Recent figures show the number of reported sexually transmitted infections (STIs) in Ireland rose over 12 per cent in 2011, with gonorrhoea now at the highest rate ever recorded. There has also been a 21 per cent increase in chlamydia levels in Dublin. We need to increase awareness, writes Anna Quigley:
THE NUMBER OF new HIV infections in Ireland has remained relatively consistent over the last number of years, with over 300 new cases each year and figures indicating the likelihood of a slight upward trend in the overall 2012 figures. This ongoing level of new infection in relation to an illness that is highly preventable is a significant public health concern and also reminds us of the need to avoid against complacency in relation to addressing the issue of HIV in Ireland.
The experience of the Lesbian/Bisexual/Gay/Transgendered (LGBT) community illustrates the need for HIV information and awareness campaigns on an ongoing basis and not just at times of public panic and crisis. The initial response to HIV and AIDS in Ireland was led by the LGBT community, with the formation of Gay Health Action in 1985 as the first NGO with a specific focus on AIDS.
GHA was highly effective both in providing information and awareness within the LGBT community and in lobbying the Department of Health to carry out broader public awareness campaigns. The response of the Irish LGBT community to HIV and AIDS contributed very significantly to limiting the spread of the illness in that community.
Not a death sentence
While the early campaigns around HIV and AIDS took place in the context of an illness that led to death, and thus generated a considerable sense of fear, the context changed as effective treatments for HIV were developed. HIV was no longer seen as a death sentence, it became a serious illness that people can and do live with, even though the stigma attaching to the illness remains very strong. By the mid 2000s, leaders in the LGBT community became concerned to see the levels of HIV infection rising again, in particular amongst men who have sex with men (MSM).
The Gay Health Network responded by developing the first ever All–Ireland HIV awareness campaign targeted at MSM, recognising the need to reach a new and wider audience of gay men and MSM with relevant messages about how to protect themselves from HIV transmission.
The other key group impacted by HIV and AIDS in the 1980s and 90s was injecting drug users (IDUs), particularly in Dublin. A targeted approach to reducing HIV transmission amongst IDUs has proved highly effective, using a harm reduction approach based on methadone and needle exchange. In 1992 almost 60 per cent of HIV new infections were amongst injecting drug users, but by 2011 this group comprised only 5 per cent of new infections.
Sexual transmission is now the main route of HIV infection for both the LGBT and heterosexual community and in this context, promoting sexual health is now the most effective approach to reducing transmission. While we need to continue to target particular risk groups, we also need to increase awareness in the wider community. We have plenty of evidence to show that Irish people are engaging in risky sexual behaviour, exposing themselves to the risk both of HIV and other STIs. Over the last two decades we have experienced a continuous increase in the reported rates of sexual transmitted infections in Ireland.
There were 13,259 STI notifications in 2011, a 12.2 per cent increase from 2010, and continuing an upward trend since 1995. There has been a 59 per cent increase in STI notifications in Ireland over a 10 year period (2001 to 2011), from 8,300 in 2001 to 13,259 in 2011. Over the last five years, more than two thirds of STI notifications were among those aged younger than 30 years and 71 per cent of all STI notifications in 2011 were among those aged under 30. This rising level of STI infection, along with the fact that 30 per cent of people who are HIV positive are unaware of their status, highlights the need to promote sexual health awareness in the general population.
Regular preventative testing for STIs is a key part of ongoing health care and this is the big step forward we need to make – to normalise sexual health promotion and testing. Doctors and GPs still speak of their discomfort in suggesting HIV or STI testing to patients, as the cultural attitudes that still linger around sexual behaviour can lead to embarrassment and reluctance to discuss the issue. We need to move from the situation where the suggestion of a sexual health test is seen as something negative rather than being a sensible, normal and regular part of taking care of yourself for anyone who is sexually active.
There are preventative testing programmes, such as breast screening and smear tests, now available as part of our health service and other types of screening such as regular colonoscopy are recommended for many adults. If we recognise the need to look after our sexual health in the same positive and proactive way, we will have a real opportunity to reduce future transmission of both HIV and STIs in Ireland.
Anna Quigley is the Executive Director of the Dublin AIDS Alliance.
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