Oireachtas Joint and Select Committees
Wednesday, 6 May 2026
Joint Oireachtas Committee on Health
Sexual Health Services: Discussion
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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I remind members of the constitutional requirement that members must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to partake when they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precinct will be asked to leave the meeting. In this regard, I ask any members partaking on Teams that, prior to making a contribution to the meeting, they confirm that they are on the grounds of the Leinster House complex.
Today, the committee will consider the availability of and access to sexual health services. To assist the committee in this regard, I welcome from the school of medicine in Trinity College Dublin, Mr. Adam Shanley; from the Sexual Health Centre, Ms Fiona Finn and Ms Muire O'Farrell; from the Gay Health Network, Mr. Pádraig Burke; and from the HSE, Professor Fiona Lyons, clinical lead, sexual health programme, Dr. Vida Hamilton, clinical director, HSE Dublin and South East, and Mr. Ciarán Browne, access and integration.
We are looking forward to today's session on sexual health. I think sexual health has never been a political priority, and it is really important that we put more of a focus and spotlight on it to ensure it becomes one. For far too long, shame and stigma have allowed it to go under the radar in Leinster House and the discussions here. As that needs to change, I am really looking forward to the discussion we are going to have. It is also important to think of the wider context. It is good that we now have a new sexual health strategy. I know there was a delay over a number of years but it is good to see this published. However, there is a lack of committed funding and timelines in this regard. We need to see more focus around the strategy and the related actions, delivery and timelines. We also need to see an expansion of services nationwide. According to a response to a parliamentary question that I got back from the Minister for Health, at present ten counties, namely, counties Cavan, Kildare, Kilkenny, Laois, Longford, Meath, Monaghan, Offaly, Roscommon and Wicklow, have no in-person public sexual health services . We saw research from the National Women's Council just last week that one in three women still face barriers accessing the free contraception scheme, so there is a lot to change. We also saw that over 800 people are waiting on access to PrEP, which is quite concerning. It could be possible to end HIV transmission in Ireland if we had the will, the funding and the resources to do it. Part of doing that involves having open and frank discussions and I hope today's session will be part of that.
On privilege, witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that may be regarded as damaging the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such directions. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.
To commence today's proceedings, I invite the witnesses to make their opening remarks.
Mr. Adam Shanley:
I thank the Cathaoirleach and the members of the committee for the opportunity to address them and for prioritising a discussion about sexual health in the Oireachtas.
Ireland has made real and measurable progress over the past decade. The national sexual health strategy provided a strong foundation and we have seen meaningful investment in prevention, expanding testing and building partnerships between statutory services and communities. These efforts have improved outcomes and, importantly, have brought services closer to the people who need them. However, while significant progress has been made, challenges remain. Ireland is not currently on track to meet international targets to reduce sexually transmitted infections, STIs, and to end HIV by 2030. What this tells us is not that our approach has failed but that it now needs to evolve. This next phase must focus on closing persistent gaps in access and ensuring that services reflect the realities of people’s lives.
Innovations in approaches to testing are one of the clearest successes, and it is also one of our clearest lessons. The expansion of options such as the HSE home testing service, community-based rapid testing in social settings and self-testing and mobile services has transformed accessibility. These models have reached people who might otherwise never have engaged with traditional clinics. They have reduced stigma, increased convenience and normalised sexual health as part of everyday well-being. The lesson here is that no single model can meet the needs of a diverse population. People encounter different barriers, whether that is stigma, geography, cost or other social determinants of health. The strength of Ireland’s approach has been in offering choice. Protecting and expanding that choice will be essential if we are to maintain momentum and reach those still underserved.
A similar picture emerges when we look at access to PrEP. The introduction of free PrEP through the HSE in 2019 was a landmark achievement and a clear example of evidence-based policy in action. It has had a significant impact and continues to do so, with demand growing year on year. Access, however, remains uneven. People outside major urban centres often face additional barriers. Some clinics are operating at capacity, which leads to waiting lists and unclear pathways of access. At the same time, we know that the acquisition of HIV is not confined to just one community.
While the uptake has been strongest among gay, bisexual men and other men who have sex with men, new diagnoses continue to occur among women, migrants and young people. This points to gaps in access and equity. Addressing this requires not only more capacity but also more flexible and inclusive models of delivery.
Alongside these issues, we must also acknowledge areas where Ireland’s response has not kept pace with need. Chemsex, the sexualised use of drugs, is one such area. It is associated with increased risks, including HIV and other STIs, as well as impacts on mental health and well-being. However, it is also important to recognise that chemsex is not experienced uniformly as problematic. Many feel in control of their engagement and do not identify an immediate need for intervention. This complexity highlights the importance of developing a nuanced response that incorporates not only culturally competent treatment and support services but also harm reduction approaches that promote safer use and informed decision-making grounded in lived experience. I acknowledge the ongoing efforts of members of the HSE chemsex working group and those bringing attention to this issue and delivering services in our communities. However, provision in Ireland remains fragmented, with limited clear pathways to care. This represents a significant but addressable gap.
Underlying all of these areas is a common thread, namely, the importance of partnership with community. Peer-led and community-based organisations have been an important partner in every major advance in sexual health in Ireland. They bring trust, insight and the ability to engage people in ways that statutory services alone cannot. Some are present or represented here today and others are continuing their work across the country. They have consistently encouraged innovation, whether in outreach, education or service delivery, and have shown what is possible when affected communities are not just consulted but actively involved in shaping responses. The HSE sexual health programme should be commended on its commitment to collaboration with affected communities in the development of services and communication strategies. It is a genuine strength of the Irish system and has been recognised internationally as a best-practice approach.
Ireland has a strong foundation to build on. The task now is to ensure our services are accessible, equitable and responsive to evolving needs. With continued leadership and with community at the centre of our approach, there is a clear opportunity to close existing gaps and move closer to our shared goal of ending HIV and improving sexual health for all.
Ms Fiona Finn:
I wish the Cathaoirleach and other members of the committee a good morning and thank them for inviting us to speak here today.
I am the CEO of the Sexual Health Centre in Cork. Our centre was founded in 1987 as the Cork AIDS Alliance to support people living with HIV. Since then, we have grown into one of Ireland’s leading community-based organisations promoting sexual health and well-being. Today, we provide a wide range of front-line services across Cork and Kerry and these services include testing, prevention, information, support work and counselling. Last year alone, we supported over 9,600 people and consequently, the recommendations in our submission today are grounded in our direct front-line work.
We must acknowledge the important progress made in sexual health in recent years. This includes expanded access to free contraception, SH:24 STI testing, improved availability of PrEP and PEP and the publication of the national health strategies. However, despite this progress, structural challenges remain. Today I will focus on five areas where we believe reform is needed.
The first area is the fragmentation of services and long waiting times. Sexual health services in Ireland are often disjointed, requiring individuals to navigate multiple providers and locations for testing, counselling, contraception and treatment. This creates complexity and delays, particularly for groups such as rural populations, young people, migrants and those with limited financial resources, for whom multiple appointments can become a significant barrier to engagement. Waiting times for STI testing, PrEP and counselling services also remain a critical concern. Sexual health is time-sensitive and delays increase transmission risk, worsen anxiety and reduce the effectiveness of prevention strategies. What we need is a more integrated approach. We recommend the development of community-based, one-stop-shop sexual health services where individuals can access comprehensive care in a single setting, as well as expanded partnerships and resources for sexual health centres to deliver integrated care in a community setting.
The second area is transgender healthcare. Access to gender-affirming healthcare in Ireland remains significantly underdeveloped and overly centralised. In 2022, the Transgender Europe report ranked Ireland last in the EU for transgender healthcare. Currently, trans people must wait more than ten years to access health services. We are clearly failing our trans community. Many must seek care abroad or outside formal pathways, increasing inequality. At present, general practitioners are not adequately supported to provide gender-affirming care. In line with the WHO classification, gender-affirming care must be recognised as a sexual health issue and it must be integrated into Ireland’s existing sexual health network. Our recommendations are to enable trained GPs and clinics to initiate and monitor hormone therapy to improve access, reduce waiting times and support a more equitable system. This would ensure safe, timely and local access to HRT. We also recommend moving to an informed consent, patient-centred model of care; supporting and training sexual health and primary healthcare workers to provide community-based, gender-affirming services; and developing a collaborative gender-affirming healthcare policy informed by the real lived experiences and needs of the people these policies aim to serve.
The third area is women’s sexual and reproductive health. We are seeing an increase in demand for counselling services related to crisis pregnancy, miscarriage, infertility, complex menopause and endometriosis. This reflects a significant unmet need. These services are under-resourced, thereby limiting access. Barriers also persist within the termination-of-pregnancy legal framework. The mandatory three-day waiting period to access a termination places additional stress on individuals without any clear clinical benefit. We also note that, while free contraception is a very positive development, access is often limited by GP capacity. We recommend increased funding for specialist counselling services, expanding supports for conditions such as endometriosis, removing the mandatory waiting period to access a termination and broadening access to contraception through community providers.
The fourth area is HIV prevention and treatment: PrEP and PEP. While Ireland has made significant progress, access to PrEP and PEP remains inconsistent. Waiting lists for PrEP are long, eligibility criteria are restrictive and most services are centred in urban areas. PEP, which must be accessed within 72 hours, is currently only available through hospitals and specialist clinics, creating unnecessary delays. We recommend expanding access to PEP by enabling GP prescribing, making it available through pharmacies and improving out-of-hours provision. We also recommend broadening PrEP eligibility criteria by determining individual suitability, as opposed to having strict eligibility criteria, and investing in public education and stigma reduction.
The fifth area is chemsex. Chemsex is emerging as a complex issue, most commonly affecting men who have sex with men. While often framed through the lens of personal risk, research highlights that it is also shaped by broader factors such as social inclusion, inequality, trauma and gaps in sexual health education. Shame and stigma mean that this issue often remains hidden and prevents people from seeking support. While we are seeing the impact of chemsex first-hand through our services, there are few dedicated services in Ireland to respond effectively. We recommend developing integrated, non-judgmental and peer-informed services for people adversely affected by chemsex, ensuring supports are accessible and inclusive and recognising chemsex explicitly in the national sexual health and drugs policy as a distinct service issue requiring integrated responses.
