Catherine Byrne (Dublin South Central, Fine Gael) | Oireachtas source

I thank the House for providing me with the opportunity to speak to Members on this important topic in advance of World AIDS day tomorrow, 1 December.

HIV is one of the most stigmatised conditions of our time. In September, I opened the national HIV conference hosted by HIV Ireland which focused on this stigma. The conference examined how the stigma of HIV/AIDS is an additional burden on the lives of people living with a diagnosis. People living with HIV can face judgment, rejection and hurt. HIV Ireland’s survey shows that one in four are not comfortable with their own HIV positive status, one in three have been rejected in a relationship due to their HIV status and worryingly almost one in five people living with HIV felt suicidal in the past year. The challenges for people living with a diagnosis cannot be underestimated.

Stigma can also be a barrier to talking about HIV and getting tested but when we create a safe space to talk about HIV, we protect everybody. The opportunity to talk to the House here today helps raise awareness of AIDS and helps us to confront the challenges of this disease. Sharing knowledge and information are important to our prevention and health promotion strategies that act to protect people from infection. The reality is that a diagnosis of HIV for a person has a long-term impact on their lives but we must strive to reinforce HIV education, awareness, prevention, testing and treatment. It is undeniable that these are all important aspects of dealing with the challenges of HIV.

I welcomed the recent publication by the HSE Health Protection Surveillance Centre of the HIV in Ireland report for 2016. It showed a reduction in the number of diagnoses by 6% in 2016 when those with a previous HIV diagnosis were excluded but there is always concern that accompanies chronic diseases such as HIV.

I remain concerned at the number of HIV diagnoses in 2016. Just over half of these 508 new diagnoses were among men who have sex with men and this group remains the most affected by HIV in Ireland. We must focus on dealing with the level of infection of this at-risk cohort.

The publication of our first national Sexual Health Strategy 2015-2020 provided the opportunity to ensure that all efforts across the entire range of sexual health - from awareness, education, training, access, treatment and surveillance - are co-ordinated, evidence-informed and based on best practice. We continue to implement our national sexual health strategy in this context. The strategy itself is set within Healthy Ireland, the national framework for action to improve the health and wellbeing of the country over the coming generation. Implementation of the strategy is in all of our interests.

The national sexual health strategy has been developed against a backdrop of a changing Ireland regarding sexual behaviour and sexuality in recent decades. This changing landscape is evident in legislation introduced in recent years, and more openness generally in attitudes and culture around sexuality and sexual health issues.

The strategy was developed based on three goals. Everyone in Ireland will receive comprehensive and age-appropriate sexual health education and information and will have access to appropriate prevention and promotion services. Equitable, accessible and high-quality sexual health services, which are targeted and tailored to need, will be available to everyone, and robust and high quality sexual health information will be generated to underpin policy, practice, service planning and strategic monitoring. The strategy recognises the diversity of sexual identities. It supports all expressions of sexual identity through positive sexual health and wellbeing outcomes. Governance structures for implementation of the national sexual health strategy have been established. The HSE sexual health and crisis pregnancy programme is the national programme charged with developing and implementing a national strategy to, among other things, improve the effectiveness and impact of sexual health services and preventative work. The programme is responsible for developing and implementing an action plan for each year of the strategy. A clinical lead for sexual health has also been appointed in the HSE.

The HSE sexual health action plan for this year specifies a range of actions being taken under the auspices of the national sexual health strategy. These include: actions related to clinical services such as completing and implementing outstanding practice guidance for HIV testing in various settings, including home HIV testing, point of care HIV testing; and the use of antiretroviral therapy in HIV prevention to include pre-exposure prophylaxis, known as PrEP, treatment as prevention and post exposure prophylaxis.

I am pleased to advise the House that a HSE recommendation on antiretroviral therapy for all people living with HIV in Ireland was signed off by the HSE leadership team on the 25 July. The HSE recommends that all HIV infected individuals attending HIV services in Ireland are offered antiretroviral therapy as soon as possible and informed of the benefits of antiretroviral therapy in improving their personal health and reducing HIV infectiousness.This was circulated to clinical services and community organisations and is available on the Health Protection Surveillance Centre website. A patient information leaflet has been prepared in English, Portuguese, French and Spanish and has been sent to all clinics providing care to people living with HIV.

