Meeting of the Joint Committee on Health and Children
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(Tuesday 1 December 2015)
Opening Statement by Ms. Deirdre Seery, CEO, Cork Sexual Health Centre
Thank you Chairman and members for the invitation to speak to the Oireachtas Health Committee.
There were 203 new cases of HIV diagnosed in the first half of 2015. That is more than one person
per day. So far this year, there have been 427 new infections, an increase of 85 since 2014. HIV is
preventable. We need to reflect on how we can improve our HIV prevention.
I will firstly look at the contextual issues of HIV visibility and touch briefly on Stigma, as Niall has
already addressed that. Then I will look at some of the prevention tools available to us.
HIV VISIBILITY – Before the current treatments were available, when HIV led to AIDS and ultimately
death, there was no escaping its reality. People were ‘outed’ when they developed AIDS. Families
and friends had to embrace the news of the diagnosis, often within a short timeframe between
knowing the status of the person with HIV and their death. Often, this was accompanied by the
realisation that someone not only had a terminal illness but that they were gay and/or men having
sex with men. Or maybe they were injecting drugs. People with HIV feared rejection and isolation at
their time of greatest need. Families kept things secret, locking themselves away from their own
support systems, often blaming themselves. “Is it my fault my son is gay? Was I not a good role
model”?
Today, there are effective treatments for HIV and those on treatment are unlikely to develop AIDS.
So people living with HIV are no longer ‘outed’ by their condition. They have choices about who and
when they tell, even whether they tell. That is a cause of celebration and a basic human right of
anyone living with any illness. But has the lack of visibility made us complacent –“I don’t know
anyone with HIV, therefore it does not exist”. HIV is no longer a death sentence, no longer visible, so
we can take risks?
To combat complacency we need to continually raise the visibility of HIV. Lighting the City Halls
around the country is one way of doing this. Awareness raising needs to be sustained and of
sufficient scale.
STIGMA and SELF STIGMA There is social stigma and self-stigma.
With social stigma people may be judged negatively by the judgements of people around them.
Some of the responses to Charlie Sheen’s disclosure of his HIV status echo social stigma.
There is also self-stigma, where people fear the judgement of others that they close themselves
from the possibility of negative judgements. This can stop people accessing services and supports.
They may be afraid to even enter our buildings in case they are seen.
People may internalise how they think others might perceive them. “I felt like a human time bomb,
waiting to go off”. “It made me feel worthless”. Some newly diagnosed people can feel suicidal at
first. We have seen people change completely when they receive counselling and support. Their
lives can turn around and they can live healthy and fulfilling lives, where HIV is part of them, not
their total identity.
We can show solidarity to people living with HIV by challenging stigma and discrimination. That is
within our control. We can provide support to individuals so that stigma is not just something that
society does to people with HIV. Stigma loses its power over people with self-confidence and
positive self-esteem; people who know that a HIV diagnosis is just that. It is not their whole person.
They can lead satisfying lives, including sex lives. Counselling and support helps this process.
We need not only to provide good support services; we also have to continually reflect upon how to
make those services safe and accessible to people when they feel at their most vulnerable. That
requires joined up thinking and real multi-sectoral partnership between policy makers,
implementers and HIV services.
OUR KEY RESPONSES
TESTING – If you have HIV you can be put on medication that will not only keep you well but will also
reduce the levels of virus in the body; your viral load. We are promoting testing with such vigour
because it is very important that people know their HIV status. If they know their status they know
what they need to do. If positive they access treatment and if either positive or negative then safer
sex is imperative.
Previously we would have had to wait a week or two for the results of a HIV test. Today we have a
HIV test that gives the result in one minute. That indeed is Rapid. When Minister Varadkar launched
the National Sexual Health Strategy recently he announced that funding is now be available for free
testing in community settings, using targeted outreach. In the UK they are also making home tests
available that people can send back to a lab and get their results in three days. Scaling up HIV
testing is an important step in improving HIV prevention. As they say, we have the technology.
The trials for PreP (Pre exposure prophylaxis where drugs are provided that help prevent HIV
transmission) were shown to be so successful that they were stopped early. PreP is administered
widely across Europe but it is also expensive. With PreP and PEP, (Post exposure prophylaxis) we
have effective measures to prevent HIV being transmitted. We need to know more about how PreP
can be best applied in the Irish situation to maximise impact. We have a clinical director of the
National Sexual Health Strategy in place to steer this process.
One possible unintended consequence of PreP is that people will not worry about getting HIV and
condom use will decline with the result that STIs may increase. So we still need to continually
promote condom use. Condoms are still the most effective way of preventing STIs. And they are
cost effective. But we also need to make regular STI screening accessible in community outlets.
Hospitals cannot cope with broadening out STI screening and there are increasingly new testing kits
being produced making testing in non-medical based settings possible and cost effective.
TARGETED HIV PREVENTION: Surely after the success of the Yes Equality campaign it is ok to be gay?
Yes, for the majority of Irish people it is. But there are still many men who have sex with men who
don’t identify as gay, who may be married, living secret double lives. Are gay men protecting
themselves? Men make up the majority of new infections in the first half of 2015, representing 47%
of all new cases. We need to provide safe environments where men who have sex with men can
easily access testing and know their HIV status. At SHC in Cork and GOSHH in Limerick we have
tested over 1,000 people for HIV. This model is now being rolled out in Dublin and Tiernan will talk
more about this.
We also have increasing numbers of people who inject drugs testing positive for HIV. There are new,
younger generations of people becoming HIV positive who would not have been exposed to the old
safer sex and safer drug use campaigns. We need to tackle our own complacency. We have not won
the HIV prevention battle – yet.
SO WHAT CAN WE DO: Our first message is “GET TESTED” – know your HIV status.
If a test result is negative, then practicing safer sex will be important. Condoms are the main
protection against HIV transmission and PreP for those most at risk.
If a test is confirmed as positive for HIV, then people can access the excellent treatments that are
available. These not only protect the health of people with HIV but also decrease the possibility of
passing HIV to others.
There are excellent services available for those who are living with HIV. Treatment is free and
effective. Counselling is free and available to those who are concerned about their sexual risk taking
as well as those who have tested HIV positive. We have to continually challenge stigma so that
people feel safe to access these services.
I have not yet mentioned talking about sex. How can we negotiate safer sex without being able to
talk about sex? Good quality sex education is imperative to our future HIV and STI prevention
programmes. And I mean sex education, not just information on reproduction.
It is not enough to do the right things. We need to do the right things right.
We need to continuously reflect and improve.
We need to work in partnership with all the key actors.
We need more testing, targeted outreach and accessible quality services.
And we need honesty – we are not yet effectively preventing HIV. We can need to improve –
continually.
Thank you.