That final area is sexual dysfunction services. Sexual dysfunction, including conditions such as erectile dysfunction and vaginismus, is a significant but often overlooked aspect of sexual health. Many people experience difficulties that may be related to physical health conditions, trauma or psychological factors, yet services are limited and pathways are unclear. Currently, most support is accessed privately, creating inequalities. We recommend the funding of counselling services for sexual dysfunction, developing regional multidisciplinary clinics, strengthening GP capacity and improving data collection in this area.
I thank the members for their time and attention. We refer them to our submission for further details on the issues mentioned in the statement.
Mr. Pádraig Burke:
I thank the Cathaoirleach and members of the committee for the invitation to speak today. I am communications director with the Gay Health Network, GHN. For more than 30 years, GHN has worked to improve the health and well-being of gay, bisexual and other men who have sex with men, and the wider LGBT communities in Ireland. Since 2011, much of this work has been developed through the Man2Man.ie national programme, developed in partnership with the HSE sexual health programme. I have worked with that programme for the past six years. I acknowledge the strength of the partnership across the HSE, public health teams, clinicians and community organisations. There is clear commitment and professionalism.
We saw this first-hand during the mpox response, where the system moved quickly, communicated effectively and worked with communities to reduce risk and protect health.
We have also seen real progress in recent years in sexual health promotion. Ireland now has a national HIV pre-exposure prophylaxis, PrEP, programme, access to post-exposure prophylaxis, PEP, and expanded sexual health-related vaccination programmes, including for HPV, hepatitis B and mpox. Campaigns such as You, Me and HIV show what is possible when the HSE and community organisations work together to reach people in ways that are relevant, trusted and accessible.
The Gay Health Network also convenes the annual Gay Health Forum, which has run for more than 20 years. The most recent forum was opened by the Minister of State, Deputy Murnane O'Connor, and brought together clinicians, researchers and policy voices, including the deputy Chief Medical Officer, Professor Lyons of the sexual health programme, SHP, and community advocates such as Mr. Robbie Lawlor and An Cathaoirleach, Pádraig Rice. In many ways, it provides an annual snapshot of where we are in relation to gay men's health and sexual health more broadly. That kind of connection is vital because services work only when they are shaped by the realities of the people who need them.
However, the focus of today's discussion is access, and access remains uneven. HIV PrEP is available in Ireland, but demand continues to exceed capacity. Recent figures suggest that more than 800 people are waiting to access PrEP. These are people who are ready and eligible to take action to prevent HIV. Long waits are not just an inconvenience, but a missed prevention opportunity.
Access to STI testing and sexual healthcare should not depend on where someone lives, yet it remains frustratingly uneven. Outside of major urban centres, particularly in the midlands, the west and the north west, there are clear gaps. As reported last week, there are ten counties with no in-person public sexual health clinics. A person's ability to protect their sexual health should not be dictated by their eircode.
Community organisations such as the Sexual Health Centre in Cork, GOSHH in Limerick, Sexual Health West and others do vital work, but these models are not yet available consistently across the country. Many people continue to face barriers linked to distance, stigma, service availability, transport, privacy and digital access.
We are encouraged by planned developments to expand access through digital routes, including in relation to HIV PEP and, potentially, PrEP. These developments are welcome, particularly for out-of-hours access. However, we would welcome greater clarity on timelines, operational details and how these routes will connect people to wider clinical care where needed.
Digital routes, including home STI testing, are a very welcome part of the solution, but digital access cannot be the whole answer. A website cannot replace a clinic for everyone. People may need face-to-face clinical care, vaccination, treatment, mental health support or simply a safe and trusted person to speak to. We must ensure that new models do not unintentionally leave behind those without digital literacy, stable housing, privacy or a safe address to receive kits.
Another area where gaps are evident is support for people engaged in chemsex. Chemsex refers to the use of specific drugs before or during sex to enhance, prolong or alter the sexual experience. Current support provision is limited across much of the country, and people can fall between sexual health, mental health, harm reduction and addiction services. A joined-up national approach is needed, with peer-led and community-informed approaches.
To support this, the Gay Health Network has recently contributed to the HSE's first national chemsex survey, CHEMSI of chemsex in Ireland. We look forward to its findings, which should help inform the type and scale of response required. However, research alone will not be enough. It needs to be followed by appropriate funding, service development and clear referral pathways.
We also wish to highlight the state of trans healthcare in Ireland. Access remains extremely limited, with waiting times of several years for an initial appointment and large numbers of people on waiting lists. Ireland has been described in recent reports and public debate as performing poorly in this area compared to other European countries. This is a question not only of access but of dignity and timely care and it requires urgent action. While the sexual health strategy recognises trans people, it stops short of outlining a clear, actionable model for trans healthcare, including pathways, capacity and timelines.
From our perspective, four areas would make a meaningful difference. First, Ireland needs expanded capacity in PrEP and STI services, with clear national access standards, reduced waiting times and public reporting on progress. Second, regional access must be strengthened in order that people outside major cities have realistic options for testing, prevention, treatment and care. That should include a mix of public clinics, community-based services, primary care, outreach and digital pathways. Third, Ireland needs a funded, integrated and peer-led response to chemsex, recognising the intersection between sexual health, substance use, mental health and stigma. Fourth is improved access to trans healthcare, including reducing waiting times and developing a modern, accessible model of care based on informed consent. The first three priorities are already reflected in the national sexual health strategy. The issue now is implementation. We need clear timelines, adequate funding, workforce capacity and accountability for delivery.
Finally, partnership matters. The strongest outcomes happen when the HSE, clinicians, public health teams and community organisations work together from the beginning, not as an afterthought. That approach builds trust, improves uptake and delivers better public health outcomes. Ireland has made real progress. The task is to make sure that progress is implemented fully, equitably and in a way that leaves no one behind.
Professor Fiona Lyons:
A similar theme will emerge in my opening statement, I think, which is reflective of and testament to the collaborative work we have engaged in. I particularly thank Ms Finn for calling out sexual dysfunction, which is something that is significantly neglected.
Prior to 2015, Ireland did not have a national approach to addressing the sexual health of the population. The publication of the first sexual health strategy represented a significant step forward for us as a nation in affording sexual health a dedicated, national approach. The second national sexual health strategy, published in June 2025, retains the vision of the first, specifically that everyone in Ireland should experience positive sexual health and have access to quality information, education and services throughout their lives.
I will focus the remainder of my opening statement specifically on services, which is the topic of this conversation, and provide the committee with a summary of progress made since the launch of the first strategy, the remaining challenges and the ongoing work within the HSE.
Access to and the availability of condoms remain important tools in protecting sexual health and preventing unplanned pregnancy. The HSE national condom distribution service was established in 2015. Managed by the sexual health programme, it distributes free condoms and lubricant sachets to services and organisations working directly with those at risk of unplanned pregnancy, HIV or STIs. This includes clinical services, general practice, community organisations and third level institutions. Under the 2025 community pharmacy agreement, the service is currently being expanded to community pharmacies. In 2025, the service distributed over 1.2 million condoms and almost 700,000 lubricant sachets.
The HSE commenced a national PrEP programme in November 2019. The sexual health programme has responsibility for overseeing this programme and hosts a multidisciplinary, multisectoral national PrEP working group, which works collaboratively on the development of national standards, clinical guidance, a PrEP monitoring and evaluation framework and information resources for the public on PrEP. Between November 2019 and the end of quarter 1 2026, almost 11,500 individuals commenced PrEP through the programme. In 2025, PrEP was dispensed to almost 7,500 individuals and over 2,000 individuals accessed PrEP for the very first time. There are currently 13 open approved public PrEP services and 45 approved private or GP PrEP services.
While gains have been made, challenges remain. A contributing factor to access challenges is the appropriate shift in national and international guidelines around eligibility for HIV PrEP with a move away from strict clinical eligibility criteria towards individual anticipated need and benefit. To improve access and capacity for PrEP, the sexual health programme has identified and introduced measures to improve efficiency within PrEP care, including changes to monitoring and the option to use the home STI testing service for interval testing. These measures have not compromised safety of care. To improve access to PrEP through general practice, a competency framework was introduced and includes completion of an online PrEP e-learning programme, which was introduced in December 2024. To date, 122 healthcare providers have completed the programme, and 28 additional GPs have become approved HSE PrEP providers.
The sexual health programme is part of a research group led by Trinity College Dublin that was awarded a grant to develop and evaluate a hybrid online and in-person PrEP model of care, using PrEP as an exemplar to assess how integrating digital services with traditional in-person care can enhance efficiency, accessibility and value for money in healthcare. The results of this project will inform policy on delivery of PrEP through an online service.
In addition to these measures, the HSE continues to advocate for additional resources to meet PrEP need. An additional seven whole-time equivalents were secured in the national service plan 2025, which was substantially below what was requested. Following a difficult assessment of greatest capacity challenges, these resources were allocated to the Dublin area. The HSE acknowledges that access to PrEP is a significant challenge and is committed to doing all it can to overcome these challenges within available resources while advocating for additional resources.
The HSE launched a national free home STI testing service in October 2022. It is the first in the world and provides geographic equity of access to STI testing, with uptake across all 26 counties. The service is an important gateway into sexual health care, with almost 40% of those who used the service in 2025 having never previously tested for STIs. In 2025, the home STI testing service received over 130,000 orders, processed almost 98,000 test kits, with a return rate of 75%, and managed almost 9,000 positive and reactive results.
Since the introduction of the service, the sexual health programme in collaboration with the national multisectoral, multidisciplinary home STI testing working group has continued to identify and implement initiatives to improve the service. This includes the online management of chlamydia, the introduction of the option to order condoms and lubricant at the time of ordering a test kit and piloting a user-activated service for individuals who cannot have kits delivered to their homes. While the service is popular and well-used, a survey of people aged 18 to 30 conducted by the HSE in 2025 found that 53% of young people were unaware of the service. The HSE communications and public affairs team is considering the findings of this report and how best to improve awareness among this group.
