Mr. Mick Quinlan:

Gay Men's Health Services, GMHS, HSE, is a community-based service and remains the only statutory body providing dedicated sexual health service for gay and bisexual men and men who have sex with men, MSM, in all of Ireland and one of the few in Europe or worldwide. The United Nations uses the term “men who have sex with men”, MSM, which covers gay and bisexual men, transgender people and sex workers.

On October 6 1992 the Gay Men’s Health Project, as it was then known, opened its first STI, sexually transmitted infection, clinic. It became so busy that it went to operating two evenings a week in January 1993. An important part of the service was an outreach service to the community and the provision of counselling services. The outreach workers maintained HIV prevention and sexual health awareness in the community, various groups and agencies during the years. The number of outreach workers has been reduced from four to one who is on a career incentive break. Counselling was provided by one full-time person but is now provided by two sessional counsellors in five client sessions per week. The GMHS STI clinical team of doctors, nurses, counsellors, health advisers and assistants are employed on a sessional basis for the two evenings per week. They are engaged from agencies or individually, which has proved ideal for this type of service and is cost effective. The medical team is trained in sexual health and many work in other STI services. GMHS works in partnership with the GUIDE Clinic and the microbiology laboratory at St. James’s Hospital, as well as a consultant in infectious diseases providing medical direction.

The GMHS STI checkpoint is based in Baggot Street Hospital, operates two evenings per week and is very busy. Over 9,800 MSM have registered since 1997. Up to 825 of these men were first‐time attendees, with 39% aged 24 years and younger, a significant increase of 20% in this age group when compared to 2011. There was a 25% increase among men from counties Dublin, Fingal, Wicklow and Kildare. STI screens numbered 3,672, with over 4,500 nursing contacts. There were 261 cases of gonorrhoea, a 43% increase when compared to 2011; 156 cases of chlamydia; 52 cases of HIV, a 37% increase when compared to 2011; and 56 cases of syphilis, a 22% increase when compared to 2011.

The clients attending come from diverse cultural and ethnic backgrounds and travel from across all 32 counties. For instance, between 2009 and 2012, of the 2,949 new registrations, 37% were born in Dublin, 26% in the rest of Ireland, while 37% were born abroad, covering 95 countries. Since 2011 we have registered ethnic backgrounds. In 2012, of the 825 new registrations, 85% identified as white, with the remainder being black African, Asian or of mixed race. Both findings indicate much more diverse backgrounds among MSM than in the national census of 2011.

During the years GMHS has helped to establish such groups as Gay Health Network, Outhouse, the LGBT community centre, the BeLonGTo youth service and others. GMHS is part of the National AIDS Strategy Committee, NASC, and was represented on the service‐working group for the national sexual health strategy. In 2009 GMHS was involved in producing the important document, LGBT Health: Towards meeting the Health Care Needs of Lesbian, Gay, Bisexual and Transgender People.

Gay Health Action, GHA, initiated the response to AIDS and HIV in Ireland among homosexual and bisexual men in 1985. It produced and disseminated information on transmission and also challenged the perception of AIDS as a gay disease. It helped found the Lesbian Health Action, Cairde and AIDS Action Alliance, later Dublin AIDS Alliance. GHA disbanded in 1989. It is worth noting that it could not receive funding from the Department of Health or hold meetings with the then Minister because of the legal position on homosexuality.

In 1989 the then Eastern Health Board established the AIDS Resource Centre at the Baggot Street Clinic providing a needle exchange programme and outreach services for intravenous drug users and free HIV testing for the general population. GMHS was established in 1992 and was also based at the Baggot Street Clinic. The AIDS Resource Centre had been renamed the AIDS-Drugs Service. GMHS was also involved in the Lesbian and Gay Health Caucus from 1990 to 1992 which was based at Dublin AIDS Alliance.

The establishment of the Government’s National AIDS Strategy Committee in 1992 was vital and recognised that the criminalisation of homosexuality inhibited promotional work in this field. It also called for legislation to be amended to allow for the sale of condoms from vending machines.

The Gay Health Network, GHN, was established in 1994 and is an all-Ireland network of agencies, organisations, individuals and MSM living with HIV. All have a shared ethos and commitment to achieving the purposes of the network, sharing ideas, work, resources and experiences. The main purpose of GHN is to promote HIV prevention and sexual health awareness among MSM, with a focus on men living with HIV, and to combat the stigma associated with HIV. GHN and its members provide a range of front-line services. The actions of the network are evidence‐based, strongly linked, developed and guided by accurate knowledge of the behaviour of MSM and are based on the findings and recommendations of research and relevant reports. The Gay Health Forum has been held since 2000 with the support of the Department of Health and HSE - social inclusion.

