THE FUTURE IS NOW

For more than 30 years, condoms were our main HIV prevention method. Although it may not be obvious from where we sit now, it’s worth recognising that the embrace of condoms by the gay community to prevent HIV was an astonishing public health achievement. And it’s one that was pioneered by the community itself – community activists designed the first safe-sex materials and promoted condoms years before politicians and public health officials did.

At the height of a terrifying and devastating epidemic, condoms provided a way for us to continue to enjoy sexual intimacy and to bolster ourselves against moralistic attacks that linked gay sexuality with disease and death. We found an effective way to respond to the crisis that didn’t require us to sacrifice the values of sexual liberation.

Yet there’s no denying that condoms alone have not been enough to stop HIV entirely. That’s why new prevention approaches like PrEP, PEP and treatment as prevention are so exciting. They offer us powerful and flexible prevention options that meet a wider range of real-world situations and needs.

With HIV diagnosis rates at historic highs in Ireland – in particular among gay and bisexual men – we can’t afford not to make use of all of the available tools in our HIV prevention toolbox. The HSE needs to stop stalling and roll out publicly funded PrEP to those who need it.

Generic versions of PrEP recently became available in community pharmacies in Ireland. This was a welcome, if unexpected, development, but at its current cost, this essential drug remains out of reach for most PrEP users. The HSE needs to speed up its evaluation process and make this drug available and – just as importantly – accessible to everyone who could benefit from it.

Testing: An Essential Component of Sexual Health

Regular testing and treatment are ways to bring rates of STIs down. But there’s no use telling people to go for testing if they can’t actually access the services they need. Overcrowding and long waits are the norm at the dwindling number of sexual health centres around Ireland – if you’re lucky enough not to be turned away in the first place.

Since 2009, HSE funding for the Gay Men’s Health Service shrank by half, while newly reported HIV diagnoses among gay and bisexual men have doubled. And it’s not just about HIV. In the last decade Ireland’s seen new diagnoses of gonorrhea and syphilis – the majority of which are among gay and bisexual men – skyrocket.

We need a commitment to increase funding, improve conditions of clinic facilities, and expand sexual health services across the country, including self-testing and community-based rapid HIV testing.

The London Model

Recent data from Public Health England revealed the first downturn in HIV diagnoses among gay and bisexual men since records began. This was due to a combination of regular testing of people at higher risk and offering people treatment immediately after a HIV diagnosis, as well as the significant increase in the number of men using PrEP.

London’s 56 Dean Street – the UK’s largest sexual health clinic – reported an 80 percent fall in HIV diagnoses compared with 2015, while continuing to test the same number of people. From a high of 70 new HIV diagnoses at the clinic in October 2015, there were only four new HIV diagnoses in October 2017.

An important factor in Dean Street’s success is the well organised and user-friendly service it offers. At first glance the Dean Street Express clinic – an automated service for routine STI screening – looks a bit like a stylish hotel. Users check in to this state-of-the-art NHS clinic with a touchscreen interface and then go to a private booth where a video walks them through the steps to provide the samples needed for testing. Results are delivered by SMS in six hours, and treatment for any STIs picked up by the tests is provided free-of-charge the same day. The clinic is so efficient, 300 people per day can get screened.

To further reduce the burden on clinical services, the UK National Health Service developed SH:24, a free online sexual health service. Using the smartly packaged selftesting kit, people can get screened for the four most common STIs with results delivered by SMS in seven days. SH:24 also gives people access information and advice, 24 hours a day.

Expanding Access, Challenging Attitudes

Addressing Ireland’s HIV crisis and the increasing rates of STI diagnoses requires more than just better sexual health services. We must also challenge negative attitudes toward sex and sexual health.

When it comes to knowing your status, ignorance is not bliss. Many times people have no symptoms when they have an STI – although they can still pass it on to partners – so regular check-ups are important for sexually active people. In fact, if you are reading this article while sitting in a STI clinic, you are being responsible; you’re looking after your health and you should never allow anyone to make you feel bad about that.

Sexual health services should reflect that same positive attitude. We need welcoming and modernised sexual health services that make it easy to get tested. If you have no symptoms, wouldn’t it be more efficient for you to do these simple tests at home using a postal self-test kit? Wouldn’t it be more effective to expand free rapid HIV testing into every city and town in Ireland in a community setting at convenient times?

HIV is a Political Crisis

In Ireland there’s an average of one HIV diagnosis every 18 hours. Over half of these are in gay and bisexual men. Addressing this crisis requires political will to make funding available and supporting prevention efforts and sexual health services a priority.

It took the Minister of Health, Simon Harris, 574 days in office to make any public statement about Ireland’s HIV crisis. Silence around HIV creates a vacuum that propagates outdated, counter-productive attitudes. Silence fuels discrimination and leaves new prevention tools like PrEP unused and unavailable.

In the early years of the AIDS crisis in Ireland, our community led the country’s response to the epidemic. In 1985, a small group called Gay Health Action produced the first literature on HIV in this country, and, although it was illegal at the time, they distributed condoms – those enablers of pleasure and intimacy in the face of fear – in gay bars and clubs.

We need a new wave of sexual health activism. One that holds on to what we’ve learned from the past but fearlessly embraces the remarkable advancements in HIV prevention for the future. We need to ACT UP and fight back.

Find out more about ACT UP Dublin at actupdublin.com