TODAY IS WORLD AIDS Day and for TV presenter and campaigner Rebecca Tallon de Haviland, it marks the end of a busy week of HIV advocacy. First diagnosed in 1987 at the height of the AIDS crisis, Rebecca shares her story openly to highlight the impact of living with HIV as a trans woman.

She is one of three inspiring women, together with UK campaigner Victoria Roscow and community worker Mary Davies [not her real name], living with HIV to feature in this year’s Glow Red for World AIDS Day campaign.

This week, Rebecca travelled to meet UK Prime Minister Keir Starmer for a reception in recognition of the work of leading HIV activists. At No.10 Downing Street she was joined by some of the UK’s most high-profile HIV campaigners, including David Furnish, husband of Elton John and members of the Elton John Foundation. There is real progress being made among UK organisations and the NHS toward the goal of ending new HIV transmissions and AIDS by 2030.

Ireland and HIV

Ireland has also shown notable progress in addressing HIV. Recent data on HIV by the Health Protection Surveillance Centre (HSPC), shows a 15% decrease in the rate of first-time HIV diagnoses in Ireland (i.e. no history of a previous HIV diagnosis) in 2023 compared to pre-pandemic year 2019. However, these figures also show us that significant hurdles remain to achieve the UNAIDS 95-95-95 targets.

These targets aim for 95% of people living with HIV (PLHIV) to be diagnosed, 95% of those diagnosed to be on sustained antiretroviral therapy (ART), and 95% of those on ART to achieve viral suppression.

While treatment and viral suppression efforts have exceeded expectations, diagnosing those living with HIV remains a critical challenge, particularly among vulnerable populations.

In 2023, there were 911 new HIV diagnoses in Ireland, a rate of 17.7 per 100,000 people. Among these, 61% of involved individuals had been previously diagnosed abroad. Yet, first-time diagnoses remain a concern, with HSPC data indicating that 39% of first-time diagnoses have been late. Late-stage detections are still prevalent among certain demographics, such as women over 40 and individuals born in Sub-Saharan Africa​.

Testing rates have also improved. Lab tests have increased by 7% and home testing by 30% in 2023. However, stigma, fear, and logistical challenges in accessing healthcare still constitute barriers to testing, particularly among groups who are at increased vulnerability to acquiring HIV like gay, bisexual and other men who have sex with men (gbMSM), people who inject drugs (PWID), and migrant populations from Latin America, Sub-Saharan Africa, and Eastern Europe.

What a new government can do

To meet the 2030 goals, Ireland needs a dedicated and well-resourced national action plan on HIV. The new government could champion this and end HIV transmissions by 2030. Such a plan must prioritise four key areas:

Expanding access to testing

Current testing initiatives need to be scaled up and tailored to reach underdiagnosed communities. Mobile testing units, culturally sensitive outreach, and free HIV testing at primary and community health facilities are essential.

We need to take a collaborative approach to reduce mistrust and stigma while bringing services to hard-to-reach populations.

Improving access to PrEP and PEP

Ireland’s national PrEP program is crucial for prevention, but access remains a challenge. PrEP or Pre-Exposure Prophylaxis is medication which when taken, can prevent the acquisition of HIV from a sexual partner who is HIV positive.

The waiting list to enrol in the program is as long as 18 months in Dublin, which undermines its efficacy in curbing new cases. Immediate measures should include increasing clinic capacity, streamlining enrolment, and supporting general practitioners across Ireland to prescribe and monitor PrEP.

Moreover, eliminating the €100 emergency department (ED) fee when an individual attends to access PEP is also vital. Taken within 72 hours of exposure, PEP, or Post Exposure Prophylaxis, is highly effective at preventing HIV acquisition. The ED charge disproportionately affects those already at economic or social disadvantages, acting as a deterrent for individuals, particularly when they are at heightened vulnerability.

Combating HIV-related stigma

Stigma remains a pervasive barrier in both testing and care. Many individuals, especially from marginalised groups, avoid seeking help due to fear of discrimination. Health campaigns should focus on normalising HIV testing as part of routine care, emphasising the effectiveness of treatment in achieving undetectable viral loads (U=U, Undetectable = Untransmittable).

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Training healthcare workers to deliver stigma-free, compassionate, culturally appropriate care is equally important. Public awareness campaigns can further challenge stereotypes and reduce discrimination.

Investing in vulnerable communities

Data from 2023 shows that vulnerable populations such as migrants, gbMSM, and PWID remain disproportionately affected by HIV. Targeted initiatives are necessary to address their unique needs. These could include offering PrEP and HIV-related services through trusted community organisations, increasing targeted mobile testing and home testing initiatives, addressing language barriers, and improving healthcare navigation for migrants.

We have an opportunity to achieve the 95-95-95 targets and end new transmissions by 2030 but it will require bold policy changes by the new government, increased funding, and a collective commitment to equity in healthcare access. We need the new government to develop a National Action Plan to help us achieve that vision for 2030.

We owe this to Rebecca, and everyone living with HIV, and to those who work tirelessly to highlight the valuable lessons learned from more than four decades of work. It’s for them that we Glow Red and pause in solidarity on World AIDS Day.

Stephen O’Hare is Executive Director of HIV Ireland.