Colm Burke (Cork North Central, Fine Gael)
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I propose to take Questions Nos. 445 to 448, inclusive, together.

Sexual health is a priority for this Government. The National Sexual Health Strategy, 2015-2020, (NSHS), was launched in October 2015 and is implemented by the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP). The NSHS aims to support sexual health and wellbeing across the lifecourse. Following stakeholder consultation and an independent review, the Strategy is currently being re-drafted by an expert Group; a refreshed version is scheduled to be published in Q3-4, 2024. An independent Review by Crowe Ireland, published in 2023 on the Healthy Ireland website, identified 56 Priority Actions, of which 49 were assessed as having been successfully progressed. The Review also provides recommendations with regard to the future direction of the next NSHS.

Current priority sexual health deliverables include:

• Providing sexually transmitted infection (STI) and HIV prevention, diagnosis and treatment services, through the national network of 23 STI clinics and expansion of the nationwide home HIV and STI testing scheme
• HIV prevention, including HIV Fast-Track Cities, the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) programmes, research, campaigns and supports to counter stigma for people living with HIV.
• Expanding access to free contraception, through the free contraception scheme for women and National Condom Distribution Service (NCDS).
• Prioritising monitoring, evaluation and research regarding sexual health, including progressing a comprehensive population survey on sexual health.
• Monitoring emerging STIs and changes in pathogenicity and/or transmissibility of existing pathogens (close links maintained with the Health Protection Surveillance Centre (HPSC) that collates STI incidence and trends, and the Health Information and Quality Authority (HIQA)).
• Improving sexual health education, training and resources, including schools, higher and further education, through www.sexualwellbeing.ie, in partnership with relevant NGOs.

A national HIV pre-exposure prophylaxis (PrEP) programme commenced in November 2019, following a HIQA HTA, which concluded that its introduction would be safe, effective, and cost saving. Free PrEP medication is available to individuals who meet clinical eligibility criteria, attending HSE approved PrEP services. These include public PrEP services, delivered through the public network of STI clinics, and some general practice (GP) services and private providers. There are currently 13 approved public PrEP services, located in public STI clinics, and 17 private or general practitioner (GP) PrEP providers. Appointments at the 13 public PrEP services are free of charge, however, the private providers charge for consultations.The number of people eligible to access PrEP has been expanding since inception, with the number of individuals re-imbursed for PrEP at least once expanding from 1763 in 2020 (the first full year of service delivery), to 3388 in 2022 and 3802 by the end of Q4, 2023. Clinical criteria for PrEP eligibility have been widened in recent years, increasing the number of people eligible for the programme. While the PrEP service continued to grow in 2023, many PrEP services are reaching (or have reached) capacity and service users are reporting challenges accessing appointments. By Q4, 2024, 6,070 individuals were approved for free PrEP medication. Additional work is required to understand the extent of the unmet need/demand for PrEP, which has been estimated as circa 30%. Additional funding of €600,000 has been allocated in 2024 to further support delivery of the PrEP scheme, bringing the total allocation to €5.9m. In order to increase capacity, a number of additional measures have been deployed and are being developed, including administrative efficiencies, the use of telephone consultations and use of the free home STI testing scheme for routine tests. In order to increase the number of providers, a PrEP competency framework and eLearning platform has been developed; these can be accessed by GPs with an interest in providing PrEP. The home STI testing scheme has received additional funding of €720,000 in 2024, bringing total funding for this to €4.22m It is of vital importance that people at risk of HIV and living with HIV (PLHIV) are promptly linked to care, for prevention of onward transmission and for clinical benefit. It is also vital that those at risk are encouraged to access regular testing and preventive programmes such as PrEP. These measures are key elements towards achieving UN and WHO aims of ending the HIV/AIDS epidemic in Europe by 2030 and supporting wider national and international commitments. In addition to further funding for both PrEP and for home STI testing in 2024, we are progressing further development of HIV Fast-Track Cities in Dublin, Cork, Limerick and Galway. We are also supporting people living with HIV and countering the stigma they may experience. To mark Pride Week, I will be launching a Community Garden, supported by the Department, at HIV Ireland’s HQ in Dublin, as part of Pride Week.Additional capacity for PrEP delivery, through the public system, its partnerships and through primary care, are being considered as part of the wider ongoing work to redraft the National Sexual Health Strategy; it is envisaged that the new Strategy will be published in late Q3, 2024. Measures included for consideration will include a Model of Care for sexual health, to examine capacity and delivery, nationwide, in the context of HIV and STI rates that are rising both nationally and internationally. Additional capacity planned for 2025 will be considered as part of the Estimates process leading to Budget 2025. Expanding the role of pharmacists is being actively progressed by the Minister for Health; primary legislation to support this is passing through the Houses of Oireachtas currently. The Expert Taskforce on Pharmacy are finalising their recommendations to the Minister, which further will inform development of both primary and secondary legislative frameworks and regulation to support the expansion of pharmacy. The capacity for community sexual health partners to support PrEP delivery in line with clinical governance and frameworks for delivery; the feasibility of expanding the proportion of public STI clinics delivering PrEP and the clinical advisability (or otherwise) of allowing online pharmacies to prescribe and/or deliver PrEP are matters requiring significant expert clinical consideration and are therefore service matters for which the input of our HSE colleagues is essential. As these are service matters, I have also asked the Health Service Executive to respond to the deputy directly, as soon as possible.