ACT UP Dublin released the following statement to coincide with Irish AIDS day on June 15.

ACT UP

DUBLN

Today is Irish AIDS Day - a day to reflect on the history of the HIV epidemic in Ireland, to remember those who we’ve lost, and to celebrate the incredible progress we’ve made in treating and preventing HIV. It’s also an opportunity to show solidarity with those of us living with HIV - and to remember that Ireland’s HIV/AIDS crisis is a political crisis.

It’s clear that the government has been hearing this message. This week we’ve had two important and immensely positive announcements about the HIV crisis in Ireland. Yesterday HIQA - the Health Information and Quality Authority - submitted a report to the Minister for Health, Simon Harris, recommending the introduction of a national PrEP programme for Ireland. Although no details or timeline were provided, a statement from the Department of Health reaffirmed Harris’s pledge to introduce a PrEP programme by the end of this year.

On Thursday, Mayors from Dublin, Cork, Limerick and Galway met with the Minister for Health and An Taoiseach to sign on to the Fast-Track Cities initiative. This initiative is intended to support city-level responses to HIV, with a focus on meeting the UNAIDS 90-90-90 targets and eliminating HIV-related stigma and discrimination.

This Fast-Track Cities signing was accompanied by the announcement of €450,000 in new funding to support community-based HIV testing and outreach services, as well as a public anti-stigma campaign and promotion of the new PrEP programme.

This is very welcome and we hope it signals a real and sustained commitment from both national and local governments finally to mount an effective response to Ireland’s HIV crisis.

However, the framework of these interventions is entirely focused on the laudable goal of preventing new infections. But what about those people already living with HIV or already diagnosed with AIDS? ACT UP cannot help but note that other than a badly overdue anti-stigma campaign, these announcements are almost entirely focused on the needs of HIV-negative people.

While we hope that an anti-stigma campaign keeps people living with HIV at its centre, we also expect that supports for people living with HIV will not be neglected in future funding.

Indeed, the critical importance of addressing the nonmedical needs of people living with HIV is highlighted by Ireland’s current 90-90-90 figures. The UNAIDS 90-90-90 targets aim to ensure that 90 percent of all people living with HIV will know their HIV status, 90 percent of people diagnosed with HIV will receive sustained antiretroviral therapy and 90 percent of people receiving antiretroviral therapy will be virally suppressed (also referred to as having an “undetectable viral load”).

These three measures not only provide targets, but they help point to where the need for improvement is greatest. According to the more recent available figures for Ireland we’re close to meeting the first 90 target, with an estimated 87 percent of people living with HIV knowing their status. And we’re doing well with the last 90, with 95 percent of people on treatment being undetectable.

It’s the second 90 where we need the most improvement: only 83 percent of people who are diagnosed are on treatment. Care and treatment are provided free of charge to anyone diagnosed with HIV in Ireland, so what other factors would prevent people from accessing the treatment that can keep them healthy and stop transmission to others?

Unfortunately we know little about why people may not be accessing care in Ireland, and about the supports that might help them get into and stay in care.

Thus, alongside prevention efforts focused on HIV-negative people, the unmet needs of people with HIV must be explored and addressed. Initiatives led by people living with HIV, such as peer support networks, should be prioritised. Stakeholders must also focus on ways in which HIV and AIDS are ramified by social inequalities, including especially gender inequality and racism. Anti-stigma efforts, and services for people living with HIV, must specifically address the needs of those communities most impacted.

It is imperative that people living with HIV be actively involved in the city stakeholder meetings and be represented on the local steering groups. The promise of effective local action will not be met if these bodies include only the familiar faces. They must engage with the full range of communities affected by HIV, and especially those most vulnerable.