Collaborative working across sectors and disciplines is central to the work of the HSE sexual health programme. The clinical programme hosts four clinical national working groups dealing with PrEP, home STI testing, gbMSM sexual health and chemsex. I have already described some of the work of the PrEP and home STI testing working groups. The gbMSM working group is a priority task-oriented group working collaboratively to identify priority sexual health needs for gbMSM. Two priority actions are the development of doxyPEP guidelines and improved access to HIV post-exposure prophylaxis, particularly out of hours. Following publication of interim guidance in August 2024, final doxyPEP guidelines were published in March 2026. Regarding access to post-exposure prophylaxis, through the collaborative work of the gbMSM working group, the sexual health programme, the emergency medicine programme and the home STI testing provider, a free online pathway for out-of-hours PEP assessment and referral has been developed to improve access to PEP out of hours. The pathway is in the final stages of testing before deployment in the very near future.
Understanding and responding to the needs of chemsex users was identified as a priority action within the gbMSM working group in April 2025. To understand need and inform the response, an online community survey exploring current patterns of drug use and service user need is under way. To date, almost 800 responses to the CHEMSI survey have been received and will inform our response. The HSE is collaborating with a team from the Royal College of Surgeons that is currently developing a survey on chemsex for front-line workers. including but not limited to healthcare practitioners. This survey will explore gaps in understanding and inform the development of resources for front-line workers.
A priority action in the sexual health strategy is the development of a model of care for sexual health. The sexual health programme is leading this work. The model of care is being developed in line with the vision and principles of Sláintecare and is due to be completed by end of summer 2026.
In closing, through collaborative, committed and smart working, the HSE has made significant strides to improving accessibility and adequacy of sexual health services in Ireland. The HSE acknowledges that challenges remain and is committed to continuing its work to realise the goal of "equitable, accessible and high-quality sexual health services".
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the witnesses for coming before us today. It is a really important area. It seems from the presentations that we have made a lot of improvements in terms of access and the recognition of the problems around sexual health. I am delighted with Professor Lyons's presentation, which was very broad. When I got some of the correspondence, it seemed to be very narrow but as I sifted through it, we need to look at it in a really global way and not allow it to be pigeon-holed down into one group, one virus or anything else. Regarding a global view of sexual health and the idea of community sexual health clinics, it is probably timely. It would be acceptable now. It might not have been acceptable 15 or 20 years ago.
Ms Fiona Finn:
It is a model that is used across London in the UK. In particular local authority areas, there are local sexual help services. It is not something that is unusual to us either because the Irish Family Planning Association has a pretty full service. The issue is around making those community-based services much more accessible and available so it stops people from having to go to us for one thing and a local genito-urinary medicine, GUM, clinic for something else. It can be quite exhausting. A lot of sexual health issues are very time-sensitive so dealing with something within the one broad-based community setting provides much more equity of service delivery, addresses multiple needs in the community and normalises sexual health. Sexual health is not something that should be hidden away. This is part of everyday life. It is part of you as a human person. It is about normalising that and encourage people to look after and take care of their sexual health in the same way they would any other aspect of their health.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I come from a general practice background. My generation would have been looking for additional information and services within a general practice setting but we also need to recognise capacity issues. That is recognised here. I do not think this says anything against the training of a GP. There may well be GPs working in Ms Finn's community clinic. It is about increasing access and the broad range of services. It is not just about sexually transmitted diseases. It has to be much broader. I see from the HSE's presentation that it has a clinic in Heytesbury Street for sex workers. Coming back to that broader view, with sexual dysfunction and infertility, even those primary services should be in the community and not just be the purview of the hospital system.
Professor Fiona Lyons:
I agree completely with the Deputy. Aspiring to what Sláintecare wants to deliver, namely, the right care in the right place at the right time, this is how our model of care is being developed. We have a network of community-based public sexual health clinics. They need to be empowered and resourced to work in an integrated way such that people can have the supports from organisations such as Ms Finn's organisation when they need them and up to more complicated care when they need it. The launch of the free contraception scheme has been very much welcomed. In my practice, I see people who are unable to access the scheme when they come to see me in the clinic when they have some other matter related to their sexual health. We need to overcome these barriers and improve access to contraception services within our network of public sexual health clinics such that they genuinely become single sites at which people can have all their sexual healthcare needs addressed.
I hope that before I retire, we will start to talk about sexual pleasure and address the huge unmet need there is in respect of sexual dysfunction. It is testament to the Cathaoirleach that he and the committee have chosen to bring sexual health in here today because we need to have this conversation. We are here because of sex. There are lots of things we need to do. As the Deputy noted, the focus should not just be on STIs. It is not about sexual ill health; it is about people attaining sexual good health and maintaining and, ultimately, achieving pleasurable sexual health. Addressing things like sexual dysfunction is a huge part of that along with having contraception needs met within community services. Within the model of care we are developing, our clinical advisory group has agreed with this approach - that people should have the things they need as much as possible in one place. We have plenty of work to do to get that completed but we will complete it before the end of the summer.
Martin Daly (Roscommon-Galway, Fianna Fail)
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But it also removes the stigma of going to a GUM clinic, for example. Let us be honest; there are patients of mine who, when I refer them to a GUM clinic, ask me whether they will see anyone while they are waiting. I have to say that GUM clinics are set up to do that and I am not making a judgment on that but I have to reassure my patients that this will be the case and they will be looked after. That is why broadening it away from just sexually transmitted diseases to sexual health in its global sense makes much more sense.
Professor Fiona Lyons:
That is why we very intentionally changed the name to public sexual health services rather than STI clinics. I look after people in their 70s and 80s who have not had sex for many years. Some of them do continue to have sex and want to have good sex and do not necessarily have STIs. It is much more about the broader aspects of sexual health so, in the model of care, we very intentionally called our network of public clinics public sexual health clinics, not STI clinics.
Martin Daly (Roscommon-Galway, Fianna Fail)
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It should be about access but also blended services. It is not the purview of any one element.
One of the difficulties we have is there has been a lot of lip service paid to primary services in primary care, which is where they should be, but we are not seeing the commensurate investment. This is just another example in primary care services.
When we look at the disproportionate investment in the hospital sector, and I will come back to PrEP and PEP in a moment and the need for access, it seems that any time there is a new idea, there is a restricted view on how access should be. Certainly, with PrEP and PEP, the witnesses described in their statement that these require access to a hospital service. Maybe I am wrong.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Sure. I would be happy to hear from the other witnesses as well.
Professor Fiona Lyons:
As I mentioned, two years ago, the gbMSM sexual health working group identified and looked at our action plan to pick out three things to work on. Two of those priorities were doxyPEP guidelines, which are now done, and improving access to PEP. PEP is available through our network of public sexual health clinics, through our sexual assault treatment units, SATUs, for people who experienced sexual violence, when appropriate, as well as out of hours through emergency departments.
It is a time sensitive intervention, as Ms Finn indicated, but people may not have an actual medical emergency requiring emergency department attendance. We have looked at and explored multiple different ways of doing it. Within our current legislative framework, what we can do right now is develop an online assessment pathway, which overcomes the mandated emergency department attendance fee, such that people can, through the home STI testing service, have an assessment done. If they meet the threshold for needing PEP, then they will be given a referral letter that overcomes the mandated fee, which has been cited by the community as a significant barrier to accessing PEP in a time-sensitive way and was putting people off getting it or going to the emergency department.
We also hope that in addition to improving access through overcoming that fee, it will also reduce unnecessary attendances to the emergency department. There may be individuals who are concerned they may need PEP but, following assessment, they may not actually need it and therefore do not need to go to the emergency department. Ultimately, I would like to see it available much more broadly, but it is difficult within the current legislative framework to do that.
I can go onto the PrEP piece then, if the Deputy wishes.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Please.
Professor Fiona Lyons:
In respect of restricted access, it may seem like restricted access but from the very beginning, when we were establishing the PrEP programme in 2019 - it took us several years to get it ready - one of the key things we did was ensure it was available through community pharmacies, which was very intentional. Antiretroviral therapy is otherwise generally available through the hospital system. We said that would be a barrier because people will want to access PrEP in different ways, such as through a private provider, their general practitioner, a sexual health clinic or through an online model if that proves to be successful. Mr. Shanley and I are working on that project together. With that very intentional piece, we said it was going to be made available through community pharmacies.
The other thing is recognising it is a public health intervention. The medication was made available for free, but there was also no dispensing fee because for some individuals that will be a barrier. It was never intended to be restricted. It is just that within the resources we have now, that is how we are able to do it.
We have significantly increased the number of GP PrEP providers in recent years. As it stands, people will have to pay for the GP attendance but they will not have to pay for the medication. Within the strategy, there is a very clear vision around having free access to sexual health services at point of access. That is a piece of work we are working on with others to try to ensure we have free access to GP PrEP care as well.
Peter Roche (Galway East, Fine Gael)
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The witnesses are extremely welcome. This is a very useful platform and conversation we are having. Whether we like it or not, many people are quite clumsy around the conversation in the general public, and they are wondering where they would go if they wanted to gain access to the services.
Many references were made in all the statements that were read into the meeting about the fragmentation of services and long waiting times. Of course, all of that is a massive challenge for the person who wants to get access and feels they want to get it urgently for whatever reasons. It is only right and fair that everyone would have the same access to that intervention, support, GP, nurse or sexual health clinic. That is a great move, if you like, to describe it as a sexual health centre as opposed to STI clinics. It makes people a little bit more comfortable.
One of the things that strikes me is if I were a migrant, for example. There are many migrants here who want to get access to those services. If you are living in the more dispersed or peripheral area of where services are available, it could be quite difficult, first, to find out about them and, second, to get access to them. The language barrier can also sometimes be a massive issue. I do not know which of the witnesses will take this question. For any of us living on this island - natives of here if you like - we can do a search much quicker. For people who have the language difficulty or barrier, what mechanisms are in place for those people who are genuinely reaching out?
Ms Fiona Finn:
From our perspective in the sexual health centre, we do an awful lot of extensive outreach to people who are living in the migrant communities. We do extensive outreach to IPAS centres in the local area. We are hoping to expand that from Cork and Kerry. The idea is we directly engage with people who are living in direct provision centres and then we provide a workshop on sexual health in a very culturally competent manner. It is about informing people about the services available and how to access them. We are building on that programme with the HSE locally to try to deliver that programme through a mobile unit across Cork and Kerry.
