Una Mullally: The new HIV crisis needs a better response

HIV is a public heath issue, but a spike in diagnoses seems to be going unchecked

GHB can impact people’s decision-making skills and boundaries in sexual situations, potentially leading to riskier behaviour. Photograph: Douglas Sacha via Getty Images

GHB can impact people’s decision-making skills and boundaries in sexual situations, potentially leading to riskier behaviour. Photograph: Douglas Sacha via Getty Images

 

The facts are stark. The current rate of new HIV diagnoses in Ireland now supersedes that of the HIV/Aids epidemic here during the 1980s and 1990s. New figures published last week show there were 531 new cases of HIV infections diagnosed in 2018, an increase from 492 in 2017.

There is now a new diagnosis of HIV in Ireland every 17 hours. Ireland’s rate of new diagnoses stood at 10.2 per 100,000 people in 2017, while the European average is 6.2 per 100,000.

In 2017, 53 per cent of new HIV diagnoses were attributed to sex between men, with 33 per cent of new diagnoses attributed to heterosexual sex. HIV from intravenous drug use now makes up a small fraction of the figures.

How can we have massive advertising campaigns on things such as the importance of putting your chewing gum in a bin, but not on protecting oneself from HIV?

Act Up, an activist group confined to the history books in many countries, restarted in Ireland in 2016 and is at the forefront of protest on the issue. While the HSE and Hiqa say they are making progress in tackling the crisis and that it is a priority for them, the proof of that is hard to see when the numbers keep rising and there is little public awareness of the crisis.

The increase of HIV rates in Ireland when they are falling in many other countries is a multifaceted problem that demands diverse solutions. But a huge part of it is down to awareness and education. 

When I contacted the Department of Education last week, it was unable to provide a list of external providers of relationship and sexuality education. It responded that it did not hold a list of external providers, but that a circular sets out best-practice guidelines.

The fact the department does not have information about which groups are visiting schools to provide sex education points to a lack of oversight for sex education in this country.

HIV is a public heath issue, yet there has been little by way of response to match the crisis. How can we have massive outdoor advertising campaigns on things such as the importance of putting your chewing gum in a bin, but not on protecting oneself from HIV? 

Medical advances

The intensity of global panic over HIV lessened as it evolved with medical research from a death sentence to a chronic condition that can be treated with medication. Now, medication is so effective that one’s viral load can be undetectable and therefore untransmittable. This is brilliant progress, allowing people who are HIV-positive to lead normal lives, mostly uninhibited by the condition as long as they take their medication properly.

We need the HSE, Hiqa and the Department of Health to show that they’re taking this crisis seriously rather than just saying they are

Equally phenomenal has been PrEP, a preventative drug that dramatically reduces the chance of getting HIV even if you are exposed to the virus. A generic form has been made available in Ireland, but is only available with a prescription and costs about €80 a month. It is not available to medical-card holders or on the drug payment scheme, as the HSE will not reimburse the cost.

The World Health Organisation recommends PrEP be made available along with other HIV prevention. There is also a need for some non-sensationalised soul-searching within the gay male community, a high-risk group, about the use by some of drugs – particularly GHB, which has been linked to deaths in Ireland – during sex and at sex parties. Like many drugs, GHB can impact people’s decision-making skills and boundaries in sexual situations, potentially leading to riskier behaviour.

Because of the legacy and contemporary reality of homophobia, sexual repression and judgmental conversations around gay male sexual behaviour, it is extraordinarily difficult to have these conversations honestly and out in the open. While many people who use GHB may not experience negative side effects, a research paper published in the International Journal of Drug Policy in December 2017 – Chemsex, Risk Behaviours and Sexually Transmitted Infections among Men Who Have Sex with Men in Dublin – found a significant minority had experienced adverse effects.

Lost consciousness

The survey of 510 men attending an MSM-specific sexual health clinic in Dublin over six weeks in 2016 found 27 per cent reported engaging in chemsex within the previous 12 months; 23 per cent reported they or their partners had lost consciousness as a result of chemsex; 25 per cent reported chemsex was impacting negatively on their lives; and 31 per cent reported that they would like help or advice about chemsex.

Individual communities can’t solve health crises on their own

According to data from a London study published in HIV Medicine last year, gay and bisexual men who engaged in chemsex were five times more likely to be newly diagnosed with HIV during a 13-month follow-up period.

Tackling our HIV crisis should also encompass a holistic response to prevention. Are people having the sex they want to have and for the right reasons? And if not, what are the underlying issues that are prompting particular sexual behaviours and how can we as a society, community, groups of friends, couple or individual begin to address that?

But individual communities can’t solve health crises on their own. While progress on the medical side can alleviate the trauma of contracting and then living with HIV, and awareness and activism within social groups can lessen the stigma of HIV, we need the HSE, Hiqa and the Department of Health to show that they’re taking this crisis seriously rather than just saying they are. 

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