Una Mullally: Anti-HIV drug must be made available

For years, a vaccination against HIV has eluded scientists. There has been amazing progression made on treatment, however, with what was once seen as a death sentence now a manageable, lifelong illness where the viral load in a patient’s blood can be reduced to an undetectable level.

It’s kind of astonishing that people with a positive HIV status whose antiretroviral treatment has been successful can essentially be at a lower risk of transmitting the disease than those who simply don’t know their status.

Yet the stigma and sex-shaming around HIV remains, even within the gay community, where knowledge and discourse surrounding the condition has traditionally been heightened.

Despite the historical damage HIV/AIDS caused to the gay community, despite the deep scars that remain, that knowledge is clearly not being passed on to a younger generation of men who have sex with men.

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In Ireland, new cases of HIV rose more than 25 per cent between 2015 and 2016.

I've heard young lads say that HIV isn't really an issue anymore

In the first three months of 2016, there were 128 new cases of HIV compared with 73 in the same period in 2015, marking an increase of 75 per cent.

In 2015, the highest number of new cases to date was recorded, a trend that continued in the figures available for 2016.

New infections in men who have sex with men have increased threefold since 2005, and among men aged 25 to 29 that increase was fivefold. What’s going on?

HIV awareness

A combination of factors seems to be behind this increase. First of all, young people are not growing up in an atmosphere of HIV awareness.

People in their mid- to late 30s, 40s and older have a memory of the public-heath campaigns that coincided with the initial HIV/AIDS epidemic.

Television and press ads, as well as public advertising, and a fairly broad conversation across media embedded HIV risk into the psyche.

While there was also concurrently hysteria around HIV/AIDS, the public-heath drive around safe sex and condom use, and the fear stoked by the risk of infection, at least raised awareness.

For the most part, the public-health campaign element of HIV has disappeared. HIV has also dropped out of the news cycle, creating an apathy towards the disease.

As treatment has improved and HIV no longer spells death, there is a sort of latent complacency around it. This is a tricky one. How do you simultaneously remove the stigma surrounding HIV yet also not delegitimise its seriousness?

I’ve had conversations with gay men in their late teens and early 20s and their ignorance surrounding HIV has been in some cases astonishing.

I’ve heard young lads say that you can tell if someone has HIV by looking at them, or that it isn’t really an issue anymore, that it exists only as something in the past.

You can’t blame young people for such ignorance: they don’t have a memory of the HIV/AIDS crisis, and they certainly are not being made aware of the facts of the illness in school, in the media, by their peers or by catching an ad on the bus or on a billboard.

There also appears to be an intergenerational communication issue in the gay community – why is the knowledge about HIV not being passed down?

The figures in Ireland show that while HIV is obviously not exclusive to men who have sex with men, they are disproportionately impacted. Nearly half of new infections are gay or bisexual men.

So, what to do? We need a renewed public-health campaign, obviously, and within the LGBT community conversations about HIV are getting louder.

But there is one thing that could reduce the spread of the virus available now, if we as a country and a health service are smart enough to utilise with it, and serious enough about stopping what this health crisis.

Preventative measure

PrEP (pre-exposure prophylaxis) minimises the risk of HIV infection.

Taken every day, it is a preventative measure. PrEP works by protecting cells and disabling HIV from multiplying should the virus enter the body.

It is a small blue pill to be taken daily, and has been found to reduce the risk of HIV infection by 86 per cent.

It's currently available in Canada, Australia, the US and France. It is essentially a daily vaccination against HIV.

If we're going to stem the rise of HIV in Ireland, we need to stop trying to police people's sexual behaviour

Last week, the NHS in Scotland approved PrEP. Scotland is doing so at a time when its HIV rates are falling, as part of an approach to stamp out HIV as much as possible. It makes sense.

The cost of treating someone with HIV over their lifetime exceeds what PrEP costs, which sold under the name Truvada is about £450 (€530) a month.

Unfortunately, resistance to PrEP recalls the inaction of governments and health authorities during the initial HIV outbreak in the 1980s.

There are also nonsense arguments about giving people a preventative drug for a virus that is linked to sex, which recall the ludicrous arguments against the HPV vaccine.

PrEP is not about “good” or “bad” sexual activity, but about preventing HIV.

Such arguments against PrEP are moralistic, judgmental and often underlined by homophobia.

If we’re going to stem the worrying rise of HIV here, we need to stop trying to police people’s sexual behaviour and start treating this as a public-health issue where every tool available should be utilised.

Empowering people to protect and inform themselves leads to safer sexual practices.

Men who have sex with men are already far more fastidious when it comes to their sexual health compared with straight men, so let there be no judgment there either. PrEP works, and forward-thinking health services are cottoning on.

If HIV can be prevented, how can we stand by and not utilise such a drug when rates are rocketing?