I agree with the Deputy that it is a challenge. In a sense, Cork is very much an urban setting. It is quite a big county and there are rural areas within it, but there are certain areas and people who we are probably not reaching. There is a lot more dispersal now from people who are coming in as international protection applicants. They tend to be dispersed across the country and that is an issue and a challenge. The HSE has translated an awful lot of its materials across different languages. There are many videos available for people. It is around trying to ensure the message gets out.
We have delivered this programme, which is like an ambassador's programme, where we work with people who are in direct provision and then they become almost like sexual health ambassadors. The idea is they will go and tell their friends and new people who come in that these are the services available in Ireland and this is how you access them. A lot of very positive work has been done by the HSE to try to make all that information accessible and available across several different languages.
Professor Fiona Lyons:
In addition, the home STI testing services can be translated and are linked to multiple different language translations. We also did a pilot last year which looked at user-activated kits where, for whatever reason, an individual cannot have a kit sent to their home, they can go to a place, such as the sexual health centre in Cork which was one of the pilot sites, where the kit can be activated and they can complete the testing. If you are in a shared room with four other people and you do not have a particular point or address that it is going to get to you, or there may be difficulty in it getting to you, then you can use user-activated kits. Also, the health promotion training programme raises awareness of services through the health promotion offices and training is done at a national level. They signpost people in centres around how to access sexual health services as well.
The language barrier is a significant thing, but it is not the only barrier in somebody providing care to people whose first language is not English. Cultural competency also needs to be considered. Having worked in Ireland and the UK, and provided a lot of care to people who have not grown up or been born in western Europe, I have often felt inept in terms of my cultural competency. This is something that needs to be addressed to ensure we are competent to provide services in a way that is meaningful. It is about understanding where people come from, their systems of belief and religious beliefs, and their education and training is part of that as well. Much has been done and there is a lot left to be done. That is the theme for today.
Another theme that is emerging today and is very welcome is that this is very much a collaborative effort. We have worked very well together thus far and will continue to do so.
Peter Roche (Galway East, Fine Gael)
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Coming from my constituency, which is Galway East, I would imagine that Galway is probably better served than most counties. For the most part, people who want to reach out want to remain anonymous as well. In terms of Connacht as a whole, several references were made to gaps in the services. In the west of Ireland, where is there a need for further investment, further intervention centres or further sexual health clinics?
Professor Fiona Lyons:
As part of our model of care work, we have recently completed a survey with all of our sexual health services to understand their workforces, any vacancies, their capacities and their needs. Within the west and north west, certainly in Letterkenny and Sligo, there are gaps in services. People there are working very hard within the resources that they have, but my view is that they need additional resources in order to meet the needs of people, particularly in Donegal and Mayo.
The Galway area is generally quite well served. There has been much mention of having services at a county level but we need to remember that we have agreed as a country to have our health service structured under regional health authorities. We do not apply county boundaries to people when they are coming to see us. We need to ensure that, at a regional level, we have access to the services people need so that they absolutely do not need to leave their respective regions in order to get the care they need.
Peter Roche (Galway East, Fine Gael)
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What would the witnesses wish for in the perfect model? Obviously, funding is one of the matters referenced in the reports. This is probably a very loaded question but how soon do the witnesses anticipate that the needs of the community will be satisfied, that is, maybe not fully met, but at least with those gaps filled and the funding mechanisms in place?
Professor Fiona Lyons:
The opportunity to have this topic of conversation today is part of democracy and how we can raise awareness, push the envelope forward and ensure that we get the resources. Access to PrEP is a key priority need because it is a very important public health intervention. I hope that we will improve access to PrEP through additional resources, but also through things like the smart way that we are working within resources and the development of a hybrid model of care. Hopefully, the research we were funded to do by Government funding under the evidence for policy programme 2024 will show that this is a model that can work. It is not for everybody but hopefully it is a model that can work. I will not commit myself to a time because there are so many uncertainties in our world right now, but I hope that we will be able to improve access to PrEP in the short to medium term.
The access to chemsex support is really an urgent priority for us.
On the wider work on sexual dysfunction, sexual well-being and sexual pleasure, it may take a little bit longer to achieve that. It is important that everybody is on the same hymn sheet in recognising how important this is and that we are not losing sight of our ultimate vision, namely, that everybody should have access to the sexual healthcare they need across their life course.
Peter Roche (Galway East, Fine Gael)
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In the 13 seconds I have left, I want to commend and thank the witnesses for the work they do. It is keeping the community informed and improving people's mental health in terms of managing all of that. I wish the witnesses continued success.
David Cullinane (Waterford, Sinn Fein)
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I apologise for being late. I was on the "The Claire Byrne Show" on an issue. I missed a lot of the questions that have been put, so I apologise if I repeat some of them.
I will start with the model of care. I support the new model of care that is going to be put in place. We need to see it in place as quickly as possible. Is the model of care to be published by the end of 2026? Is it going to come with a costed implementation plan and a workforce plan? Perhaps the HSE witnesses will take this question first.
David Cullinane (Waterford, Sinn Fein)
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Is that September or August?
David Cullinane (Waterford, Sinn Fein)
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Okay.
Professor Fiona Lyons:
It depends on how many curveballs we get in the meantime that slow down our programme of work, but the plan is to develop an implementation plan with an associated resource plan as well. We are currently finishing a survey of all our services looking at workforce, understanding need, understanding gaps, and identifying capacity to support an implementation and workforce resource plan to implement the model of care.
David Cullinane (Waterford, Sinn Fein)
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If I can, I will add to that. I thank all of the groups that made public submissions to the committee. Some of the issues raised therein were on some public PrEP services, with people waiting for nine to 12 months and regional variations. For example, there are no public PrEP services in Waterford, which is my constituency. Will the plan tackle those regional imbalances in the public PrEP services? Will this get the attention it needs in that new plan?
Professor Fiona Lyons:
We will not be waiting for the new model of care to address the inequity of access to the PrEP services across the region. We developed a PrEP programme in 2019. The HSE acknowledges that the absence of a PrEP service in Waterford is completely unacceptable. I will turn to my colleague Dr. Hamilton to address access to PrEP services in University Hospital Waterford specifically. Dr. Hamilton is the regional clinical director for HSE Dublin and South East.
Dr. Vida Hamilton:
I assure the Deputy that HSE Dublin and South East is fully committed to delivering PrEP services in the region. We recognise it as a key priority and we are actively working with University Hospital Waterford in order to identify a date to start the PrEP services. We have a consultant in post in a locum position at the moment and we are working with them to start that service.
David Cullinane (Waterford, Sinn Fein)
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I will come to the other groups in a second but will stick with the HSE for now. There are calls for a national HIV action plan to be published for 2026. Will that be done separately? It is being considered?
Professor Fiona Lyons:
The programme for Government in 2025 committed to the development of a HIV action plan. The HSE is one of the partners working with the Department of Health on the development of that HIV action plan. Many other people in this room are involved in that as well. They are overlapping areas of work and where efficiencies are found, we do not need to reinvent the wheel. The HIV action plan includes not just HIV care and the model of HIV care, which is being led by the infectious diseases clinical care programme, but also HIV and prevention, which very importantly includes HIV PrEP and HIV PEP. These many streams of work had already been happening.
David Cullinane (Waterford, Sinn Fein)
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I wish to ask about the new model of care for trans healthcare. I have engaged with the HSE on this for the best part of three years. A review was being put in place and a new plan is to be published. I got different estimations as to when that would be published and what it would look like. I want to make a broader point, which I am sure would be accepted by the HSE, about how many of the adults I have dealt with are on waiting lists. Even in recent weeks, I have dealt with two individuals who are on waiting lists, but those waiting lists are going nowhere. People might be on a waiting list for five, six, ten years or longer. We can talk about new models of care and a new trans health strategy but the services simply do not exist. That is the problem. When is it envisaged that the new strategy, plan or, more to the point, model of care will be in place? Is there an acknowledgement that it will require very significant investment, additional supports and additional staff to ensure that people can then access services?
Professor Fiona Lyons:
The HSE completely acknowledges that the poor access to gender-affirming care for trans people is unacceptable. The sexual health programme does not actually have remit over gender healthcare. With the committee's permission, I would ask that we seek a written submission for the Deputy after the meeting from the national clinical programme for gender healthcare.
David Cullinane (Waterford, Sinn Fein)
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Okay. Of the groups that sent in representations, a number focused on trans healthcare because it is so important.
David Cullinane (Waterford, Sinn Fein)
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I accept that it does not fall directly under the SHP's remit. However, the new model of care has been promised. I know there is consultation. There are concerns about the level of consultation and what might underpin that model, but for me the issue is access to services and those services being available.
Dr. Vida Hamilton:
I might be able to give some information, but as Professor Lyons said, we can give the committee a more complete written submission. I understand the model of care should be delivered in July of this year, subject to unanticipated delays. Significant work is being done to stabilise the service and it is recognised that significant investment will be required to be able to deliver the care that is required.
David Cullinane (Waterford, Sinn Fein)
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I will turn to some of the other groups because other people have put questions in the submissions we received. Chemsex was one of the issues raised, as was access to HIV testing. There were a lot of different issues and a lot of different gaps in services regionally and locally were raised. Is there anything that has not been covered that any of the other groups would like to come in on?
Mr. Adam Shanley:
It is welcome to hear that all those present have named chemsex as an urgent issue. We have known of this as an issue that affects primarily gay and bisexual men in Ireland for quite a while. One of the first pieces of research on the topic of chemsex was done in 2016. At that point, there was a recognition that around 25% of the people attending the gay men's health service during a six-week period had engaged in chemsex and that was ten years ago. Similarly, a third of those who were engaged in chemsex at that stage identified that they would appreciate information and support. We have known about this issue for quite a while and, as I mentioned in my opening statement, the HSE has had a working group for quite a while in recent years to discuss this issue. Now, resources and funding to deliver resources to the affected communities need to follow the understanding of the issue. I definitely welcome that the HSE has a national chemsex survey under way. It is encouraging to hear there are more than 900 responses to that, so we will get a strong understanding of the situation in relation to chemsex today. When we have that evidence - we will have quite a considerable evidence base - action and funding will need to flow from it.
David Cullinane (Waterford, Sinn Fein)
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Okay, I thank Mr. Shanley.
