To mark the 30th anniversary of World AIDS Day 2018, HIV Ireland held a political briefing on 28th November 2018 in the AV Room in Dáil Éireann, and published a key framework document asking for political commitments to prioritise and accelerate the response to the growing HIV crisis in Ireland.

Since 2011, there has been an increase of 35% in new HIV diagnoses in Ireland, with a total of 508 people diagnosed as living with HIV in 2016, and 506 in 2017 ( Official figures are likely to understate the scale of the crisis. According to the World Health Organisation (WHO) 15% of people living with HIV in Europe are undiagnosed. It is likely the number of people living with HIV in Ireland is considerably higher than the number of diagnosed cases.

In 2018 to date (week 45) there have been 454 new HIV diagnoses in Ireland, 66 more than the previous year. Ireland now has an average of 10 people per week being diagnosed with HIV.

#1. Increase resources to expand community-based and healthcare-based HIV testing across Ireland.

HIV Testing: People who don’t know their HIV status run the greatest risk of poorer health outcomes, and of transmitting HIV to others through unprotected sex or sharing of needles. HIV symptoms may not appear for years; therefore, the only way someone will know they are living with HIV is by getting tested.

HIV Ireland provides community testing in Dublin, in Drogheda, and is the Dublin partner in the KnowNow Rapid HIV Testing project, which incorporates testing in Cork, Galway, and Limerick. Both community-based and healthcare-based HIV testing needs to be expanded and become a normal part of healthcare screening. HIV testing can mean earlier diagnosis and more effective treatment. With early treatment, a person’s health prospects can improve, with life expectancy similar to someone not living with HIV.

The UN promoted theme for World AIDS Day 2018 is ‘Know Your Status’ encouraging people to get tested. While HIV Ireland supports this theme, the current availability of HIV testing in Ireland does not meet the demand, or the need. In 2017, HIV Ireland’s testing services catered for 1,082 people. However, we had to turn away a further 384 people because we did not have the resources to provide a service to them.

#2. Resource national promotion of the U=U message to combat HIV-related stigma and encourage more people to get tested.

Stigma and U=U: If someone is on HIV treatment, and has attained a status where the HIV virus is undetectable within their bodies (virally suppressed), they cannot pass on the virus. There is currently a campaign called U=U (Undetectable = Untransmitable) which aims to promote this message. Apart from acting as an incentive for people to access treatment, it also helps to break down HIV-related stigma within society.

In 2017, HIV Ireland released the findings of a major HIV stigma survey, the first in Ireland since 2007. The report found that HIV-related stigma still persists, and affects the everyday lives of people living with HIV. A majority of people living with HIV fear being judged and treated differently if they disclose their HIV status to others. The stress of HIV-related stigma would appear to explain why there is a high level of low self-esteem amongst people living with HIV, and why suicidal thoughts were reported by over 17% of people living with HIV who participated in the survey.

#3. Commit to the international Fast-Track Cities initiative to accelerate the response to HIV nationally.

Fast-Track to controlling HIV: The Fast-Track Cities initiative is a global partnership between the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Human Settlements Programme (UN-Habitat), in collaboration with local, national, regional, and international partners and stakeholders.

Fast-track cities commit to build upon, strengthen, and leverage existing HIV-specific and HIV-related programmes and resources to:

1. Attain 90-90-90 targets.
2. Increase utilisation of combination HIV prevention services.
3. Reduce to zero the negative impact of stigma and discrimination.
4. Establish a common, web-based platform to allow for real-time monitoring of progress.

The initiative was launched on World AIDS Day 2014 in Paris, with more than 250 cities internationally having joined this initiative, including London, Paris, San Francisco, Melbourne, San Paolo and New York.

It is time for cities in Ireland, and Ireland as a whole to join other modern global cities and regions by signing up to the Fast-Track Cities initiative.

#4. Increase resources for community-based supports for people living with HIV in Ireland.

Resources: Organisations like HIV Ireland are very underfunded. It’s a constant struggle to make ends meet, especially with increased demands upon our services. HIV treatment in Ireland is free and of a very high standard. Unfortunately, supports like counselling, education, awareness, and advocacy are severely underfunded. This links with the negative impact of HIV stigma on people’s lives.

#5. Invest in HIV Prevention services and implement a national PrEP programme in Ireland.

Pre-Exposure Prophylaxis (PrEP): PrEP is a once daily medication that, in combination with safer-sex practices, has been proven to significantly reduce the risk of sexually acquired HIV infection among uninfected adults at high risk. As part of HIV prevention, the safety and efficacy of currently approved PrEP medication is well established, and the high level of support for PrEP implementation among key stakeholders and potential end-users points to the need for immediate steps to be taken to make PrEP available freely and widely in Ireland.