AIDS: the fight goes on

“But I still take precautions
Because you can’t put aside my fears
About everyone you’ve ever slept with
Over the last 10 years.” – an excerpt from ‘Condom Sense’ by Tim Gibbard

AIDS kills a figure equivalent to 81% of the Irish population every single year. In 73 days, the number of new HIV cases diagnosed worldwide will equal the population of Dublin. The march of the ‘big disease with a little name’ is relentless. We should never forget this.

According to the Irish National Disease Surveillance Centre, from 1994 to 2001 the number of newly diagnosed HIV infections per year in Ireland has increased four fold. December 2000 to December 2001 saw 299 new cases of HIV in Ireland. Of these, 23% were men who have sex with men and 8% were intra-venous drug users. The majority of people diagnosed were heterosexuals.

There have been 2,645 cases of HIV reported in Ireland since testing began in 1983. Of these cases, the cumulative figure for men who have sex with men is 24.3%. The figure for intra-venous drug users is 39.1%. Heterosexuals (who are not IV drug users) accounted for 26.9%. These statistics do not tell lies.

“At the moment, it seems that HIV and AIDS have gone off the agenda,” says Noel Walsh, HIV and health editor at Gay Community News. “One of the main reasons is because of combination therapy-medication that lowers the amount of the virus in your system and raises your T-cells, which fight off infection.

“These drugs have given people a new lease of life. As a result, the younger gay generation haven’t seen the face of HIV, so they’re not afraid of it. It’s always hard to get a message across to young people that something is going to kill them, but now it’s even harder because they think that if you do get infected, you can take this medication and everything’s going to be OK – which just isn’t the case. People are still dying from HIV and AIDS.” It is an issue about which Noel Walsh is passionate, for personal as well as political reasons.

“I’m HIV positive and I take about 20 pills a day,” he adds. “If you aren’t compliant with the drugs and don’t take them properly at the right times, you build up a resistance to them. That’s what happened to a lot of people, especially younger people.

“Could you picture yourself taking medication every morning and every night, every day, for the rest of your life? There’s only about five or six combinations, so the therapy will only work for a certain amount of time, unless you’re compliant.

“Aside from that, there are only one or two new classes of drugs in the pipeline. It’s not like five or six years ago, when there were a ton of new medications coming out.”

So what can be done to get the threat presented by HIV and AIDS back onto the agenda? Noel Walsh believes that government agencies need to be constantly pro-active.

“Older gay men realise that it’s still around because they’ve seen it, and they’ve lost friends to it,” he reflects. “What the government needs to do is come out with a whole new prevention campaign. They need to go into the schools and teach the kids how to protect themselves. We need free condom distribution in the heterosexual bars, as well as the gay bars. The issue of HIV needs to be raised again. Infection rates are getting higher. People need to realise that these drugs are not the key. Education is.”

It’s apparent that, despite our self-acclaimed broad mindedness, the stigma surrounding HIV and AIDS is still very real concern. We, as a society, have failed to recognise the facts about the disease, relying instead on the blindfold of ignorance to protect us from the unknown.

“We’re part of a European Gay AIDS Prevention Network, which met in Madrid about three weeks ago,” comments Will Peters of Gay HIV Strategies, a non-governmental gay agency that works with government departments to improve awareness among the gay community nationwide. “15 European Union countries were there and the one thing we all agreed on was that it’s even harder now to come out as a HIV Positive person than ten years ago.

“The stigma hasn’t gone. One of the reasons is that, in Ireland, there is very little peer support. If I’m HIV Positive, I end up developing very complex relationships with doctors and pharmacists, but not necessarily with other HIV Positive people. So there’s a sense of isolation – the support isn’t there and that’s because there’s no investment in the gay community.

“You can’t do good health promotion, if you don’t invest in community development,” Will argues. “We need to create a culture whereby once a year, everybody goes for a sexual health check up. Like the NCT with your car.