The new sexual health model of care will provide an opportunity to fix gaps in services. Women's healthcare is another issue that came up a lot in the submissions. There have been some moves in recent years in respect of free contraception for women and I support that. Are there gaps in women's healthcare that need to be in this new model and which may not have been addressed so far this morning? Do any of the groups want to comment on that? I will leave my last minute for that response.
Ms Muire O'Farrell:
I am happy to come in on that. We definitely note some gaps in women's health services in particular. We run free counselling services funded by the HSE for a number of different topics including crisis pregnancy, post termination, infertility, complex menopause and recurrent miscarriage. We see huge demand from women seeking to access those services. We are lucky to be able to provide an in-person service for people in our region but there is huge demand in Cork and Kerry in general for those services, around women's health and reproductive health in particular, so we definitely call for increased funding of those areas.
Access to contraception is fantastic with the new funding for free contraception but there are definitely barriers to access purely based on GP capacity. We get phone calls about that consistently. A broader access model would be great to enable sexual health services like ours to offer contraceptives and a one-stop-shop sexual health service.
The three-day wait for terminations connected to the legislation is incredibly problematic and something a lot of women raise with us. That mandatory wait time does not exist for access to any other medical service and it is quite infantilising for women to have to wait three days after a decision they have already made, especially in a tight window.
David Cullinane (Waterford, Sinn Fein)
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There is no medical or clinical rationale for it.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions at this point.
I thank the witnesses for all their work, advocacy and engagement. I have followed the work of many of their organisations over time and I have always been impressed. It is worth putting some of this in its historical context. In the past, where the State failed to provide services, organisations like the Cork AIDS Alliance, now the Sexual Health Centre, stepped in and filled that gap and it has shown real innovation over many years in delivering services and pushing boundaries, as well as in reaching some of the more marginalised groups in the community. It is good to have its representatives here, hear about their expertise and hear them advocate for how we can improve things.
Similarly, in the work with gay and bisexual men, the Gay Health Network has always brought together a collection of different organisations to advocate strongly for improving services. Mr. Shanley's previous work through MPower was really impactful and he has been a fantastic community champion. His ongoing work in Trinity College is greatly appreciated. It is great to have him here.
It is remarkable how the HSE sexual health team works with other organisations and external partners in a way other parts of the HSE do not. It is always great to see that engagement and the partnership working. Professor Lyons and her colleagues have always been good at engaging with organisations, reaching out to communities, engaging in the Gay Health Forum and all the other additional work, which is on top of the other work they have to do. It really makes a difference so I thank them for that.
I also thank everyone who made submissions. We received a substantial number of quite detailed submissions from a range of organisations and individuals who will contribute to our ongoing work. Today, we wanted to bring together a selection of different perspectives from the regional perspective to the academic perspective and the HSE, so it is good the witnesses are here.
I will start with HIV. For a long time, we were waiting for the big game-changers for HIV and now we have them, with rapid testing, PEP, PrEP and U=U. Now, we need to seize that moment and get to a point where we end transmission in Ireland. It is disappointing to hear we are off track on that and that we will probably miss that big goal. I would be interested to hear about Mr. Shanley's perspectives on what we need to do urgently to get back on track. Is it possible to reach that goal by 2030 if things change now?
Mr. Adam Shanley:
Yes, I certainly think it is very possible. As the Cathaoirleach mentioned, we have all the tools we need to end HIV. What is necessary now, as we begin this new national sexual health strategy, is that funding follow where we have recognised there is a need to close gaps. Despite the fact there is not a sexual health service in every county, what is most important is choice in the way in which people access services. Bricks and mortar clinics will always be an important part of sexual health, particularly for those with more complex needs or those who simply feel more comfortable engaging one-to-one with a clinical professional. However, we are in a space where there is an opportunity for us to engage many different tools to deliver sexual healthcare. An exemplar of that is the HSE home-testing service, which brings STI testing to individuals. Community based services also add to that by making sure people who cannot accept test kits at their home address for various reasons have other touchpoints for their sexual health. PrEP is an important tool for us to be able to achieve ending HIV transmission by 2030 or any time after that. When we recognise there are severe service capacity issues, we have the opportunity to capitalise on tools. The pilot I am working on with Professor Lyons in Trinity College looks at using the infrastructure of the home-testing service to deliver PrEP services online for those who have an uncomplicated relationship with PrEP and do not need more structured services.
I think we have all the tools to end HIV and to make inroads in curbing other STIs. It is about building in choice and making sure that choice and those services are properly funded so they reach the people who need them.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is absolutely about the resourcing, investment and prioritisation. I take the point about regionalisation. We make the point on the counties as an example to show the fragmentation, how there are gaps and how things are sometimes disjointed. One of the people who made a submission said that the PrEP programme serves 26 counties, but in 16 of those there is no in-person way to access PrEP. There is no public place in 16 of the 26 counties. I see the need for innovation and to move to online access, but there are people who will want to go to a physical location. There are digital literacy issues. In the conversation on access to sexual health I think having more public in-person sexual health centres that provide a range of services and supports around sexual assumption would help to normalise things.
We constantly get correspondence from individuals who are deeply frustrated by lack of access and who want to access PrEP and take steps to prevent HIV infection but cannot access it. The latest data we have from the HSE is that over 800 people are on a waiting list. We know some places have closed their lists so there are potentially even more people who would like to be considered and are not. Somebody contacted me and asked me to ask the witnesses if we know how many people become HIV+ while they wait for PrEP.
Professor Fiona Lyons:
I cannot give an absolute figure but we endeavour, through our surveillance systems, to understand that. When we were introducing PrEP part of understanding the impact of it was to include it in our advanced surveillance forms for HIV. HIV is a notifiable disease so information on that form includes whether or not somebody had been on PrEP in the six months prior to their diagnosis with HIV. We have that information. I cannot give it off the top of my head but I can send it on as a written submission afterwards. The situation with respect to accessing PrEP is something we absolutely see as a priority. It is one of the things that has led to delays in our developing other aspects of our sexual health model of care because we have had to respond to the increasing demand and need for PrEP. As I mentioned in my opening statement, some of that is because there has been an appropriate relaxation in not having to prove your risk or need. It is your anticipated need or benefit that an individual sees as being good for them. It is hard to say how much that has increased the demand and want for PrEP but that is something we continuously work on in trying to build efficiencies and develop new ways of doing things. It is important to note that while we are doing the work on looking at a hybrid model of care, as Mr. Shanley has mentioned, it cannot be one single model of care. An individual's view on how they wish to access care may change over their life course or as their care needs change. Our services need to be built in a flexible and integrated way that allows people to flex in and out of care as they need it across their life course.
Pádraig Rice (Cork South-Central, Social Democrats)
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Professor Lyons mentioned in her opening statement or submission that there were seven new staff for the PrEP service in 2025. How many were requested?
Pádraig Rice (Cork South-Central, Social Democrats)
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There were 28 requested and seven were provided.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is a huge shortfall in terms of required staff.
Professor Fiona Lyons:
It is a huge shortfall, but the HSE sought the responsibility for giving the resources they were allocated, so we had to engage in a process of identifying the least worst way of deploying those resources. Through the work we have done gathering surveillance information and various data sources, those resources were allocated to the Dublin services. In respect of that, we have national standards for HIV PrEP which we developed and contributed to the European Centre for Disease Prevention and Control on how PrEP standards should be developed. We have those rolled out through our PrEP working group and we monitor these on a regular basis. One of the things we monitor is access to PrEP. We have a core standard that people should be able to refer themselves to a PrEP service within three months. We would not like it to be three months; we would like it to be much earlier. However, we knew there were such big challenges with access, so that was something we could try to work towards in the first instance. When we got word of the allocation of resources in the national service plan 2025 in November 2024, we went through an exercise of looking at what services around the country were way off the mark in terms of reaching that core standard. At that point it was the Dublin services that were not able to meet that core standard.
Pádraig Rice (Cork South-Central, Social Democrats)
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I want to be clear. The service requested 28 staff in the 2025 service plan and got seven. What about the 2026 service plan?
Pádraig Rice (Cork South-Central, Social Democrats)
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There were no new staff in 2026.
Pádraig Rice (Cork South-Central, Social Democrats)
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This is despite the huge number of people waiting and wanting to get access to the service. Despite the shortfalls and the ambitious target of trying to get to no HIV transmissions by 2030, there are no additional staff.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have more questions, but I might come back in with those.
Colm Burke (Cork North-Central, Fine Gael)
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I thank the witnesses for their presentations and for the work they have been doing in this area for a number of years. There has been a huge improvement in services and supports provided over the past 20 years. I start with the HSE youth health service, which seems to be under pressure. It is an important area as regards getting information and support out to young people. In the current review, is there a proposal that the HSE youth health service be expanded and properly supported? What is the target for that area?
Professor Fiona Lyons:
We know that young people between the ages of 18 and 24 experience disproportionate levels of STIs in Ireland. At that time in their lives, they often have additional needs and vulnerabilities. Within the model of care, we will be calling out particularly vulnerable groups like young people who will need additional supports. Our model of care will address these gaps and, hopefully, the implementation and funding resources will follow through with that.
Colm Burke (Cork North-Central, Fine Gael)
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Professor Lyons accepts that there are gaps.
Colm Burke (Cork North-Central, Fine Gael)
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Are we talking about a time period with regard to trying to fill those gaps? Will it be two years, three years or five years, for example?
Professor Fiona Lyons:
I have indicated that we will deliver on the model of care by the end of July 2026. We would also like to deliver on the development of an implementation and resource plan. It is beyond the scope of the HSE to have those resources, but with those resources it would follow after that. We are in an uncertain time in our world, and I do not know what resources will come. However, the HSE will fulfil its responsibility of developing the model of care and advocating for and identifying resources.
Colm Burke (Cork North-Central, Fine Gael)
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The other thing with young people concerns the availability of information. With the way social media has changed, young people rely so much on it. Is there a view that more work can be done in that area so that people can access information and find out where services are available?