In Ireland HIV and other STI infections, particularly syphilis and gonorrhoea, are in high numbers among MSM. This trend, with the Government’s 2002 national AIDS strategy report and the education and prevention plan for the period 2008 to 2012, highlighted the need for actions with and for MSM. In the 1980s and 1990s communities, including the gay community, were greatly affected by AIDS-related sickness, death and emigration. Since the 2000s, with new treatments, various committees and the national AIDS strategy, efforts have been made to address the issue with some success. Nevertheless, the increase in the level of HIV infection seems relentless and proves the need for continued investment in prevention and support and partnerships with various communities and groups such as the Gay Health Network. Another issue is AIDS-related stigma and challenging this needs to be part of prevention awareness campaigns.

Research is the key to planning and strategy. In fact, GMHS was established as a result of a survey carried out in December 1991 of the Dublin gay scene. The report published by the then Eastern Health Board on the 470 gay and bisexual male respondents showed that, although nearly half had been tested for HIV, two thirds had never been screened for a STI and 84% had never had the hepatitis B vaccine. Since its establishment, GMHS has led on research among MSM in Ireland. With GHN members, it has produced many of the research reports on health needs and HIV prevention and support services.

The most recent report is on the European men who have sex with men Internet survey, published by the European Centre for Disease Prevention and Control, ECDC, last May. This was the largest survey of its kind in the world, with 180,000 respondents across 38 European countries, including 2,610 respondents from the island of Ireland, the largest number ever here.

The seven MSM research reports produced between 1992 and 2012 showed the rates of not ever having had a HIV test had increased from 47% to 62%, as had rates of HIV positive results from 5% to 9%. We were also able to indicate the non-testing rates for all counties in Ireland for planning purposes.

The Man2Man report two, Living with HIV, found that a significant number of the 143 respondents had experienced direct stigma and discrimination. Over nine in ten respondents indicated that they had personally heard others say unfavourable or offensive things about people with HIV and had seen or read things in the media about people with HIV that were hurtful or offensive. Three quarters of the men indicated that others had treated them less favourably when they learned that they were living with HIV. Importantly, a total of 44% of men have been advised to lower their expectations in life because they have HIV, while 11% indicated that they had been denied medical help because they were HIV positive. Encouragingly, a large number said their friends were supportive and understanding on learning that they were living with HIV.

The most recent Man2Man report three, Our Sex Lives, takes a look at sexual activities, happiness rates and substance use. It highlights how important it is for men in steady relationships to talk about their HIV status and to be tested together before they decide to stop using condoms. The main European men who have sex with men Internet survey, EMIS, report also shows the need for comprehensive STI screening services for MSM. They include throat, genital and ano‐rectal examinations, with tests for HIV, syphilis and hepatitis. GMHS has shown that type of service and access are key and can be successful. We hope to lead the way for the next 21 years and look forward to participation in the implementation of the sexual health strategy.

I spoke about the lack of outreach workers owing to the effects of the recession and recruitment embargo, but we continue to provide a service, as do others. Recently GMHS has developed partnerships with other GHN members such as Outhouse, BeLonGTo and Gay Switchboard Dublin to continue the personal development and assertiveness courses, outreach services in the community and the availability of safe sex packs. Sustaining these efforts will be a cornerstone of funding requirements.

As mentioned, MSM are recognised as a key target group for HIV prevention. Knowing one's target audience is vital in planning services and health promotion strategies. EMIS devised a 3% guide figure in estimating the MSM population. According to the 2011 census, there were 2,272,699 males in the State. Using the figure of 3%, we estimate that we have a minimum target population of MSM aged 15 to 69 years of 54,000. We have also devised this figure by HSE region.

As a result of HIV and STI trends, research and other reports and the partnership approach adopted by the GHN and the HSE's health promotion and social inclusion office, the first national HIV and sexual health awareness programme for MSM was born. The Man2Man programme, a joint initiative taken by the HSE and the GHN, was launched in December 2011 with support from the then Minister of State, Deputy Róisín Shortall, and the Lord Mayor of Dublin. In December 2012 it ended with the support of the Minister of State, Deputy Alex White, for translating Man2Man, taking account of the ethnic mix of MSM.

I will now hand over to Ms Donlon who will make a presentation on the Man2Man programme and the GHN.