Although Ireland has a history of creating plans, strategies and frameworks that never amount to much, there is a lot to be hopeful about with this one. It seems unlikely that some of the more optimistic and nebulous goals of the Strategy (e.g. “the development of a culture of support, encompassing education in and outside of the school, education in the home and among sexual health practitioners”) will be realized any time soon, but an 18-point Action Plan for this year and the next sets out realistic targets which, if accomplished, could do quite a lot of good.
Much of the press coverage focused on the first concrete measure announced as part of the Strategy: a €150,000 grant to the Dublin-based Gay and Lesbian Equality Network (GLEN) to initiate a pilot project to offer free, rapid HIV testing in community locations in Dublin. The grant will also support the expansion of existing efforts in Limerick and Cork.
No specific details were revealed, but the prospect of free, rapid testing being available in Dublin is tremendously positive (and long overdue). While free blood testing for HIV has been available from STI clinics for years, it requires a blood draw and takes about a week to get results. Rapid testing is available at private clinics, but the cost (as well as the need to visit a clinic) is a disincentive to many.
Rapid HIV testing has been available for less than 3 years in Australia, but prevention organisations and public health agencies there were quick to take advantage of the opportunity to increase testing rates and in particular to reach people who were otherwise reluctant to be tested. So far all signs are that these efforts have been enormously successful.
Several studies from Australia have reported that rapid testing is preferred over conventional blood testing, that men test more often with rapid tests, and that they would recommend it to their peers. In addition, the availability of rapid testing seems to have led to an increase in early detection in New South Wales (late diagnosis being a particular problem in Ireland).
Although it didn’t make the news (and it’s not referred to specifically in the Strategy) pre-exposure prophylaxis for HIV (PrEP) was discussed explicitly at the launch event. Dr. Fiona Lyons, the new clinical lead for implementation of the Sexual Health Strategy, said that developing and implementing guidelines for PrEP in Ireland was a “priority focus”. Later Minister Varadkar, answering a question about resources, noted that while PrEP would involve new costs it would also produce savings in the long run.
While there were no specifics about when PrEP might become available in Ireland or to whom, the fact that it was addressed forthrightly and without hedging suggests that PrEP has been part of conversations among decision makers in Government, that they recognise that it’s a matter of when and how, not if, PrEP will be made available here.
Even if that optimistic reading is accurate, there’s still a huge amount of work for advocates of PrEP to do. There’s an enormous amount of education that needs to happen among gay and bisexual men about PrEP, many myths and worries to address, many earnest questions to answer. Approval and availability of Truvada for PrEP is only the first step. For PrEP to be successful, the community needs to support it and the people who can most benefit from it need to actually use it.
Building demand for PrEP in the community will also help keep the pressure on to make it available promptly. Given the likelihood of delays in implementation (the Sexual Health Strategy was initially intended for release at the end of 2012!) it’s imperative that we show that this is an issue that matters to our community, that we do expect our political and public health institutions to make use of all the tools that are available to maintain our sexual health and wellbeing.
So I’m enjoying this moment of hope, of potential, but not for too long. We need to keep our noses to the grindstone, we’re a long way from done.