Inclusive approach to HIV remedies is urged

Clinicians treating HIV in Ireland face a major challenge in trying to develop culturally sensitive and inclusive treatment programmes for immigrants who may be infected with the virus, a HIV/Aids conference in Dublin heard yesterday.

Prof Fiona Mulcahy, director of HIV services at St James's Hospital, Dublin, said immigration was a "huge issue" for doctors in Ireland and other European states. She was speaking at the opening of the 10th European Aids conference, which has attracted 3,000 delegates to the RDS in Dublin.

Prof Mulcahy said Ireland's clinicians had been concerned about patients being dispersed around the country, which made it more difficult for them to gain access to treatment. She said "the Government has been quite enlightened" on the matter however, in that it no longer insisted on dispersion where a doctor recommended against it.

Questions remained about whether immigrants on direct provision payments had sufficient access to special dietary requirements, or the ability to refrigerate medication.

She added that clinicians faced a particular problem with non-disclosure. "Sometimes it is very difficult for people to disclose that they are HIV-positive because they feel they will be ostracised by their family or community."

She said doctors were susceptible to being sued if a patient's non-disclosure led to onward transmission, and it was "a real dilemma for us" as to whether client confidentiality should be breached to protect another person's health.

The three-day conference, hosted by the European Aids Clinical Society (EACS), comes ahead of the expected publication next week of new HIV/Aids figures for Ireland by the Health Protection Surveillance Centre.

The centre recorded 356 newly diagnosed cases of HIV in Ireland last year, a 10.8 per cent fall when compared with 2003. Of the 305 cases where geographic origin was known, 136 were born in Ireland and 130 in sub-Saharan Africa.

Jens Lundgren, of the scientific board of EACS, said there was a natural tendency for migration to Europe from countries where treatment was less available.

He stressed that there was also a major problem with new infections in eastern Europe.

Three-quarters of Europe's two million people diagnosed with HIV were living in eastern Europe, and 75 per cent of these were less than 25-years-old.