There is no room for complacency as the number of STIs continues to grow. Elaine Edwards reports
Of the 40 million people worldwide living with HIV/Aids, based on last week's UNAids/WHO report, around 4,000 live in Ireland.
The vast majority of those infected with the virus live in sub-Saharan Africa and there are fears that the overall numbers may be greater than official figures show.
But Irish people should not be complacent and should not believe that because the numbers are relatively small, they can throw caution to the wind and that there's no risk of becoming HIV positive, disease surveillance experts insist.
While the safe sex posters and information campaigns of the late 1980s and early 1990s are now largely conspicuous by their absence, the number of HIV/Aids infections in Ireland continues to grow.
Almost 4,000 people have been diagnosed with HIV/Aids here since 1983. There have been 862 cases of Aids and 398 deaths from Aids notified to the Health Protection Surveillance Centre (HPSC).
Deaths from Aids-related conditions peaked at 75 a year in the mid-1990s, before more successful anti-retroviral drug therapies began to help increase life expectancy. The number of deaths, however, has begun to rise steadily from 13 in 2000 to 41 last year.
Dr Mary Cronin, specialist in public health medicine at the HPSC, emphasises that the HIV diagnosis figures only provide a snapshot - they don't reveal undiagnosed levels of the virus in the community generally.
"We're only reporting on the newly diagnosed cases, not the number of cases that are actually occurring," she says.
And the stigma that those living with HIV/Aids still believe exists around the disease probably indicates that more people are HIV positive than official figures show.
"We have relatively small numbers anyway, but there is a concern.
"While there hasn't been much transmission among the Irish-born heterosexual group, we would be concerned that we've seen an increase in STIs [ sexually transmitted infections] year on year," she says.
"Having another STI greatly increases the risk of transmission of HIV," Cronin says.
She acknowledges that Ireland doesn't have a HIV/Aids crisis on the same scale as that in other countries, but says this is not a reason to be unconcerned.
"HIV doesn't go away. It's not curable, even though people live with it. The prevalence or the pool of people living with HIV is increasing all the time, it's being added to every time a new diagnosis is made," says Cronin.
"So there's more of a risk because there are more people living with HIV. I don't think we can ever be complacent.
"There is a real worry with STIs that we are seeing kids who are getting chlamydia, teenagers who are heading for infertility in their 30s and looking to have families but we are looking at a screening programme,"Cronin says.
More HIV cases are now being diagnosed in the immigrant community here, but Cronin says this is merely a reflection of changing demographics and the prevalence of the virus in some parts of the world.
"It isn't surprising that we've seen a rise in HIV from people coming from sub-Saharan African countries in particular and that's reflected in the demography," she says.
"I suppose the good news is that the number of newly diagnosed cases in the heterosexual category has decreased. We saw a decrease last year and for the first two quarters of this year.
"We hope that will be sustained," she says.
There were 148 newly diagnosed HIV infections in the first two quarters of this year.
Of the 140 where the probable route of transmission was known, 75 were acquired heterosexually - exactly three times the number of HIV infections acquired in the same period in the category known as MSM (men who have sex with men).
Some 37 of those 140 infections were among injecting drug users (IDUs). Of the newly diagnosed people, 85 were male and 63 were female.
Where geographic origin was known, 64 of those people were born in Ireland and 54 were born in sub-Saharan Africa.
Information on where the infection is likely to have been contracted is not collated, but the HPSC believes there is evidence that the transmission of HIV in Ireland itself is increasing.
"The number affected with HIV is a very small number and many of the people who are infected would be within particular communities, such as the gay and bisexual community, the drug-using community or the immigrant community," says Cronin.
"We are concentrating prevention efforts within those communities, but I think the message for the population at large is that really, the risk is there and people need to practise safe sex," Cronin says.
James O'Connor of Open Heart House in Dublin, a member-led centre for people with HIV/Aids, says there is still huge stigma attached to those with the disease here in Ireland.
"My experience of working with HIV positive people here in Open Heart House is that, for a lot of people who are HIV positive, it's an internalised stigmatising. People feel they are going to be stigmatised.
"And because HIV is generally sexually transmitted, it means that if you're HIV positive, people are asking how did you pick it up? Are you gay? Are you a drug user?
"And for a lot of people who contract it today, that's heterosexual too. But it forces people to think about sexuality."
A major knowledge, behaviour and attitudes survey of adults between 18 and 65 in relation to sex and STIs is being carried out for the Crisis Pregnancy Agency in conjunction with the National HIV/Aids Strategy Committee. It is due to be published next year.