Una Mullally: Preventative HIV drug must be made available

Almost 25 years ago, homosexuality was decriminalised in dark days of HIV/Aids

 Act Up campaigners last year calling on the Government and others to address the HIV crisis. Photograph: Eric Luke

Act Up campaigners last year calling on the Government and others to address the HIV crisis. Photograph: Eric Luke

 

Next year marks 25 years since homosexual acts between men were decriminalised in Ireland. There seems to be little awareness of this landmark anniversary, even though it was a profound moment of liberation in Irish history. What is generally and incorrectly referred to as “the decriminalisation of homosexuality” – women’s sexuality was made so invisible that there was no need to criminalise lesbians, apparently – also came at a time of intense crisis and tragedy in the gay community. The HIV/Aids plague is another fact of history that continues to be erased. 

 Do we know how many people died from Aids in Ireland? Do we care enough to count? As Sarah Schulman recalls in her excellent memoir about the Aids plague in New York, The Gentrification of the Mind: Witness to a Lost Imagination, gay lives were tossed aside, the 80,000-plus deaths occurring in New York City alone paving the way for the gentrification of the neighbourhoods those people occupied.

“Sometimes they were too sick to live alone or to pay their rent and left their apartments to die on friends’ couches or in hospital corridors,” Schulman writes, “Many died in their apartments. It was normal to hear that someone we knew had died and that their belongings were thrown out on the street. I remember once seeing the cartons of a lifetime collection of playbills in a dumpster in front of a tenement and I knew that it meant that another gay man had died of Aids, his belongings dumped in the gutter.” 

LGBT emigrants

In an Irish context, it’s important to mention New York and indeed San Francisco and London, as those cities are intrinsically linked to our own Aids crisis. Irish LGBT people left the country en masse in disproportionate numbers at the height of emigration in the 1980s. They left to live more open lives, leaving a country that was viscously sexually repressed, that criminalised their sex lives, that murdered and beat up their gay peers, and that refused to offer them a future. And in fleeing, they walked smack bang into the plague in the cities they gravitated towards for freedom. How many of those gay men in New York and San Francisco who were left for dead were Irish? How many sons and uncles and brothers and cousins never came home, dying mysteriously young, the cause of their deaths fabricated in country towns for the benefit of the neighbours? How many had their belongings dumped in the gutter?

 Schulman reminds us that every time you meet a gay person in their 40s or older, you need to realise that they lived through an experience of profound trauma and loss. Tonie Walsh, the Irish queer activist, historian and archivist, says he once tried to count the number of close friends he lost to Aids and stopped at 43. “I still feel guilty about funerals I didn’t go to,” he told me earlier this year, when I was writing a piece about RTÉ DJ and presenter Vincent Hanley, another Aids victim. “I just was so exhausted with funerals.” 

 Oh that this bleak period was an artefact of history. Right now in Ireland, a new HIV infection is diagnosed every 18 hours. Record numbers of infection are occurring. Record numbers. In 2016, 512 people were diagnosed with HIV in Ireland. Nearly half of those (237) were men who have sex with men. To put that in the context of other high-risk demographics, just 19 of new HIV infections last year were people who inject drugs.

 During the Aids plague, Act Up (Aids Coalition To Unleash Power), the direct action advocacy group, was formed in New York in 1987, and protested and fought for policies and medical treatment for HIV/Aids victims. Here’s how bad the HIV epidemic is in Ireland right now: 30 years later, that group has restarted in Dublin. 

Ghostlike virus

HIV medication – a single pill taken daily – is so effective now that one’s viral load decreases to the point that the virus becomes ghostlike, reduced in one’s system despite one’s positive status. Awareness about this fact is summed up by the term “U=U”, that undetectable equals untransmittable. This essentially means that a person who is HIV positive and taking their medication properly is safer to have protected sex with than someone who doesn’t know their status. 

 The current HIV crisis in Ireland is complex, and the memories of foreboding ad campaigns have faded. One of the massive challenges regarding HIV is the stigma it still has. It’s hard to think of another condition that so unfairly stigmatises people. That stigma exists in the LGBT community, and outside it. Along with the medical implications of HIV – which have been dramatically reduced thanks to amazing progress made in treatment – is how it can profoundly impact one’s mental health, a pressure and stigma that needs to end. We can’t solve this crisis by being silent or ashamed by it, we need to face up to the practical steps that can be taken. 

 The answer to solving the epidemic is staring us in the face. Public health experts in Britain are now forecasting the end of their HIV epidemic. Sexual health clinics in London are reporting a 40 per cent drop in HIV diagnoses. This is due to frequent testing, rapid treatment, and the game-changing drug PrEP, preventative medication that means those taking it cannot be infected. Here’s how effective PrEP is: there has been an 86 per cent fall in new infections among men who have sex with men who are taking it in England. PrEP is not available through the public health system in Ireland. That needs to change, urgently.

Perhaps that’s one way that we as a nation can mark that 25-year anniversary. Let the legacy of decriminalisation be a caring one, and one that faces up to the healthcare needs of the men who were historically abandoned. 

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