Professor Fiona Lyons:
Availability of services and information and education resources for the population are key pillars of the sexual health strategy. Within the HSE a lot of work is done to make sure people have access to the information they need to support them in making better sexual health choices. Additionally, research is continuously done to understand if we are meeting the mark in making sure people are best equipped to meet their sexual health needs. A survey was done in 2025 of 18- to 30-year-olds. It identified that while there was good knowledge in respect of aspects of sexual health, some people aged between 18 and 30 were not translating that knowledge into proactively going out to improve their sexual health. As mentioned in the published opening statement, 53% of that cohort were unaware of the home STI testing service in 2025. A lot of work is done through developing resources and ensuring the information and resources developed are meeting the bar and meeting our key priorities in terms of information and resources for young people.
Colm Burke (Cork North-Central, Fine Gael)
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There is information showing an increase in STI infection, as I understand it. Is that correct?
Colm Burke (Cork North-Central, Fine Gael)
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What kind of increase has occurred?
Professor Fiona Lyons:
The year 2020 was a particularly bad one in respect of STIs because our surveillance systems were so badly affected by Covid.
For STIs this year, weeks 1 to 13 of 2026, which is the most up-to-date information from our surveillance systems, there has been thus far an increase in chlamydia infections of 7.8%, an increase in gonorrhoea of 10.8%, a decrease in herpes simplex of 6% and a slight decrease in syphilis. Chlamydia disproportionately affects young people. Most people with chlamydia are aged under 25.
Colm Burke (Cork North-Central, Fine Gael)
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Is the big increase among people aged under 25?
Colm Burke (Cork North-Central, Fine Gael)
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That raises the following questions. Are we getting enough information out there and how do we improve that conveying of information?
Professor Fiona Lyons:
As I mentioned, the HSE's communications and public affairs team does a lot of work on communicating messages and, with the programme, identifying priority messages for target groups like young people. We need to acknowledge that some of the increase in numbers of STIs in recent years, though not all of it, has been due to better case ascertainment. We estimated that the home STI testing service, in its pilot phase, would lead to increased access to testing by 33% across the population. We were blissfully unaware of that prior to that time. There is better case ascertainment, which will lead to an increase in numbers. I am not saying that it is all of it but it is a complicated matter.
Colm Burke (Cork North-Central, Fine Gael)
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Is there a seriously planned programme over a period to get information?
Colm Burke (Cork North-Central, Fine Gael)
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What level of contact has been established with secondary schools and third level facilities to convey information?
Professor Fiona Lyons:
This is my direct area of work, so I will refer to my notes. The current campaign for young people is sexual well-being, which aims to empower 17- to 30-year-olds to make informed choices about their sexual health, recognising that they are disproportionately affected by STIs. The campaign promotes positive sexual health, condom use, contraception and how to access sexual health services such as the free home STI testing service. It aims to deliver messages to young people on platforms on which they are most active, particularly TikTok, Snapchat and Instagram. A large research project was undertaken of this age cohort in January 2025 to understand their knowledge, attitudes and behaviours towards sexual health to inform subsequent campaigns.
Colm Burke (Cork North-Central, Fine Gael)
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Obviously, there is constant review to convey information.
Colm Burke (Cork North-Central, Fine Gael)
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I will now discuss a totally different area and other people may wish to comment. I want to know about the provision of support to people who are in prison as regards a comprehensive programme of care in relation to HIV, etc. Do all of the prisons have a programme in place to deal with sexual health and HIV? I am talking about all the prisons, including places of detention for young offenders, women's prisons and the main prisons. Is services provision connected? There is a view whereby the Department of Health could very well say that sexual health services are an issue for the Prison Service and, conversely, the Prison Service could say that the provision of sexual health services is a matter for the Department of Health. I know that level of confusion arises from time to time.
Professor Fiona Lyons:
I have personal experience. My first consultant appointment, when I returned from the UK in 2007, was to establish an in-reach HIV and sexual health service in Wheatfield Prison and Cloverhill Prison, which are prisons in Dublin for the detention of males. I established those services and they are still in existence. Colleagues from St. James's Hospital also provide services into the Mountjoy complex.. Outside of that, there is not a joined-up, centralised programme for sexual health and HIV within prison settings that is delivered by people like me who work in sexual health centres, but we certainly do see prisoners who come into the services from prisons . As part of our model of care work, we have recently had engagement with the prison health services to see how they can better meet people's sexual health and HIV care needs.
Colm Burke (Cork North-Central, Fine Gael)
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Would that not be better rather than transferring a prisoner from a prison setting to a hospital setting, where that care could be provided and there would be prison services? Why has that not been developed in all of the prisons to provide such care? There is a huge cost in taking one prisoner to a hospital clinic, whereas prisoners could be treated by the person with the expertise coming out to the prisons.
Professor Fiona Lyons:
It is not just cost effective. It also affords the person a greater degree of dignity and privacy in their consultation when the care is delivered in the absence, where appropriate, of prison officers in the consultation room. Unfortunately, I cannot answer the question as to why that has not been done. It is outside our area of work, but I will say that we have engaged with the Prison Service around including it in the model of care and I hope that can be done in future.
Colm Burke (Cork North-Central, Fine Gael)
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Does Professor Lyons accept that a lot of work needs to be done in this whole area?
Colm Burke (Cork North-Central, Fine Gael)
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The big challenge now is that the Prison Service is under pressure in terms of numbers and, therefore, a sexual health service is even more of a priority now.
Colm Burke (Cork North-Central, Fine Gael)
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The HSE is conducting a review of services and where there may be gaps. Does Professor Lyons agree that a real effort needs to be made in making sure that people in lower income areas have access to services? There are gaps in provision in these areas. In Dublin, Cork, Galway and Limerick, while services are available, they are not necessarily available in the areas where they are most required.
Professor Fiona Lyons:
Yes, this is also really important. Ireland Inc. should be very proud of the home STI testing service as Ireland is the first country in the world to provide such a service. We have sung the praises of the home STI testing service today and while we have geographic equity of availability of access to the service, we need to ensure that there is equity. We need to ensure that people who live in more socially deprived areas and experience social deprivation are not left behind by a development such as this. That goes into not just the home STI testing service but also how we will develop the model of care. We have collected figures to try to understand need. In 2017 and 2018, we looked at a sexual health needs assessment and we tried to adjust for social deprivation, recognising that some people will disproportionately experience sexual health and many other aspects of sexual health because of their social determinants of health.
Pádraig Rice (Cork South-Central, Social Democrats)
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Do members have any additional questions?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Yes. We must recognise what has been done and that a framework has been created in which an awful lot more can be done with proper investment. I am reading the paper provided here by Mr. Adam Shanley in terms of the issues that he reviewed. For example, he concluded that Ireland has made substantial and commendable progress in strengthening sexual health services, and I recognise that. I have been in practice for nearly 40 years. I am ageing myself now, but that is the reality. Certainly from the eighties to noq, the service is almost unrecognisable. The culture is also unrecognisable, which is hugely important because if you do not have the culture right, then you cannot hang these services on to the framework, develop them and seek funding in a meaningful way. The expansion of HIV and STI testing service is remarkable. It is also remarkable that Ireland is the first country to introduce the innovative home testing of STIs service. There has been the introduction of the PrEP programme and there is the increasing recognition of complex issues such as chemsex. That would not even have been considered ten or 15 years ago. Mr. Shanley also mentioned that there is a strong integration of community leadership to demonstrate a system that is responsive and collaborative - collaboration is absolutely brilliant - and grounded in public health evidence, which is the basis for any service to be developed.
As Mr. Shanley mentioned in his paper, there are the issues of equity, choice and flexibility. We need geographic equity in terms of access to PrEP services. There is also the issue of the generality of sexual health services. Again, we do not want to go down this tunnel because sexual health services must be provided in the broadest sense.
Ms Finn talked about sexual dysfunction and sexual pleasure. We need to be able to talk about those things and people need access to those services. My mother was a GP in the west of Ireland in the sixties and she described the absolute absence of knowledge of sexual function there, and how there was no place to even go and seek that knowledge.
I commend the witnesses on their work. I recognise there is a lot to be done. The Cathaoirleach said the same, as did the rest of the members. The witnesses are pushing an open door. I advocating more funding.
Recognising what Mr. Shanley and the Cathaoirleach said on the question of HIV, going back to the 1980s, people were treated like they had the plague. I recall a senior colleague who contracted HIV and who was treated like a leper. That is just the honest truth. We have moved to a situation that is a public health game-changer in the prevention, treatment and the management of HIV. We need to recognise how groundbreaking that is as well.
Professor Fiona Lyons:
The work in stopping people with HIV being made to feel like lepers is not yet done. I commend the huge work that has been done by the Poz Vibe Tribe in collaboration with the HSE on the You, Me and HIV campaign to address the very significant and real stigma that people living with HIV in Ireland still experience. We know that prior to the launch of the campaign less than one in three people were aware of the protective effect of successful treatment in preventing the onward transmission of HIV. Since the campaign that is almost one in two people. The brave, commendable, passionate voices that have come forward with the lived experience of living with HIV in Ireland have made significant further breakthroughs in addressing the stigma. However, our work is not yet done in respect of stigma for people living with HIV. That is true of the general population but also in healthcare settings.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I accept that. I will withdraw my comment about being treated like lepers because that is pejorative. They were ostracised and treated with a complete lack of compassion and respect. It was something I reflected on when a senior colleague contracted HIV and was isolated in their workplace and died in their workplace isolated. We need to reflect on those people as well.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions. I want to pick up the point around trans healthcare because, like others, I am deeply concerned around the waiting lists and the clear failings on behalf of the State to provide access to gender-affirming care that has proven to be lifesaving for trans people. Does the HSE agree with the World Health Organization that trans healthcare should fall under sexual health?
Pádraig Rice (Cork South-Central, Social Democrats)
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We would have a far better system if it was under sexual health. We would have a more inclusive system and we might have shorter waiting lists and fewer barriers to access if that was the case.
Ms Fiona Finn:
The Sexual Health Centre in collaboration with the trans community in Cork has begun a small pilot programme looking at how informed consent models can be employed around gender-affirming care. It is based on successful international examples in both Australia and the US. It is intended to minimise the risks associated with self-medication and enable the trans community in Cork who may be accessing their care abroad to be overseen in an Irish healthcare setting through the provision of safe access to blood tests, monitoring, counselling and peer support. It is quite small. It is a small project and is GP-led. It is also run by a nurse. It operates once a month. The people we are trying to reach are trans community members who have no access or very poor access to healthcare. We are going to try to roll this out and see how it works. It is built on a informed consent model.
