Analysis: this will require political will, a rethink of our healthcare services and especially a reduction in stigma around HIV

In 2015, then Minister for Health Leo Varadkar launched the National Sexual Health Strategy with this message: "Ultimately, good sexual health is down to personal responsibility but the Government can help by … improving access to affordable testing and treatment."

Since then there have been yearly increases in new HIV diagnoses. The highest number of new diagnoses to date was recorded in 2019 at 532. New diagnoses for 2020 and 2021 dipped to 444 and 404 respectively. These are likely an under-representation, given that services were significantly curtailed due to the pandemic.

The minister's assertion that good sexual health is a question of personal responsibility is correct. However, it disregards the fact that capacity to exercise personal responsibility is not equally distributed amongst our citizens. If we are to reduce the number of new HIV diagnoses, we need to create more equitable access to sexual health service provision and reduce HIV-related stigma.

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From RTÉ Radio 1's Ray D'Arcy Show, Luke Toomey and Keith Donaldson talk about the reality of having HIV in Ireland

Testing is a cornerstone of HIV prevention, but research has shown that barriers include difficulty accessing services, cost, lengthy waiting times, and inconvenient opening hours. Such barriers are faced by people who have the greatest need of services. These tend to be those with less access to power, money and resources, including young people, the unwaged, migrants, and those on lower incomes.

Like many other parts of our health system, access to testing for STIs or HIV is very much dependent on location and ability to pay. Existing services are over-burdened, under-resourced and provision is not equitable.

HIV and STI testing is facilitated by most GPs, but this comes at a prohibitive cost for those without a medical card or GP visit card. Consultation and screening fees amount to around €140, while private services can cost up to €545 for premium screening packages.

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From RTÉ 2fm's Jennifer Zamparelli show, sex therapist Rachel Cooke on STIs

A mapping exercise by the Sexual Health and Crisis Pregnancy Programme (SHCPP) in 2018 showed that free sexual health services are available at 23 public clinics, eight NGO-run services and nine student health clinics. Some clinics report waiting list times of up to seven weeks. Seven of the 23 public services have to cancel clinics each year to facilitate staff annual leave, resulting in gaps in service of up to four weeks in some places. Meanwhile, 10 counties - Cavan, Kildare, Kilkenny, Leitrim, Longford, Meath, Offaly, Roscommon, Wexford and Wicklow - had no services at the time.

In order to plug this gap, the SHCPP have launched an online testing service. This is a welcome move to expand access. However, as a report by the British Society of Sexual Health outlined recently, online testing may not be suitable for everyone. There are difficulties associated with ordering online tests for the digitally excluded, those with lower literacy, and people with language barriers.

Online testing is not recommended for those experiencing symptoms, who are most in need of swift access. Online services will certainly help improve the current situation, but they are no replacement for face-to-face services, which can facilitate opportunities for sexual health promotion interventions.

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From RTÉ Archives, Evening Extra report in 1987 on the Health Action's information service about HIV and AIDS

Strengthening our existing sexual health infrastructure and expanding access to services is essential if we are to diagnose and treat new cases and prevent future ones. Expanding access would also help to normalise sexual health clinic visits and this could have a powerful de-stigmatising impact on STIs and HIV.

In Ireland, approximately 7,200 people are living with HIV. The development and improvement of antiretroviral medication now means that people living with HIV lead long healthy lives, and have a normal life-span. Crucially, the medications are so effective that they reduce the virus in the body to undetectable levels. This means that HIV-positive people cannot pass the virus on to their sexual partners, while women with HIV can safely give birth to HIV-negative children.

Despite these vast improvements to the quality of life for people living with HIV, stigma remains an entrenched problem. A survey conducted in 2017 by HIV Ireland found that 30% of people with HIV reported feeling stigmatised by family, 27% by health professionals and 23% by friends. Discrimination occurs against women with HIV, who are denied access to IVF services because of their status and must travel abroad if they need fertility treatments.

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From RTÉ Radio 1's Drivetime in 2019, Dr. Aisling Loy, Consultant in Sexual Health and HIV at St James' Hospital, on the stigma people face when they are diagnosed with HIV

Stigma in healthcare settings is a particularly pressing issue, as there is evidence to show this results in health avoidance behaviours and negatively impacts on prevention efforts. Overturning discriminatory policies, such as the one denying IVF treatment to HIV-positive women, and implementing anti-stigma policies in all healthcare facilities would be two specific and impactful measures to begin addressing HIV-related stigma in Ireland.

As part of the UN Sustainable Development Goals, and Fast Track Cities Initiative, Ireland is committed to working towards ending the HIV epidemic. Both programmes have set targets of reaching zero new HIV infections, AIDS-related deaths and HIV-related stigma/discrimination by 2030. These are ambitious goals, but not impossible.

With Covid-19, we saw how political will was possible to mobilise resources to create mass testing and vaccination facilities to protect public health. With a fraction of the same will and a bit of vision, it would be within our grasp to create more equitable sexual health provision and reduce stigma. This must happen if we truly want to reach zero and make HIV a thing of the past.

The Joint National Survey on HIV-related stigma in healthcare settings in Ireland is currently underway and participants are welcome


The views expressed here are those of the author and do not represent or reflect the views of RTÉ