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Limited access to HIV services during pandemic an ongoing concern for LGBT+ community

Closures and scaledowns of sexual health services have raised issues for HIV prevention and testing.

Image: Shutterstock/BlurryMe

SOME PEOPLE WHO “urgently need” the support of HIV services have not been receiving it during the pandemic as restrictions limited the accessibility of clinics.

Closures and scaledowns of sexual health services over the last 15 months have significantly impacted access to HIV testing and support, threatening to undermine progress on HIV in Ireland.

In particular, the Gay Men’s Health Service (GMHS) in Dublin has been closed or operating with reduced services since the onset of restrictions last year.

Its closure has acutely impacted men in the LGBT+ community who use the clinic for HIV screening, treatment and advice, as well as other medical services.

Bill Foley, the secretary of the Gay Health Network, said that STI services have been “severely cut back” during the pandemic.

Speaking to The Journal, Foley said that “initially, they were cut almost completely, so there was little or no testing and treatment being done”.

People living with HIV were able to access treatment, but it was difficult for new patients to make appointments.

After being closed last year, the GMHS began to reopen on a phased basis from January.

Currently, the service is only taking bookings for its PrEP (a medication to prevent contracting HIV) and asymptomatic screening services, and appointments can only be made over the phone due to the cyberattack on the HSE.

“When things began to open up again before Christmas, the Gay Men’s Health Service was one of the last services to be opened at all, which is a very highly regarded service within the gay community,” Foley said.

“It’s the only specialist service of its kind in Ireland,” he said.

The absence of that meant that a lot of people who were in the pattern of having regular testing or having a place to go if there was an emergency, for instance, around exposure, possibly, breakage of condom or whatever it might be, no longer had that route of access for help and support.”

“There’s still an issue in terms of the absence of walk-in clinics, because most people, if they have a problem, they want to be able to go somewhere immediately. There’s been a delay in all that,” Foley said.

“The gap is that previously it was an open walk-in clinic so that if you had a problem you could simply go down to the clinic, take a ticket and wait your turn. Even that was a bit problematic because they tended to get more people than they had spaces available,” he said.

“The absence of that drop-in facility is a big one because it facilitates ease of access.”

BeLonGTo, an organisation that supports LGBT+ people in Ireland between the ages of 14 and 23, surveyed over-18s on their sexual health as part of a study into the impact of the pandemic on the community.

It found that 76% who were sexually active have not accessed a sexual health check-up during Covid-19.

In its report, BeLonGTo recommended the reopening of sexual health clinics as a priority in line with public health advice, including the full reopening of the GMHS.

Speaking to The Journal, chief executive Moninne Griffith said the GMHS being closed has had a “terrible impact because that’s the one that people are used to going to and they’re happy going to it because they know that they’re not going to experience homophobia, biphobia or transphobia”.

Additionally, there was limited knowledge among young people about where they could access sexual health services during the pandemic, which, coupled with closures, meant that “people weren’t accessing those services despite urgently needing them”.

24% of the sexually active over-18s said they couldn’t access sexual health checks specifically due to the closure of GMHS and other key service providers being closed in their local areas.

Transmission

Provisional data for 2020 from the Health Protection Surveillance Centre as of June 2021 recorded 449 new HIV notifications in Ireland – a national rate of 9.4 per 100,000 people.

There were 536 cases in 2019 (11.3 per 100,000) and 522 in 2018.

This means the figures recorded so far for 2020 are lower than previous years, but there are concerns that this could be due to fewer cases being identified as opposed to an actual decrease in transmission.

HIV graph 2021 HIV diagnoses in Ireland by year Source: Health Protection Surveillance Centre

“Anecdotally, we’re hearing that the HIV rates during Covid have risen,” Foley said.

“Part of the problem is that testing wasn’t being done and recorded in the way it normally is,” he said.

In November, the HSE facilitated a new programme that allowed people to test themselves for HIV at home by ordering a kit online.

“Those were snapped up, such was the level of demand for them – they were gone in an instant sort of thing,” Foley said.

“The HSE had to roll back on that a little because they realised they needed to resource it,” he said.

“While it was a very positive initiative, it was again under resourced.”

Policy and practices

There are a range of strategies and policies in Ireland that are designed to guide progress on HIV and sexual health.

In particular, the Programme for Government promised that the government will “implement the National LGBTI+ [Inclusion] and the LGBTI+ Youth Strategy to create a safe, supportive and more inclusive Ireland”.

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Under the National LGBT+ Inclusion Strategy 2019-2021, goals that were due to be reached during the first half of 2020 included expanding community HIV testing to people at higher risk for HIV – mainly MSM and migrants – through NGO partners, and developing a “national stigma campaign” to raise awareness around transmission, testing and treatment, with a “strong focus at the city level for the cities that sign up to the fast-track cities initiative”.

Additionally, it set out that the Department of Health and HSE should “develop and provide Sexual Health Advisor training for nurses across public STI/HIV services, student health services, prison and addiction services and primary care” by the end of 2019.

The Department of Health did not respond to a query from The Journal on whether those goals have been achieved or what progress has been made towards achieving them.

Of the aims set out in the two strategies, Griffith said that “some are and some aren’t” being met.

Covid, naturally enough, is a valid reason that there’s been delays in relation to some of the actions under the Youth Strategy and the Inclusion Strategy, but we can’t ignore it, we have to get back to doing some of those things.”

The National Sexual Health Strategy, which sets out the overarching policies for sexual health in Ireland, was originally intended to cover 2015 to 2020, but has been extended into 2021.

Responding to a parliamentary question, Minister of State for Public Health Frank Feighan said that the Department of Health would consult with stakeholders and review the strategy this year. 

‘Even before Covid, the STI services were oversubscribed’

The last year has exacerbated problems that existed within Ireland’s sexual health care before Covid-19, and looking beyond the pandemic, those remain to be resolved.

“In relation to the lessons that we’re learning from Covid about the importance of track and trace and the resourcing of it, and how effective that is when you resource it, I think that lesson needs to come back into the health service generally in terms of how we manage ourselves post-Covid,” Foley said.

“The idea of looking at those services and systems within STI service provision is really important so that we get on top of epidemics as they emerge rather than being constantly backfooted by them and in a position of reacting to them once they happen – we should be in a position of preventing them in the first place,” he said.

“If we have a system that deals with symptomatic STIs as they emerge, the spread of them gets reduced and you’re talking about a lesser investment over time because of the reduction in illnesses.”

He said that “even before Covid, the STI services were oversubscribed”.

“We’re seeing, coming back in a slow way, that that demand is still going to be there and we anticipate a much higher demand for the services when they’re fully open, and again we think they’re going to be severely under resourced so there’s needs to be some thought and consideration put into expanding the services not just in Dublin but nationwide.”

Similarly, Griffith said that Ireland needs additional capacity and training in existing services as well as developing new ones.

The LGBT+ specific services need to be opened as quickly as possible, but also, we need better training and capacity within the mainstream health services and then targeted messaging from those services to the community to say, ‘we’re here and we’re supportive of you, we are inclusive, we’ve done training, we have policies in place and you’re going to be welcome here so that people feel that they can do that’.”

“We need specific targeted services as well for people who don’t feel comfortable or included, especially if they live in small rural areas where there mightn’t be a sexual health clinic near them and they might travel to Dublin to attend a targeted service,” she said.

“The lucky ones can get on the train, bus, or drive to Dublin to get to a clinic, but for those who can’t, there needs to be other ways that we can find getting sexual health information, STI tests, contraception and whatever they need to them.”

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