HIV diagnoses in Ireland have skyrocketed. Health Protection Service Centre data reveals that 276 people have already been confirmed as newly infected, by July 2018.

In 2011, between 300-350 new positives were diagnosed. By 2017 the number of new cases had risen to 500, within that 12 month period. That figure may well increase again in 2018. This crisis is even more troubling given that the trend elsewhere is in the opposite direction. The recent UNAIDS report 'Miles to Go', showed numbers of HIV diagnoses worldwide have decreased by nearly half since 1996. The document, does argue, however, that partial success in stopping new HIV infections is giving way to 'complacency'.

Will St. Leger - spokesperson for HIV activist group Act Up - tells Hot Press: "The reason for HIV's rise in Ireland over the last five years is down to government complacency, and neglecting to respond to upward trends in diagnoses."

Drug-users sharing equipment and young people having unprotected sex are not major factors in rising HIV rates, says St. Leger. "HIV acquisition in drug users is about 4 per cent of the overall figures, because preventative measures such as needle exchange programmes have been effective." St. Leger notes that young people having unprotected sex are more likely to catch bacterial infections like chlamydia and gonorrhoea than HIV. Instead, the activist points out, it's "Men who have sex with men that are disproportionally affected, making up 51 per cent of figures." While heterosexual contact is the second most common cause of transmission at 28 per cent, most cases here involved people who were born in countries with generalised HIV epidemics.

St. Leger and Act Up link rising numbers to the fact that the budget allocated to the Gay Man's Health Service (an STI treatment and HIV testing clinic in Dublin) was cut from €892k in 2009 to €556k in 2016. Speaking to GCN about the statistics, St. Leger said: "Regular testing and treatment are the most effective ways to bring rates of STIs down. But there's no use telling people to go for testing if they can't get access to the services. Overcrowding and long waits are the norm - and that's if you're lucky enough to not be turned away."

According to St. Leger, this is just one example of the Irish government dropping the ball in HIV prevention. Others include the Department of Health only releasing a National Sexual Health Strategy or implementing a rapid HIV test service in 2015. "They didn't acknowledge there was a HIV crisis. They are playing catch up," he says.

2016 figures reveal that 44 per cent of those diagnosed are 'late presenters' already infected for 3-5 years. A growing number of HIV transmission routes are also unknown (16 per cent). This concerns Act Up, who struggle to target those affected. "We need greater investment in epidemiological and data analysis," St. Leger tells Hot Press. "It is the government's responsibility to educate people about HIV. It should be treated like any other long-term illness."

PHARMA WARS

Anti-HIV medication is difficult to obtain in Ireland. In the US, in 2012, the FDA approved the drug PrEP (pre-exposure prophylaxis) to treat those at high risk of contracting the virus. It works by creating protections around T-cells, which play an important role in the immune system, keeping HIV from penetrating cells and duplicating. HIV Ireland report: "Taking PrEP every day reduces the risk of getting HIV from sex by more than 90 per cent."

However, it only became available in Ireland in December 2017. "The government took its foot off the pedal. As HIV diagnoses were going up and other countries were introducing PrEP, they missed an opportunity to organise a trial programme. That would have reduced numbers," argues St. Leger.

The version of PrEP available in this country, he adds, is only here because "private company Gilead sought to market it in Ireland - nothing to do with the government." The medication is unavailable to patients under the HSE's general medical services scheme (GMS) or the drug payment scheme, meaning a 30-day supply of Gilead's version of PrEP - Truvada costs €400. "Only the mega-rich could afford that," says St. Leger. "I don't know anyone in Ireland taking Truvada PrEP. I know plenty taking generic PrEP which costs €60-90 for 30 days."

The right of Mylan or Teva Pharmaceuticals to sell generic PrEP in Ireland is being challenged in court by Gilead. The American biopharmaceutical company argues that these cheaper rival drugs violate their patent.

While Ireland's HIV figures are shocking, matters may be set to improve. On July 25, 2018 the European Court of Justice, rejected Gilead's attempt to prevent commercialisation of a Truvada generic. Cheaper alternatives to PrEP will remain available in Ireland until the dispute is settled in Irish courts. "The European ruling will be considered by the Irish courts," Will says. "It isn't binding but it lends itself in favour of generics staying on the market." In the same week, Mylan's HIV self-test kit - capable of detecting the virus in 15 minutes - went on sale in Irish pharmacies. Launched by TV Presenter James Kavanagh, it has an RRP of €35.

Taoiseach Leo Varadkar and Minister for Health Simon Harris announced last month that PrEP will be accessible via the HSE in 2019. Act Up will be meeting the Minister soon to discuss the plan. When asked if the 2019 goal is achievable, St. Leger responds: "It's ambitious. To have a PrEP programme, users require monitoring every three months for STIs. For that, substantial investment in sexual health services is needed. It's not just making a pill available through the HSE. There must be a support system and political will to make it happen." Does that will exist? We'll see...