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Closure of PrEP service will 'undoubtedly' have impact on HIV rates, experts warn

Staff from the GMHS have been redeployed to Covid-19 test centres in recent months.

THE INDEFINITE CLOSURE of the Gay Men’s Health Service (GMHS) in Dublin and the discontinuation of its PrEP programme will “undoubtedly” have an impact on HIV rates, people working in the sector have warned.

The GMHS was closed during the Covid-19 pandemic, but its PrEP services were up and running until this week.

Staff from the GMHS have been redeployed to Covid-19 test centres in recent months.

PrEP (Pre-Exposure Prophylaxis) is medication taken by people who are at an increased risk of getting HIV in a bid to stop them from contracting the virus. When taken correctly, it has been found to be about 99% effective.

PrEP has been available free of charge in Ireland since November 2019 to those who meet the eligibility criteria.

The GMHS has been operating for 27 years and is the only statutory public health service for gay and bisexual men, men who have sex with men (MSM) and the trans community.

The PrEP programme at the GMHS was one of the busiest services of its kind in the country, with about 1,000 people accessing medication through it last year.

Adam Shanley, who oversees HIV Ireland’s MPOWER Programme, said he and colleagues are very concerned about the continued indefinite closure of testing and treatment services at the GMHS.

He said the decision on Wednesday to discontinue PrEP services at the GMHS “has further deepened our concerns and has led us to formally engage with HSE decision-makers on the move”.

Almost 12,000 gay and bisexual men and trans people availed of testing, treatment, vaccination and prevention services at the clinic last year.

Shanley said advances made since the PrEP programme started “are at risk of being lost due to the continued indefinite closure of GMHS, and instead we are facing crisis levels of new HIV and STI cases”.

“As we move into a period where demands on the health service are certain to increase, we have written to HSE decision-makers to advocate for the reintroduction and continued maintenance of sexual health service provision at GMHS and have highlighted the urgent need for the sexual health of gbMSM (gay, bisexual and men who have sex with men) to be recognised as a priority.

“Delays in the reintroduction of these services will have a substantial negative impact on the sexual health and wellbeing of our community members,” Shanley said.

He stated that while the country continues to deal with Covid-19, “we must remember that the HIV epidemic in Ireland is continuing”.

“The key difference between the two is that we have all of the tools we need to end new HIV transmissions – one of which is PrEP.

“The closure of the busiest PrEP service in the country will counteract initial gains and will undoubtedly have an impact on HIV rates in the short term.”

The Health Protection Surveillance Centre last week confirmed that there were 357 HIV notifications so far this year, roughly on par with notifications for the same week last year (389).

“This is alarming considering testing services have been dramatically scaled back, yet new notifications have remained steady,” Shanley said.

‘Some type of normality’

David Field, a clinical nurse specialist in sexual health and PrEP at the Mater hospital in Dublin, said the GMHS “provides culturally competent care for gay, bisexual, men who have sex with men, and the trans community, all of which are disproportionately affected by HIV”.

The Mater is one the other locations in Dublin where people can access PrEP but Field told these clinics “don’t have the same resources as the GMHS had to see the same volume of patients”.

Field said he understands why certain services had to be scaled back and resources re-deployed during the height of the Covid-19 pandemic, but added that people’s sexual health cannot be sidelined indefinitely.

“People are getting back to some kind of normality and a part of that is sex, you know, there’s no way around that. I think we need to back that up then with sexual health services.”

Field said “a tremendous amount of work” went into promoting PrEP among the LGBTI+ community in the last year and an extended closure of the GMHS means some people will “not be able to access medication and have the same protection”.

Service-users who attended the GMHS PrEP clinic received a rapid HIV test, a full STI screen, kidney function monitoring, and a detailed consultation regarding the medication and regular follow-up screenings.

Field noted that if this level of service is not being completed “it’s allowing other infections to also increase in the community, and those infections can then go on to be a driver for HIV because obviously when you have one infection, you’re more susceptible to a second infection or third infection”.

Field said “continuity of care and having a relationship with your healthcare provider” are also “extremely important”.

The GMHS is a community clinic so could offer out-of-hours services, something hospitals generally can’t do, he added.

“The impact of even a short-term loss of that service is going to be really felt by by the community and by the other services which will endeavor to support the community, but are already stretched,” Field said.

‘Unprecedented interruption’

When asked about the suspension of services at the GHMS, a spokesperson for the HSE said the Covid-19 pandemic “has led to an unprecedented interruption to normal healthcare activity, with all services affected”.

“In line with guidance from NPHET and to facilitate the re-deployment of staff to new and essential COVID-19 services, the Gay Men’s Health Service (GMHS) has temporarily closed until further notice.”

The spokesperson said that following a surge in demand for Covid-19 testing, staff from the GMHS were redeployed to Covid-19 test centres.

“The HSE is actively recruiting staff who will be dedicated to the provision of Covid-19 services. This will enable staff from the GMHS to stand up the service with protection from the impact of peaks and troughs of the virus on service delivery.”

More information and support can be accessed through HIV Ireland’s MPOWER programme.