Mr. Tiernan Brady:

A couple of reasons feed into it. Strong Irish research was carried out, the second phase of which is to be published next year, which identified a collection of perceptions. People perceive that their local doctors will not be familiar with LGBT issues. People perceive that they have had negative reactions in the past when they have engaged with others regarding their sexual orientation. People fear a negative reaction and judgement. One of the great challenges for all health services, and services in general, is that LGBT people have grown up with the expectation that, more often than not, they will encounter a negative reaction. The way they access services is terribly damaged as a result of it, especially sexual health and other health services. Unfortunately, people presume that somewhere along the line they will be rejected or judged negatively by people. Rather than go through this experience, they decline to engage with services.

How do we address those barriers within primary care services? Most of it is by building the capacity and knowledge of health care providers. To get most people to test, we must provide a full range of services. No one service is right. Most people go to primary care services. There are STI clinics, NGO services and community settings. Rather than identifying one best model, we must understand that, due to the nature of sexual health and the fact that most people do not look forward to testing, we need to provide a full range of services. We must ensure there is a service that suits each person, no matter what their previous experiences have been. It will not always be primary care. GLEN does much training with primary care nurses and doctors about it. So much of it is just about awareness building. There are great courses, and the primary health care providers get a lot from them. We have created guidelines with the Irish College of General Practitioners about how to engage, but this will always be only one pathway.

Given that sexual health is so stigmatised and taboo in general, we must always be thinking about innovative, imaginative, new pathways in order to make it as easy as possible for people to do something they are not looking forward to doing. This lies at the heart of the challenge. Next year’s project will be an innovative part of it. We will be happy to keep the committee fully updated as the pilot rolls on. As Deputy Healy mentioned, I would love it to be a national project. I am convinced it will work, as evidenced by all the research from Europe, the European Centre for Disease Control guidelines and the number of countries that are already doing it. We are very late to the table. This is the first national rapid testing project. It has been happening in many countries for years.

A few years ago, Ms Seery and I visited Denmark, where they do these tests upstairs in a shop on their equivalent of Grafton Street. It is a lovely little place, where people can pop upstairs, have their test, and off they go. It is the entire test, and all the medical equipment needed is a chair. It is a nice comfortable place where people can do it. The more we keep up with the technology and the more accessible and convenient we can make the test, the more successful it will be. Nobody wants to wait seven days. When we design services, we should think about what we would like if we were attending the service rather than providing a service, opening the door and awaiting the customers. Sexual health services will never work this way. I hope the pilot will be a success and will shape national policy. There is no reason this cannot be provided in every corner of the country and every conceivable setting possible. The more it is, the more we combat the stigma around sexual health and HIV.

Deputy Costello was correct to highlight how interwoven sexuality and bisexuality was with AIDS at the beginning. When it was first noticed and named, it was called gay-related immune deficiency, GRID. While we have managed to move past the stigma for lesbian and gay people to become one of the best countries in the world, we have not done the same for HIV stigma. Given the journey of gay and lesbian people in Ireland, we know it is possible. It is about committing to building awareness and investing in the type of anti-stigma programmes that can deliver the change that has taken place in other areas of Irish society. It is not impossible.