Denis O'Donovan (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit, Deputy McEntee, go dtí an Teach.

Fintan Warfield (Sinn Fein)
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On 1 February Sinn Féin received a response from the Minister for Health, Deputy Harris, regarding Question No. 52 on the new Irish Blood Transfusion Service questionnaire, a form completed by those wishing to give blood. Question No. 52 asks whether the prospective donor has in the past five years taken medication to prevent HIV infection, that is PrEP or PEP. We queried the inclusion of that new question and the response from the Minister states that the persons who have taken medication to prevent HIV, that is PrEP, are deferred for a five-year period. That struck us as remarkable given that this is preventive medication.

I am sure many people will have seen last night's "Prime Time" programme which is timely to this discussion. PrEP is the use of antiretroviral medication which prevents HIV infection in someone who has been exposed to HIV. It prevents the user from contracting HIV with a 99% effectiveness rate. Condoms used for vaginal sex have an effectiveness rate in the high 90% range and for anal sex an effectiveness rate in, I think, the high 70% range.

This is an extra tool in the prevention of HIV. Anyone who can get hold of PrEP is being responsible and is doing good work for the blood supply in this case. However, under the current IBTS policy, a man who has sex with another man is allowed to give blood after 12 months, but someone who has taken extra precaution and extra safety measures now has to wait five years.

The reply to the parliamentary question by the Minister, Deputy Harris, stated that a study in the US showed a sharp rise in STIs in men on PrEP and associated the use of PrEP with a greater likelihood of being diagnosed with an STI. We researched this and the only study we could find was one by Scott and Klausner, which contains questionable referencing and is pretty thin evidence on which to hang an entire new policy. Ireland is the only country we can find that prevents people who are taking PrEP from giving blood.

Before Christmas I attended an LGBTQI community discussion in the Cobblestone in Smithfield. It was organised by ACT UP. It was everything one could hope for from a positive community engagement and discussion.What struck me about the event was that members of the gay community spoke publicly and took ownership of a whole range of issues, from Grindr and drugs to sex and chemsex. Those in attendance wanted to feel more empowered in their sexuality. They came together and it gave them the confidence to speak out and take responsibility, thereby fuelling greater consciousness of sexual health. What message is the IBTS now sending to people who want to be more responsible? What we are asking for is a statement of inclusivity from the Minister of State and the Department.

Helen McEntee (Meath East, Fine Gael)
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I thank the Senator for raising this issue. I am responding on behalf of the Minister, Deputy Harris. While I might not be able to give the Senator all the responses he needs, I will certainly relay his views to the Minister.

The remit of the Irish Blood Transfusion Service, IBTS, is to provide a safe, reliable and robust blood service to the health system. It keeps all its deferral policies under constant review to ensure the ongoing safety of the blood supply. It is in this context that, on 16 January 2017, the permanent exclusion of men who have sex with men from donating blood was changed to a 12-month deferral from their most recent sexual contact with another man. While this one-year deferral protects against the risk of transmission of HIV, issues could arise in regard to an emerging infection. In this regard, those who have had a sexually transmitted infection such as chlamydia or genital herpes are deferred for five years after completion of treatment. Those who have had syphilis, gonorrhoea or other specified sexually transmitted infections are already permanently excluded from donating blood.

The general approach of the IBTS to blood donation is that adults are eligible to donate provided they fulfil the donation criteria. One of the fundamental criteria is that they must not have been involved in an activity or visited an area where they could be exposed to viruses that have been identified as risk factors that could compromise the ongoing safety of the blood supply. The IBTS has a range of operational options available to it to implement management measures to protect both the recipients and the donors of blood and blood products. All these measures are aimed at minimising, or acting on, identified risks.

The inclusion of Question No. 52 in the donor health and lifestyle questionnaire, which coincided with the change in the donor deferral policy for men who have sex with men, is one example of an extra precaution taken by the IBTS to protect recipients of blood and blood products. The question asks potential blood donors whether in the past five years they have taken medication to prevent HIV infection. The medication involved is pre-exposure prophylaxis, PrEP, or post-exposure prophylaxis, PEP. Persons who have taken PrEP or PEP to prevent HIV infection are also deferred for a five-year period. Studies of gay and bisexual men have shown that PrEP reduces the likelihood of HIV infection by more than 90% if used consistently. A common concern is that PrEP will also lead people to stop using condoms, putting them at risk of other sexually transmitted infections.

A study published in the United States in 2016 showed a sharp rise in sexually transmitted infections in men on PrEP and associated the use of PrEP with a greater likelihood of being diagnosed with a sexually transmitted infection. If the Senator has not been able to find any information bar this study, I will request that the Minister revert to him on this. Perhaps he could seek further clarification on the which study this actually is.

More broadly, the IBTS has protocols in place to minimise transfusion-transmitted infection of blood. This risk is at its highest when individuals donate blood during the five-day to 16-day period following exposure to a virus when there is no biological measure to detect infectivity. As a consequence, the IBTS temporarily or permanently defers from giving blood an average of one in five people who are ineligible to donate for a variety of reasons on the day they attend.

Fintan Warfield (Sinn Fein)
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I accept a common concern is that PrEP may lead people to stop using condoms, thereby putting them at risk of other sexually transmitted diseases or infections. In light of the lifting of the lifetime ban preventing gay men from donating blood and the introduction of a 12-year deferral period, the policy is an admission that HIV can be caught in a 12-month period. The concern is that sexually transmitted diseases could be caught in that 12-month period also. What we are saying is that the five-year wait is extreme. It is a considerable amount of time and we do have to challenge it. What is the logic of demanding that those who take extra safety measures be required to wait five years rather than one? If HIV can be caught in the 12-month period, I do not see the need for those who take PrEP to be deferred for five years.

Denis O'Donovan (Fianna Fail)
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The Minister of State probably cannot add much more.

Helen McEntee (Meath East, Fine Gael)
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To reiterate, there are two different groups of sexually transmitted infections, and individuals infected by some of them are permanently excluded from donating. Perhaps that is the reason. As I have said, and as the Senator has said himself, the lifting of the lifetime ban and other changes introduced recently were to ensure a fairer system. We need, however, to ensure we take precautions to protect not only the recipient but also the donor. I ask the Senator to write to the Minister to clarify the cases in question. That might help.