Pádraig Rice (Cork South-Central, Social Democrats)
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There is a lot to be considered in trans healthcare and it warrants its own session perhaps later in the year, once the model of care is concluded, for a detailed analysis by the committee and by the Oireachtas more broadly.
I have a couple of other points for the Sexual Health Centre. I welcome the remarks on the required reforms of the abortion laws and the three-day wait period. It is an issue that will be considered by the Oireachtas next week. My colleague Deputy Holly Cairns will introduce a Private Member's Bill next Wednesday to deal with that issue. That should be removed and there are other barriers in terms of fatal foetal abnormalities while other reforms as recommended by the O'Shea report need to be implemented. We will have a chance to debate and visit that next Wednesday.
What are the biggest barriers to the free contraception scheme? Is it the age cut off for over-35s?
Ms Muire O'Farrell:
The current biggest barriers reported to us are gaining access to the free contraception itself, depending on somebody having a current GP and getting a GP appointment to access the care. A lot of GPs have reported to some clients that have contacted us that they do not have space or capacity within the service to input or remove the long acting, reversible contraception. Those are the kinds of barriers women face on a consistent basis. We very much welcome the provision of free contraception. We do not have much evidence that the over-35s limit is a barrier for women. Generalising age ranges is, perhaps, not necessary. Those brackets could be expanded to those in need. They are the main pieces.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the witnesses.
Colm Burke (Cork North-Central, Fine Gael)
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I want to come back in on the Prison Service. There is a submission from a registered nurse who worked in the Prison Service. She states that while an infectious disease consultant runs a clinic once a week, it is simply not enough. She prioritises co-infected groups of people with HIV, hepatitis and occasionally views someone with symptoms of sexually transmitted infections. She goes on to state there is no routine testing for sentence inmates who may be engaging in risky behaviours throughout their time in custody. She further states that there is no review going on within the prisons. For instance, in the prison she mentions, a consultant comes in. It is my understanding that an awful lot of the prisons do not have a consultant coming in. I am wondering about the need for co-ordination between the Department of Health, HSE, Prison Service and Department of justice.
Colm Burke (Cork North-Central, Fine Gael)
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Is there an ongoing engagement on that issue?
Colm Burke (Cork North-Central, Fine Gael)
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In 12 months, will a different process be in place in all prisons or will it be in only one or two prisons?
Professor Fiona Lyons:
If we think the model of care is going to be done by the end of July this year, I hope that we would be in a position to improve services across the prison campus by the following year but I cannot say when exactly that will be. I imagine the gaps are quite significant. To identify those gaps, identify the resources and get the resources to meet those gaps would likely be quite-----
Colm Burke (Cork North-Central, Fine Gael)
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We do not have a huge number of prisons. It is easy to identify the gaps. The question is about putting the services in there.
Colm Burke (Cork North-Central, Fine Gael)
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I know there are an awful lot of different parties-----
Colm Burke (Cork North-Central, Fine Gael)
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-----because there are the prisons, the Departments of justice and health, the HSE and the medical profession. Surely, they should be able to get this together in a short enough period.
Professor Fiona Lyons:
I would love to think that we could but we have very significant constraints on our time. I thank the Deputy for bringing up not leaving the prison population behind as an important priority . We can ensure that within our model of care development there is specific mention of prison populations, which is our intention. As I mentioned, we have started engaging with the Prison Service.
Pádraig Rice (Cork South-Central, Social Democrats)
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Perhaps we could write to the Minister for justice-----
Colm Burke (Cork North-Central, Fine Gael)
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I think we should.
Pádraig Rice (Cork South-Central, Social Democrats)
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-----as a committee and flag this. There should be access to condoms and sexual health services in prisons.
Martin Daly (Roscommon-Galway, Fianna Fail)
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There are many health service issues in the Prison Service.
Pádraig Rice (Cork South-Central, Social Democrats)
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There are. It may be the topic of another session we could consider.
What percentage of the first sectoral strategy was implemented?
Professor Fiona Lyons:
I cannot give the Cathaoirleach a figure on that. When the strategy was launched, the then Minister for Health, Leo Varadkar, said we had to develop an action plan. We developed a priority action plan. I cannot remember, but I think there were 30-odd actions within the priority action plan, one of which was development and implementation of antiretroviral therapy as a prevention strategy, which includes PrEP, PEP and treatment as prevention. One action probably took up 60% of the time within the first three years of rolling out the sexual health strategy. It continues to take up a significant amount of time. Unfortunately, I cannot provide an absolute figure.
Pádraig Rice (Cork South-Central, Social Democrats)
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In terms of the second strategy, how much funding has been allocated for resourcing?
Professor Fiona Lyons:
A lot of the strategy revolves around continuing to deliver on things that we have started, with a particular focus on equity of access to sexual health services, including PrEP and PEP. Vaccine equity access is a particular area. The Department of Health is chairing a number of implementation groups to oversee the implementation of the strategy. It is at those groups that we can advocate for resources to fully implement the strategy.
Pádraig Rice (Cork South-Central, Social Democrats)
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From our earlier discussion on staffing, it would seem that not enough resources have been allocated. That is one takeaway. Somebody asked us to ask about third level. There was an interesting pilot in TUS at campus level. Will that be expanded?
Pádraig Rice (Cork South-Central, Social Democrats)
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I believe it was award-winning.
Professor Fiona Lyons:
It won an award. Recurring funding is available for that service. There have been calls to consider such a model across the other third level institutions. The Department of Health has done a lot of work in engaging with third level institutions. Those institutions are included in the model of care as well.
Pádraig Rice (Cork South-Central, Social Democrats)
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Is it likely that this model will be expanded?
Pádraig Rice (Cork South-Central, Social Democrats)
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A number of witnesses mentioned chemsex. I am not clear on that. A survey is under way. I am happy for anybody to come in on this. What is next? Is it that solid action will be needed after the survey is done? What is the pressing action? Mr. Burke or Mr. Shanley might have thoughts on this. What needs to happen next? I am not clear where we are at.
Mr. Adam Shanley:
Obviously, we should be led by what we learn from the national chemsex survey. However, as I have said, particularly from working within the community over the past decade or so, it is clear that comprehensive information is not available around people engaging in sex and drugs. We had developed a first aid guide for people who found themselves in emergency situations and how to deal with those. The confluence of the use of these drugs and sex precipitate an emergency situation. It is about giving people some of the information and some of the skills around what to do in those situations. It also follows on to understanding and Man2Man and drugs.ie have comprehensive information about the drugs themselves. It is about understanding the potential harms and what kind of services would be available.
Services are fairly lacking in that space. Some people are doing wonderful work in terms of outreach and engaging with people and signposting them on to some of the structured supports that are available. Those supports are very slim on the ground. The Rialto Community Drug Team has one person who has taken up the mantle in terms of supporting people through their youth. That is one person in one pocket of Dublin. We know - and I am sure the chemsex survey will show - that this is a phenomenon that is engaged in across the country. We will need harm reduction resources. We will need education and learning as well.
It is good to hear that there will be parallel survey for healthcare providers because it will be really important for us to identify any knowledge gaps and learning opportunities, not just in sexual health services but also there can be quite a lot of presentations to our emergency departments as well. First responders and those in the emergency departments should have an understanding of what this phenomenon is and how best to offer support and signposting. Peer supports and structured support are all key elements of what is missing. There will be a really solid evidence base to work off once the survey has been completed. We have mentioned in every aspect of what we have spoken about today that it is really important for us to have evidence. Unless funding and action flow from that, however, we will possibly be talking about this at another meeting.
Pádraig Rice (Cork South-Central, Social Democrats)
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Before we come to the two remaining speakers, we will take a short break for three minutes in order to give the witnesses a break. Is that agreed? Agreed.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank our guests for coming in this morning. There is one specific area I want to ask some questions on. I cannot recall who it was earlier on who mentioned the gaps in women's healthcare.
Pádraig Rice (Cork South-Central, Social Democrats)
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It was the Sexual Health Centre.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It was Ms O'Farrell. I apologise. She referred to the difficulty in accessing it due to GPs. From her experience and from what she sees in her role, should the pilot scheme at St. James's Hospital - that opportunistic testing of blood when somebody presents to an accident and emergency department - be expanded where there are people who either cannot engage with scheduled healthcare or are meeting barriers around that, for example, GP referrals?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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My apologies. St. James's Hospital has a pilot programme where, if someone presents through an emergency department, ED, there is an opt-out facility there for a range of blood tests to be carried out. I as trying to ascertain something. We know where the gaps are but we cannot keep talking about the gaps. We would love to fill them overnight. Realistically, that is not going to happen. Are there other methods or levers there that we could be looking at? If what is happening in St. James's could be rolled out in Cork, would Ms O'Farrell see a benefit to that?
Ms Muire O'Farrell:
Absolutely, we would be very supportive of opt-out testing in emergency departments for screening for HIV, for example. It would be incredibly beneficial. You have a general population flowing through an accident and emergency department for multiple reasons, and opt-out screening would enable us to screen for multiple sexual health diseases, especially notifiable infectious diseases, that we could then pick up on an ongoing basis. It is a stigma-reducing way of going about things. It is mass screening. We are not identifying specific vulnerable groups or naming specific cohorts as being the transmitters of particular infectious diseases. I refer to that kind of mass generalising of sexual health services, what we spoke about a little bit earlier of sexual health just being a part of everyday life, normalising the conversations around it and access to it, and making it something where there are no barriers. For everywhere there are barriers, a very simple solution to capture multiple data points and access to multiple services would be fantastic. We would definitely agree with something like that.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Is Ms O'Farrell aware of any conversations like that happening in the region she operates in?
Ms Muire O'Farrell:
We are part of a steering group with the infectious diseases clinic in Cork University Hospital, CUH. We operate rapid HIV testing in our centre and we have funding from the HSE. We have a regional HIV project manager based in Cork working towards the Fast-Track Cities goals of HIV eradication by 2030, which we know we are not on track for. As part of that group, we discuss at the steering groups ways within our regional action plan through which we could potentially meet those goals. One of the topics that was raised with CUH was opt-out screening in emergency departments being rolled out. We would raise it and it is something we will put forward into the action plan that needs to be taken up from there.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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That is interesting. Does anybody else have a comment they would like to make on that?
