Wednesday, 7 December 2016
Topical Issue Debate
I am very glad to have the opportunity to raise the critical matter of the dramatic increase, the skyrocketing, in detections of HIV in Ireland. The Minister of State will be aware of the statistics. The Health Protection Surveillance Centre, HPSC, has identified a 30% increase from 2014 to 2015. In the category of men who have sex with men, MSM, comprising predominantly gay and bisexual men, the increase in detections was even higher, at 34%. Our rate of HIV infection, at 10.6 per 100,000, is significantly above the EU average of 6.3 per 100,000. We must address the problem. It is as big a problem in terms of numbers contracting HIV, as existed at any time during the 1980s and 1990s.
We must take a wide variety of approaches to it. It is a complex issue that requires a huge variety of actions. However, I want to see if the Government can ensure that two simple, relatively immediate actions happen. First, could we push the implementation group for the sexual health action plan to prioritise a decision to make pre-exposure prophylaxis, PrEP, more widely available to high-risk groups? The drug Truvada has been approved in Ireland. International trials show it is extremely effective in cutting back the onset of symptoms of the virus. The number of people appearing in accident and emergency departments, particularly at weekends, is at crisis levels. Will the Minister, through the implementation group for the sexual health action plan, seek to have the drug made available for high-risk categories?
Second, there has been very welcome funding from the national lottery to the voluntary organisation KnowNow's nationwide rapid HIV testing programme. This needs to be preserved and the organisation needs to receive secure funding into the future. It must be supported, given that it is one of the best immediate responses. People who have HIV can find out very quickly. It is a very simple test that can be done outside of clinical settings. Half the men presenting to the programme to be tested have never been tested for HIV before. Across the country, the detection rate is five times higher than in a typical clinical setting and in Dublin city it is up to ten times higher.
The organisation is providing a vital service to allow men to find out whether they might be infected with HIV. If we can expand and strengthen it, provide the drugs I mentioned and do a range of other sexual health education programmes that, no doubt, need to take place at the same time, it would help stop the immediate emergency which we face. I would be keen to hear the Minister of State's view as to whether she would be able to provide those drugs to people in high-risk categories and whether she could provide secure funding for the KnowNow voluntary organisation.
I thank the Deputy for giving me the opportunity to update the House on this issue. In 2015, 485 people were newly diagnosed with HIV in Ireland, an increase of 30% compared to 2014. The increase was mainly confined to HSE east. A number of factors contributed to the increase in HSE east, including an improvement to the national surveillance case definition introduced in January 2015, which resulted in improved sensitivity and timeliness and an increased number of notifications. There was also an outbreak of HIV among people who inject drugs and an increase in diagnoses among non-EU men who have sex with men.
In 2016 a national. multi-sectoral group was established by the HSE HPSC to investigate the reasons for, and respond to, the increases in HIV, syphilis and gonorrhoea. Clinicians, HSE public health, the HPSC, addiction services and the non-governmental organisations are all contributing to the group. The group is working with the Gay Health Network and Positive Now to encourage the use of condoms and regular HIV and sexually transmitted illness, STI, testing via man2man.ie, social media and community outreach among the MSM community.
The National Sexual Health Strategy 2015-2020 was launched in October 2015. The strategy was developed in response to a recommendation of the national AIDS strategy committee on the need to establish clear leadership within the health sector around the area of sexual health. At the launch of the strategy, the Department provided funding for the KnowNow pilot. This is a peer-led, point-of-care HIV testing initiative in pubs and clubs. The pilot has had considerable success in identifying new cases of HIV. As we all know, earlier diagnosis of HIV allows for timely initiation of treatment, which confers significant benefits on the individual living with HIV and reduces transmission within the population. The HSE is reviewing how this method of testing might be developed in 2017.
The National Sexual Health Strategy 2015 to 2020 contains 71 recommendations that address all aspects of sexual health and the sexual health action plan for 2015 to 2016 contains 18 priority actions for immediate attention. One of the priority actions identified in the action plan for 2016 is to "prioritise, develop and implement guidance to support clinical decision making for STI testing, screening and treatment and on the appropriate use of antiretroviral therapy in HIV prevention". An implementation group has been established within the HSE as an outcome of this action. The group will make recommendations on the appropriate use of HIV PrEP in the overall context of the national approach to HIV prevention. It is intended that work will start on a national demonstration project in 2017.
I thank the Minister of State for her response. I am somewhat encouraged by the last line of her response, which I interpret as a signal that the Minister of State intends to launch a national demonstration project. I am reading between the lines that the Minister of State is aware that the KnowNow pilot project has been a success and that this will translate into the sort of support my question was prompting. I have a slight concern. We are looking to roll it out on a more full-time, secure basis in 2017, and we are not far from the new year.
Can the Minister of State say in her further reply whether the decisions in this regard will be taken before the end of the year or what timeline is intended? I agree fully with the Minister of State who outlined in her response that there is a whole variety of other issues in terms of promoting condom use and other sexual health education measures, but the scale of the crisis with 480 people contracting HIV is not small. It is one which could very rapidly grow if we fail to stem it at the earliest stage. That is the advantage of the two measures I have set out in particular. While there might be costs involved, it is clear that prevention is better than cure. While the costs of identifying and supporting and providing those anti-viral drugs for the very high at-risk groups would have to be borne by the State, the advantage would be that the prevention of infection would not only save the quality of life of the individual who might otherwise contract HIV but also the State in terms of the services we would have to provide to that person through his or her life. While I am encouraged by the Minister of State's response, I will be looking for a very definite decision in the coming weeks so we can go into 2017 with certainty for those working in the area.
I thank Deputy Ryan. I was privileged last week to launch at Outhouse on Capel Street on World AIDS Day the free rapid HIV testing that was being provided on the day on a number of locations nationally. It is a matter which is of grave concern to everybody in the Department of Health and the HSE. To that end, access to testing has been increased this year. If people are concerned, they can access testing that is widely available and free through www.hivservices.iewhere they will find local venues for HIV and STI testing. It is a very important website for anybody in this day and age. With people using the Internet to access information, it is crucial that they access good information. As such, www.hivservices.ie is the place for them to start as well as the man2man.iewebsite. The HSE has said that the demonstration project will commence later this year or in early 2017. The pressure is certainly on to achieve this. I will certainly bring the Deputy's concerns to the attention of the HSE which will be delivering this and try to provide him with an actual timeline. I would be happy to do that.