A HSE multisectoral PrEP working group is continuing to work on recommendations around the introduction of PrEP in Ireland. Work to date includes a report on the estimated number of people likely to avail of PrEP in Ireland in the first year, which has been submitted to the Health Protection Surveillance Centre, and the development of national standards for the delivery of HIV prevention and PrEP care.

I also want to mention the Know Now project, which is a community HIV testing project. It has been successful in reaching people, particularly men who have sex with men, who have never been previously tested for HIV. During the pilot in 2016, a total of 1,465 tests were conducted in Dublin, Cork and Limerick.

The report of the third annual Healthy Ireland Survey of 7,500 people aged 15 and over and living in Ireland is directly relevant to this. It gives an up-to-date picture of the health of the nation and reports on many lifestyle behaviours such as sexual health. The Healthy Ireland Survey reported that over the past year, 21% of respondents reported having had a HIV test during their lifetime, 12% of men who have sex with men had a HIV test in the past 12 months, and 28% of men who have sex with men have had a test during their lifetime. This is the first time we have asked about HIV and sexually transmitted infection, STI, testing in this kind of survey. I am pleased to note that most people were happy to answer these questions and give us this information. This is indeed a welcome development. We also know that younger people, especially men who have sex with men, are an important at-risk group, and the survey shows that these were more likely to have had a test. Again, this shows that the stigma around testing is probably reducing and that our work to make testing more accessible is having an impact.

Surveillance is also crucial for this infectious disease, and HIV monitoring and reporting have improved over the past year. This is in line with meeting Ireland's obligations to report on our national response to the HIV epidemic to the European Centre for Disease Prevention and Control as part of the Dublin Declaration Partnership to Fight HIV/AIDS in Europe and Central Asia, and to UNAIDS-WHO as part of the UN General Assembly Political Declaration on HIV and AIDS. The HSE has advised my Department that Ireland is in the top ten in Europe on achieving the target that 90% of those estimated to be living with HIV are on treatment. This is indeed welcome.

Actions related to communications and information in the HSE sexual health action plan include the provision of targeted information and campaigns to at-risk groups and a communications working group targeted at men who have sex with men is now in place under this heading. Members include representatives from the Gay Men's Health Service, the Health Protection Surveillance Centre, and the Gay Health Network. The latter is a network of organisations and individuals in Ireland providing the national resources, response, support and expert network for the promotion of HIV prevention and of sexual health and well-being for gay and bisexual men and for and men who have sex with men.

We know that enormous progress has been made in the treatment of people infected with HIV. Earlier testing and treatment mean that life expectancy is similar to that of the general population, thus bringing it into the realm of chronic diseases. Such therapies aside, however, the key challenge is to prevent the disease from occurring in the first place. HIV-AIDS is, after all, a life-changing disease. We must work together to strengthen the prevention arm of our national sexual health strategy in this context.

I want to emphasise another point to the House. The close working relationship and engagement of voluntary and community groups with the HSE sexual health crisis pregnancy programme and its national clinical director have been central to the implementation of our national sexual health strategy. This partnership helps to strengthen the implementation of the strategy, which is having an effect on dealing with the challenges of HIV. We have more work to do in this area. We must protect our population and especially at-risk groups from infection. I assure the House that my Department and the HSE are working closely with our partners in the voluntary and community sector to deal with this. Efforts will continue in line with our strategic perspective and policy enshrined in our national sexual health strategy.

I will finish by saying that I have visited many services in my role as Minister of State with special responsibility for the national drugs strategy and I have been very impressed by the work being done on the ground, particularly by community groups, to remember above all those who, sadly, have passed away from HIV. I have also been impressed by the work being done to educate young people to protect themselves, especially when it comes to sexual activity. The celebration of World Aids Day tomorrow, first introduced by the United Nations on 1 December 1988, is very important to the Government, to the Department of Health, and indeed to all of us here. It is very important that we as a nation continue to do more than our best to make sure that there will be no stigma around HIV in the future. Above all we must protect those with HIV and ensure that they live lives as long and healthy as the rest of the population.