Mr. Tiernan Brady:

I thank the committee for having us. Before we say anything, it is always worth saying that one of the great things about the committee simply having these meetings is that it raises an issue that finds it very difficult to get airtime. The figures demonstrate that diagnosis rates are getting higher in younger people, especially with gay and bisexual men. These generations have grown up in the absence of the type of national awareness campaigns in the 1980s and 1990s that we would have seen right across the world. Having committee meetings like this, which are broadcast and get coverage, is incredibly important and beneficial. I thank the members and the Chair in particular for doing this.

There are two issues I wish to discuss. I want to try not to say anything that everybody else has already said. The two key areas are the trends emerging and continuing among gay and bisexual men for HIV in Ireland, which are worrying, and one of the key responses we hope to put together, starting in 2016, as part of tackling that. There are a couple of key recommendations about how we might move forward. Mr. Mulligan has highlighted the overall figures, but within those figures, unfortunately, the picture for gay and bisexual men is not good. If we take a ten-year view on this from 2005 to 2014, there has been a more than 200% increase in the gay and bisexual diagnosis rates. There were 60 cases in 2005 and 183 in 2014. That will increase this year as we are already well past last year's figures and, unfortunately, we still have another month to go this year. These are the highest diagnosis rates on record for gay and bisexual men and the highest percentage of the total diagnosis that gay and bisexual men have represented. Of the total diagnoses, 48.5% are gay and bisexual men this year, which is a record high.

Within this figure there is another incredibly worrying trend that is exacerbated especially among the gay and bisexual population. The median age of a diagnosed person in 2005, to take a ten-year span, was 37 but the median age last year was 31. Younger people are contracting HIV and this new generation of people are being exposed to risk. Cases of people under 35 now represent six from ten of the new cases. Between 2005 and 2014 - the ten-year span - there has been a 500% increase in new diagnoses in those aged between 25 and 34. There is a large key target group emerging from these figures. This is not just gay and bisexual men but within that are, very clearly, young gay and bisexual men.

One of the key parts of our response to this, as highlighted by both Mr. Mulligan and Ms Seery, is the importance of people knowing their status. There are two clear reasons for this. From the person's perspective, the sooner somebody knows his or her status, the better. If it is negative, it provides great peace of mind, and if it is positive, the earlier one is diagnosed, the better the long-term health outcomes. The second element flowing from this is that most HIV is passed on by people who do not know they have HIV. Getting people to know their status radically reduces onward transmission rates of HIV. The challenge around this is how to provide services and get people to engage with such services when we know it is a difficult area for engagement with people. Simply providing the service, opening the door and saying, "Here we are, this is HIV testing," is not an answer by itself because nobody looks forward to getting a HIV test. Nobody wakes up in the morning and asks, "Guess what I am doing today," before heading to the STI clinic or the general practitioner to talk about sexual history and get tested with a smile. We must accept and recognise that this a service that has significant barriers to people accessing it. Many of those barriers are socially constructed so how do we identify and dismantle them?

One of the pilots we are introducing in 2016 will address many of these barriers. We hear from those engaged in prevention research that many people do not like clinical settings or having to wait a long time to get a test result. Many people find cost a barrier. If one goes to the private sector, one can get a rapid test result but it will cost €150 or €200. We put together a proposal that I am thankful the Minister, Deputy Varadkar, has agreed to fund for 2016 to provide community-based, free and rapid HIV testing. The technology has moved on and our approach to how we get people to test needs to move on with that. We have technology that now means somebody may walk into a community setting, such as the Gay and Lesbian Equality Network office, a bar when it is not open or a community centre, for example, and get tested, with a result in 60 seconds, before going back out and getting on with life. It is about trying to make this service as accessible, convenient and non-judgmental as possible, because we understand this is not a service which most people ever look forward to.

The rapid pilot will start in 2016 and run for 12 months. We are making it clear that this is a pilot. It is a piece of research and we want to shape policy with it. We want to see how well this works and whether it increases testing rates. We want to see what places work more effectively in engaging people to test. Judging from research across Europe, I am pretty convinced it will be successful but we cannot prejudge such issues. We must be able to take in the data and see, at the end of the 12 months, if it can shape better policy and get more people to engage for the reasons we discussed. The more people who know their HIV status, the better it is for them and for cutting HIV rates in Ireland.

Ultimately, we have a couple of other key recommendations to look at. This has been a good year, to many degrees, with respect to sexual health. The first national sexual health strategy has been launched and the pilot programme was initiated for HIV testing as part of that.

That means that for the first time we are, I hope, going to have clear, strategic implementation of a unified approach to sexual health targeted at and tailored to meet the needs of those who need it most. That is something with which we are incredibly happy, especially from the perspective of gay and bisexual men. Of course, like all strategies, what matters is what will happen to implement it. There are plenty of lovely strategies that sit on shelves all over the world, but we must ensure this one becomes a reality in the next three years in order it can have the impact everybody genuinely wants it to have.

Another recommendation is that testing be carried out in conjunction with the GOSHH in Limerick and the sexual health centre in Cork in order to gather data from outside Dublin because there are gay people and others who live outside the capital. We need to ensure we engage with people nationally, not just in the capital city.

Our final recommendation is that we remind ourselves all the time that the level of knowledge and awareness of HIV is not what it was. Those of us who are of an age that we have a conscious memory of the 1980s, even if we were only three years old at the time, will have embedded in that memory massive national public advertising campaigns about HIV and AIDS which carried the words, "Don't die of ignorance". They were campaigns based on fear and featured icebergs and tombstones which are etched in our memories. If we want to be effective about how we create the right level of awareness, we must realise we will not have that kind of national campaign anymore, but we do need to marshal our resources and target campaigns at those groups which are most at risk in order that we raise their level of awareness. Ultimately, HIV is preventable. If we can build people's capacity, they will be the instruments of creating their own best sexual health outcomes as they become aware of and confident in the decisions they make, thus reducing their exposure to harm. As we roll out the national sexual health strategy, that targeted approach will I hope be at its centre.

I thank committee members for their time and look forward to answering questions they may have.