Professor Fiona Lyons:
Yes. The St. James's opt-out screening programme has been operational for over ten years now. It is well-embedded within our emergency department. That is where I work clinically in St. James's Hospital. It is a really important opt-out. Access to HIV testing is an important aspect, particularly in preventing late diagnoses for individuals who present for healthcare and who may have something related that may or may not be related to an underlying HIV diagnosis, giving them the opportunity to test. Ireland has to be commended for how successfully it implemented antenatal screening for HIV, starting with anonymous, unlinked testing back in 1999 and then the subsequent release of the antenatal screening programme in April 1999. To date, well over 90% of people presenting for antenatal care are offered a HIV test. The vast majority of those will take up the test.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I believe the uptake rate is 86% or something in that region.
Professor Fiona Lyons:
It is probably even higher than that. I am not familiar with it. I keep an eye on it and it is always in the 90s. It is an area I have a particular interest in.
With respect to what the Sexual Health Centre talked about in regard to Fast-Track Cities, project managers have been appointed to the four Fast-Track Cities to work on things, including local city plans, and consider what needs to be done in respect of access to HIV testing and the different ways of doing it. Mr. Shanley has alluded to how we need to have an infrastructure in place that allows people options around how they access things like testing and services. This is particularly true for HIV. In the programme for Government HIV action plan for getting to zero, this is something that will definitely be addressed through the work that the Department of Health is leading on how we need to improve access to HIV testing in a range of different ways. The home STI testing service is something that has definitely delivered on increasing access to home STI and HIV testing for people who do not want to have it done in a face-to-face consultation.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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In a clinical setting, yes. I can understand that. What I do not and cannot understand is, if St. James's has been on a pilot scheme since 2014 and not all of us live in cities, why is this not more broadly available?
Professor Fiona Lyons:
I may stand corrected on this but there have been a number of other pilots looking at it. I think Galway did a pilot. I apologise if I have misquoted or provided misinformation on that. This is something that we need to do more work on to ensure that we reduce the number of late diagnoses of HIV and people who are coming to healthcare settings are tested earlier than they may otherwise have been when they have something that is clearly a manifestation of undiagnosed HIV. As to why it has not happened thus far, I do not know why it is not completely done. I know what progress we have made but the commitment in the programme for Government to having an HIV action plan to do this work is something that is very welcome. While we may not meet the mark by 2030, we will hopefully meet the mark of achieving zero HIV transmissions at some point in the not-too-distant future.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I was reading some independent peer reviews and papers yesterday on opportunistic testing, not just from St. James's and Ireland more widely, but from across Europe. To my mind, as a member of the health committee who is a not a medical professional, statistics are statistics and these statistics show that this works for HIV but also other diseases and contagious diseases, whether you are talking about hepatitis or STIs. The question I find myself asking repeatedly - and I respect this is one Professor Lyons cannot answer - is on why things stay as pilots for so long when the figures are there to prove that they work.
Professor Fiona Lyons:
My understanding of the situation at St. James's is that it is no longer a pilot. It is embedded in the service and the pilot phase is complete. The reason the hospital was doing the pilot was to determine whether the background prevalence within the catchment population attending the emergency department was such that it made economic sense from a health economics perspective to just have no conversation and offer the option of having the test unless people decided they would prefer not to have the test. That was the case for the St. James's catchment area in respect of HIV, hepatitis B and hepatitis C. It is well embedded and every year, we pick up people who otherwise may not have been afforded the opportunity of an earlier diagnosis of their condition.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank Professor Lyons. Does anybody else have a comment on it?
Mr. Adam Shanley:
I think they have been quite successful in rolling out opt-out HIV testing in emergency departments and hospital settings in the UK. The mechanism by which they made that happen was largely through their own HIV action plans. It is really welcome that a HIV action plan is forthcoming and I think there are opportunities like that - that kind of differentiated delivery of testing - that are a platform for discussing and implementing those.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How important would Mr. Shanley say it is to have opt-out opportunistic screening included in the HIV plan?
Mr. Adam Shanley:
It is very important. One of the points I probably made quite a bit is that we need to ensure we have choice and that we are meeting people where they are at in the realities of their lives.
For some people, maybe the only time they will have a HIV test is because they have broken their arm and they end up in the emergency department. As Professor Lyons has mentioned, the statistics show we have quite a large proportion of people being diagnosed late. The outcomes for people diagnosed late are much poorer, so everything we can do that looks to address the persistent gaps in testing and access is definitely welcome and the HIV action plan is fertile ground for that to happen.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the witnesses.
Michael Cahill (Kerry, Fianna Fail)
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I welcome our guests. I have a few questions. What services are being provided by the State to deal with sexually transmitted infections? What would the witnesses suggest be implemented to improve current services? Currently, individuals with sexual health concerns present themselves at University Hospital Kerry, UHK. What services are available there? What extra things should we be doing to improve services in UHK for the people of Kerry? Are there current waiting lists? If so, how long are they? I would also like some information on the types of condition that are being reported.
Professor Fiona Lyons:
I thank the Deputy. He has asked me quite a lot of questions, so I apologise if I have to be reminded of some of them. We discussed earlier how we were working on the model of care for sexual health. As part of that, we have been understanding the resource allocation to the existing network of public sexual health services countrywide. The current working allocation within the sexual health clinic in Kerry is 0.4 whole-time equivalents, so there is no full whole-time equivalent working in that service. My impression, and I think the impression of everybody in this room, is that that is likely not serving the needs of the population of Kerry in respect of their sexual health services. That is something that will be addressed through the sexual health strategy.
With respect to access to STI testing more broadly, the home STI testing service has been a game-changer in improving access to testing. This is accessed across all the 26 counties. Kerry was one of the participants when we did the pilot back in 2021.
The Deputy asked about waiting lists. Our public sexual health clinics generally do not keep waiting lists because these are time-sensitive interventions and we try not to have waiting lists, but sometimes that can be very challenging. For PrEP services specifically, some services maintain waiting lists but not all. The Kerry service sends people to the Cork clinic. I stand to be corrected but the last time we asked, the waiting list in Cork was in the region of 85 people. The clinic continues to offer people appointments but it is experiencing challenges in that it is not able to offer people appointments within the time it would like to.
I think the Deputy asked about the range of conditions being presented. We know that the home STI testing service is contributing very significantly to the reported number of chlamydia and gonorrhoea cases. About 40% of the chlamydia cases diagnosed every year come from the home STI testing service. Some of the increase we have seen in chlamydia rates in particular is due to us now having better ascertainment of infections we may previously have been blissfully unaware of. Chlamydia particularly affects people under and up to 25 years of age. The home STI testing service is picking up a lot of chlamydia cases and about 28% to 30% of the gonorrhoea cases as well. Across our network of other services, common infections would be chlamydia and gonorrhoea. These are readily managed but can have significant consequences for individuals and their sexual partners if they are left untreated. Another important infection we do not see as many cases of but is of great significance is syphilis. Early infectious syphilis re-emerged as an infection of importance in the late nineties in northern Europe and has not really gone away since. That is an important infection we would see.
We have had some discussion here about how, in the development of the model of care, we have shifted our focus from calling our public network of sexual health services "public STI clinics" because we need to identify, realise and make advances in extending the management of sexual health beyond just the incidence of infections. It is not just about STIs but people having the best possible sexual health they can have. Many of the people I look after in my clinical practice at St. James's Hospital will not have STIs but will have very significant sexual health needs that can be met within our public sexual health clinics.
In summary, we have done quite a bit of work but we have quite a lot of work yet to do. I hope the forthcoming model of care will set out how Ireland should respond to meet the sexual health of the population, with an appropriate implementation and resource plan to follow.
Michael Cahill (Kerry, Fianna Fail)
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I thank Professor Lyons for all of that detail in a short couple of minutes.
Michael Cahill (Kerry, Fianna Fail)
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It is kind of a difficult question but is she satisfied with the level of services available in Kerry and, indeed, Cork, given that a lot of the Kerry patients are referred to Cork? The sky is the limit in the context of services, so I acknowledge it is a difficult question.
Michael Cahill (Kerry, Fianna Fail)
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Right.
Professor Fiona Lyons:
We in the sexual health programme have been tasked to deliver on the development of a model of care that will address that. Part of that is stepping out what is available and I have indicated to the Deputy what is currently available, so the simple answer is "No". It is incumbent on us - and we will continue to work on the model of care - to identify what the workforce plan should be and what the resources should be to develop on the model of care that we agree should be available to people across the country.
Michael Cahill (Kerry, Fianna Fail)
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I thank Professor Lyons.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks very much, Deputy Cahill. Picking up on the point about Cork, somebody contacted me and asked me to point out how disjointed the services can be. There is a HIV clinic in CUH and the public sexual health centre in the South Infirmary Victoria University Hospital. I think neither has a dedicated space. The latter's is definitely a shared space. There is no dedicated clinical space in CUH. That causes issues for clinicians and people accessing services. Sometimes, people are moved between different services. In the second largest city in the Republic, we should have one centre that is better resourced providing holistic support and services. Maybe that could be put into one of the forthcoming plans. I am aware that there is lots of work on the way with the model of care, HIV action plan and lots of others, but I was asked to raise that point, so I wanted to put it out there.
Before we conclude, do any of the witnesses have any burning points they would like to make that have not been made? They are happy enough. I thank them very much everybody for their engagement, work and preparation. I know a lot of time and effort goes into a session like this and the detailed submissions. I also thank the people at home who contacted us. It is greatly appreciated. This is part of an ongoing piece of work that we are doing. As I said, I hope for us to have further engagement, especially on the trans healthcare piece, later in the year. We will look again at HIV when the action plan comes out. I hope the committee will be in a position to produce a report based on the evidence today and some of the submissions as well. We will continue to engage with the HSE, the Minister for Health and the Department. For my part, I will continue to advocate. I thank Mr. Shanley, the staff from the Sexual Health Centre, the Gay Health Network and the HSE for their time.