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The number of people diagnosed with HIV in Ireland is rising amid concerns that ambivalence about the disease is putting increasing numbers of people at risk.
A record 512 cases of HIV were diagnosed in the State last year.
Rates have been rising steadily since 2011, with experts saying “complacency and risk-taking” among a younger generation is contributing to the rising numbers.
"This generation hasn't grown up with the legacy or even the reality of HIV," said HIV Ireland executive director, Niall Mulligan.
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“It was a massive issue in the 1980s and we were aware of it. We were very scared and, thankfully, this is not the case now but I think we still need a greater level of education and awareness for this generation.”
“The treatment is so much better now than it was 15 or even 10 years ago. The medication available now has probably decreased the fear element somewhat, but I suppose it still doesn’t prepare people for the impact of being diagnosed with HIV, and the reality of the long-term impact on their lives.”
“I think there is certain logic to the idea that the growing number of HIV diagnoses could be because of sexual activity such as chemsex [the consumption of drugs to facilitate sexual activity]. We are concerned about the growing culture of chemsex here in Ireland,” said Mr Mulligan. “Chemsex definitely is an issue and is certainly on the increase in Ireland.”
In the UK, unprotected sex and communal drug use at chemsex parties are partly to blame for the high levels of HIV infection – which has been at around 6,000 people a year since 2009 – as well as the growing epidemic of syphilis, gonorrhea, and a new infection called lymphogranuloma venerium (LGV).
Along with the increase in HIV cases there has been a dramatic rise in other sexually transmitted diseases (STIs) in Ireland in the past 12 months.
Dr Derek Freedman, a specialist in sexually-transmitted disease, told The Irish Times that as well as a growing culture of unprotected sex among the gay community, he has seen a rapid increase in the number of patients treated for other STIs.
“Certainly if you look at the number of people coming in with infections to be treated, it would appear chemsex and group sex parties are a problem,” said Dr Freedman.
“There has been an utter surge in cases of gonorrhoea, syphilis and with people coming to me with anxiety about HIV in the past 12 months. People became very afraid of HIV in the 1970s and the 1980s; people became very careful with their sexual activity. Infections like syphilis and gonorrhea had virtually disappeared, but then fast forward 20-30 years and we are seeing an epidemic.”
Factors
Dr Freedman said two factors needed to be examined.
These are the attitudes of a new generation towards HIV and secondly, the widespread availability of effective treatment for HIV.
“We need to look at the current generation who are born in the new age of HIV and are not so frightened of it. In fact, some would be foolish enough to count it as a badge of honour to have acquired HIV.
“Secondly, the widespread availability of effective treatment for HIV. We now have a range of almost 30 drugs we can use against this disease.
“However, there’s now the notion that these drugs are ‘so good’ as a preventative to stop you acquiring HIV, that you don’t need to be safe.
“This is the wrong attitude. People forget there are another 28 [STI]infections out there, some of which can be equally as lethal as HIV.”
Dr Freedman notes the growing online culture among the LGBT community of using apps such as Grindr for random sexual encounters; Tinder is an equal catalyst.
“We know PrEp (pre-exposure prophylaxis) is highly effective for HIV, and can reduce rates by 80 per cent, but not by 100 per cent,” said Dr Freedman. “Of course ,the drug should be available like any tool that is effective in reducing the disease. Who PrEP is suitable for is another matter.
“ The drug has been proven effective among a population of high risk-takers, particularly in London. People who are going to parties and are having maybe six or seven partners in a night.
“When we talk about chemsex we talk about parties where there are multiple sexual activities within a group. You are dealing with drugs that loosen the inhibitions and we see this in particular with gay men.
“This is all part of a spectrum of behaviour. Obviously chemsex and sex parties are very attractive to some people. We are seeing the potential for bridging from the risk-taking communities into the general community where people have partners or spouses.”
“The backbone of prevention today is test and treat. People who are taking risks should be tested on a regular basis. These party goers should be tested every three months depending on the activities they are engaging in.”
In a recent survey, the Gay Health Network (GHN) reported that 27 per cent of respondents admitted using crystal meth, GHB, GBL, mephedrone or other NPS (new psychoactive substances) to facilitate sex.
“G” – the term for depressant-type drugs GHB and GBL – was the most commonly used drug for chemsex, with 57 per cent of those engaging in chemsex having used the substance within the past 12 months.
"I think there is definitely a scene which would be described as the chemsex scene here in Ireland," said Dr Des Crowley, addiction specialist at the Mountjoy Street Medical Practice.
“It’s the association of the use of chemical drugs with multiple sexual partners, group sex and unsafe sex. Individuals in general are engaging in more high-risk behaviour, which we know because of the rising level of sexually transmitted diseases.”
Dr Crowley said that people’s decision not to engage in safe sex is very complex. “I don’t think it’s just one thing. I think, clearly if your peers are engaging in this activity it might influence you. Also, the fact that HIV is no longer seen as the death sentence it once was, it’s seen as a chronic manageable disease.
Dr Crowley was keen to stress that not all of the rise in HIV diagnosis or STIs could be attributed to chemsex. “It’s not always in the context of the chemsex situation. Sometimes individuals are just engaging in high-risk behaviour.
“Clearly something like the Grindr app has changed the landscape for gay men. A lot of people go to international dance parties and Pride events so the gay scene has become very internationalised.
“My advice to people is to get tested if they are in doubt. If you have engaged in sexual activity, and you think you’ve been exposed, then go to a clinic and get PrEp which will significantly reduce the chances of a HIV transmission.”
HIV notifications in Ireland in 2016: 512
Male: 394
Female: 118
Men who have sex with men: 237
Heterosexuals: 91
People who inject drugs: 19
Other/Unknown: 165
(provisional data from Health Protection Surveillance Centre)