Parting Shot

It was May of last year, COVID restrictions in the rearview mirror, that our preparations for a ‘hot queer summer’ were interrupted by the arrival of Monkeypox.

The virus, now known as mpox, is endemic in parts of Western and Central Africa but cases were unexpectedly identified among gay and bisexual men in London and Lisbon. Dense sexual networks within our internationally connected queer communities allowed for the virus to spread rapidly, leading to an outbreak almost worldwide.

Just as quick as mpox was identified, information about how the virus is acquired, its symptoms and how to get tested was shared across the community. Due to limited global stocks of the smallpox vaccine, which can be used to prevent or lessen the symptoms of mpox, access wouldn’t happen in Ireland until late autumn. Strong uptake of the vaccine and a collective effort from our community to make informed choices about our sex and social lives helped bring the outbreak under control. This is evidenced by the fact that Ireland has had only two cases of mpox in 2023 so far.

The response to mpox is a strong example of how engaged our community is in our collective sexual wellbeing. When empowered with knowledge and given access to tools to navigate our sexual health, our queer community has proven time and again what can be achieved.

Arguably one of the most important breakthroughs in sexual health science in recent years is the U=U message. A person living with HIV on treatment with an undetectable viral load cannot pass on HIV to their sexual partners. The risk is zero.

The queer community in Ireland were one of the first to embrace the message. Posters, t-shirts, social media posts, podcasts, TV and film were produced to share this groundbreaking news. Until then, many people living with undetectable HIV had anxiety about onward sexual transmission due to perceived risk that is now known to be non-existent. The U=U message not only contributes to ending new HIV diagnoses and a new lease of sexual freedom, but also works to dismantle stigma which has been pervasive both within our community and beyond.

Almost simultaneously, the national PrEP programme was introduced in late 2019. Another breakthrough tool to bring an end to rising rates of HIV in Ireland which continue to disproportionately affect gay and bisexual men. Such is the desire from the community to get hold of this revolutionary drug, clinics offering the preventative intervention have mostly reached capacity. Again, a strong demonstration of the importance our community places on embracing solutions to our sexual health needs. But we must not leave anyone behind. We will only achieve an end to HIV if everyone gets the opportunity to benefit from the prevention tools available, and so our advocacy to improve access to PrEP continues.

Alongside that fight is our response to STIs, which have been making their presence known of late. A nationwide outbreak of syphilis is ongoing, and rising rates of chlamydia and gonorrhoea continue to raise concern both in Ireland and internationally. However, breakthroughs in sexual health have been bountiful in recent years and the outlook is positive. Enter DoxyPEP – the antibiotic doxycycline which is used within 72 hours of condomless sex as an STI prevention option. DoxyPEP is showing strong evidence in preventing syphilis and chlamydia in gay and bisexual men, with some potential for gonorrhoea too. Concerns about antimicrobial resistance are valid and careful use of the intervention is planned internationally so it reaches those who may benefit the most. It’s a tool we will be pushing for here in Ireland.

However, using DoxyPEP to prevent STIs may only be a stopgap, as development of STI vaccines is underway. Alongside established STI vaccines such as Hepatitis A, B and HPV, there is promise that a vaccine currently used to protect against meningitis B may also offer some protection against gonorrhoea. Vaccines for chlamydia have entered clinical trials and syphilis vaccines are in earlier stages of development.

While word of new STI outbreaks is never something we look forward to, breakthroughs in prevention offer us reason for optimism. Our community has a proven legacy of caring for our collective sexual wellbeing and continues to be best placed to lead that charge. As queer sexual health evolves, the MPOWER team is committed to bringing Ireland along with it.

Adam Shanley is the MPOWER Programme Manager at HIV Ireland. His interests sit at the intersection of public health and social justice with a particular and intentional focus on increasing the positive sexual health outcomes of gay and bisexual men.

Visit mpower.hivireland.ie to access sexual health testing, information and support and to learn how to volunteer with the MPOWER team.