school settings through work with National Youth Council of Ireland, Foroige and Youthreach, among others.

Examples of this work also include the development of the B4uDecide.iecampaign and supporting resources for teenagers, parents, teachers and youth workers. The aim of the B4uDecidewebsite, information materials, and teaching resources for schools and youth work settings is to give young people the information they need about sex and sexuality, and to promote healthy, informed and responsible decisions about relationships and sex.

A range of materials to support parents in talking to their children about relationships and sex are disseminated through healthpromotion.ieand other channels direct to parents.

Sexual health services in Ireland provide a wide range of services, including STI screening, diagnosis and treatment, contraception, crisis pregnancy services, counselling, advocacy and support, health promotion, outreach, data collection, information and support, and psychosexual services. Some services are exclusively information or education services, some are exclusively clinical or counselling services, and some are a mixture. Some services are particularly targeted at groups such as men who have sex with men, and young people. Services are currently provided in multiple community and hospital based clinical and non-clinical settings, by a mix of public, private and non-governmental organisations.

As well as providing services directly, the health service is also involved in funding programmes such as those delivered by the Dublin Aids Alliance, the Sexual Health Centre in Cork, and the Red Ribbon Project among others. It is also involved in the provision of free condoms in GUM and drug services for IV users.

An important initiative that has been developed through EU funding is training for people working in this field to improve the effectiveness of prevention work. The health promotion and improvement service has been involved since March 2013 on an EU-funded project on quality improvement in sexual health services preventing the spread of HIV in particular. The aim of this project is to develop a cross-country policy model, standards, tools and training which will be applied by all states and NGOs to work in an effective way across Europe and within individual countries. This dovetails with the approach of the new national sexual health strategy to work to standardise service delivery in the area of sexual health.

In the area of HIV-AIDS, as with all work in such fields, service user involvement is important to ensure that services are targeted and delivered in a manner that supports their use and effectiveness. Involving people living with HIV in the design, implementation and evaluation of prevention initiatives is an important component of the work undertaken by NASC and the Gay Health Network.

Health intelligence supports good decision-making for better health and health outcomes by using an evidence base to inform such decisions. This includes the work of the health protection surveillance centre, HPSC, and commissioned work and reports from various partners. Over the last ten years, a large amount of research work has been undertaken in this field.

The Gay Health Network has received funding to produce a number of reports and surveys such as the all-Ireland gay men's sex surveys, the European men who have sex with men Internet survey, and the EMIS Ireland reports.

The HSE's crisis pregnancy programme and the Department of Health have commissioned a number of nationally representative surveys and reports that have covered sexual health behaviours and attitudes, such as the 2006 Irish Study of Sexual Health and Relationships, ISSHR, and the two Irish contraception and crisis pregnancy surveys in 2003 and 2010. The findings from this research have been disseminated and used to inform strategy development, including the new national sexual health strategy and the content and targeting of national awareness campaigns and education supports and services. I have to say they have been hugely useful.

In conclusion, the new health and well-being division will move forward with its planned review of sexual health services and preventative work, to ensure a more co-ordinated and integrated approach in this area. The division will co-ordinate the development of an implementation plan for the new national sexual health strategy as part of the broader Healthy Ireland framework. We have aligned our work plans with the Department of Health and look forward to continuing to deliver on this agenda in partnership with a broad range of partners and stakeholders, as I mentioned earlier.

That concludes my statement. Together with my colleagues, I will endeavour to answer any questions that members of the joint committee may have.