Dr. Fiona Lyons:

It has been a privilege to have been a health-care professional working in this very exciting area for the past 20 years. It is great that we are discussing this matter at this Oireachtas committee meeting. There were many questions on breaking down the barriers to promote testing. The past 20 years have taught us that from an individual perspective and a population perspective, the benefits of knowing one's HIV status are beyond all doubt. Improving availability of and access to testing will take several strands, but normalisation is key. It must become normal to have a HIV test. As I have learned in the past 20 years of medical practice, this virus does not discriminate. It does not care whom it infects. Unfortunately certain people in our community are more likely to be affected, but it does not care whom it infects.

We have demonstrated that we can do this. The antenatal screening programme introduced in 1999 has been a resounding success in reducing the number of vertically infected children. It has happened and the percentage uptake rates have been in the high 90s. It was introduced in 1999 following anonymous unlinked testing. We decided that if it went beyond a certain threshold, there was a benefit at a population level to introduce screening and that we would stop doing anonymous testing when the uptake exceeded 95%. In every year since its introduction the percentage uptake has been in the high 90s. We can do this in this country. So it is about normalisation, and the developing and fostering of partnerships.

With respect to why we need to do this, some very important data have been published in the press over the weekend about the number of people who were diagnosed having presented at the Mater Hospital emergency department. It is not just about targeting high-risk groups; given the prevalence in our population, certainly in the greater Dublin area, we may need to consider that everybody, regardless of whether they are in an at-risk group, is at a point where they would benefit from knowing their HIV status. Some 14 cases were picked up in the Mater where they did not come for a HIV test but had a HIV test, with 11 of them being brand new cases. That represents a very significant benefit for those individuals as well as at a population level.

I would like to speak about what the 2012 HIV figures show us. Everyone has acknowledged we have come a long way but we still have some problems. Based on the 2012 data, the proportion of people who are presenting late is still too high. Some 48% of people who presented with HIV at the time of their diagnosis had evidence of significant damage to their immune system at that time. There is a clear need to get people to access testing. That needs to be addressed from a service-user perspective and from a service-provider perspective. As a health-care professional, I work with my colleagues in trying to make it normal for people to have a HIV test.

Within the 48% of people who are presenting late, some 63% of the people who acquired infection through heterosexual sex were late, which is much higher than the proportion of men who have sex with men who were newly diagnosed in 2012 and were late. That demonstrates the successes in promoting testing.