“In the ’80s, there was a lot of investment in safe sex messages,” he adds. “But a lot of the people who are getting infected today were children back then, and were probably oblivious to it. The bottom line is that there has been no real investment in public campaigns. You don’t see safe sex adverts on TV anymore.”

David Maloney is the Principal Officer of the Community Health Division, who play a key role in developing policy in relation to AIDS awareness and prevention.

“Our role in relation to HIV and AIDS is that we run the secretariat to the National AIDS Strategy Committee, which is a committee comprised of senior officials, Non Governmental Organisations, agencies and people living with HIV and AIDS,” he says. “The national aids strategy was agreed in 2000, and the committee overseas the implementation of that strategy. Education and prevention is very much a part of this – and that involves sending out the appropriate messages about risk behaviour, with other aspects including the Social Personal and Health Education project in secondary schools. So on a lot of different levels, we try to promote behaviour which reduces the incidents of HIV and AIDS.” David is acutely aware of the facts and figures – and the need to respond as positively as possible at the most basic level.

“Through working together with the NGO’s, we’re addressing the problem in the most meaningful way we can,” he observes. “One of the core principals for the strategy is to consider HIV and AIDS in the context of sexual health, generally, so it’s very much one of the planks within the strategy committee framework.”

Specific strategies are also in place to tackle high risk demographics, with a campaign currently being planned to raise awareness on a more all-encompassing level.

“There are initiatives in relation to education and prevention, drug misusers, the gay community and the prison population,” he says. “We support further initiatives in relation to young people and we’re recommending that those staff, who are at the fore of dealing with risk groups, have training with HIV and AIDS and know how to deal with those issues in a sensitive and appropriate way.

“The categories that are most affected by HIV and AIDS have changed in recent years and the indicents of HIV infection have increased,” he adds, “so the kind of advertising campaign that we’re working on at the moment is focused on bringing people’s attention to that. Those messages are directed towards the broader heterosexual community in a very explicit way, in order to remind them of the inappropriateness of certain risk behaviours and to enable people to be aware of that risk.

“People can become complacent about HIV infection and we have been trying to counteract that amongst the entire population, as well as having specific initiatives.”

Higher immigration levels and more widespread travel have also contributed to a rise in the incidence of HIV infection recorded in Ireland.

“The National Disease Surveillance Centre who collect the statistics on HIV and AIDS have produced figures that show a breakdown by geographical origin,” David Maloney explains. “What that shows us is that some of the new cases of HIV are people who have been infected abroad. When you look at the changes in migration patterns over the last ten years, it’s no surprise.

“It creates a set of issues that we’re trying to address. There are cultural differences to be dealt with. At the moment, we fund NGO’s who work directly with non-national groups mainly through outreach work and interaction with the groups themselves.”

University College Dublin is the largest college in the country. With many young people having their first sexual experiences during their time in college, active on-campus awareness about HIV and sexual health education is extremely important.

“Every year we have a sexual health and guidance week to promote safe sex, carrying condoms and getting tested,” says the Student’s Union Welfare Officer, Seamus O’Maonaigh. “This year it’s happening from the 25th to the 29th of November. We’re working very closely with Durex and the Irish Family Planning Association and we’ve got 10,000 free condoms to give away, leaflets and information, as well as workshops during the week.

“Students don’t pay enough attention to the risks of HIV,” he adds. “It’s down to the fact that the government haven’t implemented proper learning procedures. College is a confusing enough time for anyone, but if people haven’t got the backing of good sex education they mightn’t be aware of the reality of STDs. Every time you sleep with someone, you’re sleeping with everyone they’ve slept with too. That’s the message we need to get across.”

World Aids Day is December 1st.

Acknowledgements: Thank you to Mick Quinlan, Coordinator of the Gay Men’s Health Project; Ann Nolan from the Dublin Aids Alliance and all the people quoted in this article.