Continued closure of GMHS highlights glaring lack of accessibility in Irish sexual healthcare

Marking one year since the Gay Men's Health Service was closed due to COVID-19, activists, researchers, and artists address the consequences to its prolonged absence.

Exterior of the GMHS building

The closure of the Gay Men’s Health Service (GMHS) split a chasm between the LGBTQ+ community and accessible sexual healthcare in Ireland. From March 2020 onwards, activists, artists, researchers, organisations, and so many more have voiced their deep concerns about the consequences of the HSE neglecting these vital services. 

Defining An Essential Service

Speaking on the way spaces such as the GMHS are vital in breaking down barriers within the healthcare system in Ireland, researcher at NUI Galway’s Health Promotion Research Centre, Dr Elena Vaughan, shared, “There is a fair body of evidence to suggest that gay and bisexual men, and the LGBT community more broadly, experience health inequalities. At least part of the reason for this is due to barriers in accessing healthcare because of stigma – whether perceived or enacted. Services targeted at gay and bisexual men – who in Ireland are disproportionately affected by STIs and HIV – are vital in helping overcome this barrier and reducing health inequalities.”

Dr Vaughan has explored a myriad of research topics regarding health related stigma and living with HIV in Ireland. Considering ways for sexual health services to become accessible for the queer community, she expressed, “I think one simple step would be if services were to implement communication strategies to provide relevant information for the community; this would plug an information gap by more effectively communicating about LGBTI+ sexual health, signal that they are inclusive spaces and foster trust among service users. Providing clear non-judgmental information is an important facet of a rights-based approach to sexual health care, which is considered best practice internationally.”

“I also think it’s important generally that services are designed around the needs of their users. This includes looking at practical things such as opening hours and facilitating training to staff to provide appropriate information and person-centred care,” Dr Vaughan continued. 

Between 1992 and 2020, over 120,000 of the GBT+ community attended GMHS, reflecting the ever growing demand for accessible sexual healthcare services in Ireland. According to the GMHS Annual Report 2019, “1176 men attended GMHS for the first time and a significant percentage had never tested previously for HIV (29%) or other STIs (37%) proving that the continuation of and increased access to the GMHS STI checkpoint is vital.”

However, since March 2020, GMHS has remained closed as staff were repeatedly redeployed to assist in COVID-19 testing centres. While most STI clinics resumed services at the end of last year, the LGBTQ+ community are left waiting for the return of these urgently needed services.

Regarding the current state of sexual health services in Ireland, Dr Vaughan addressed the impact of GMHS’ continuous closure, “Sexual health services in general in Ireland are over-subscribed and often tricky to access for the populations that need them the most (due to limited places and inconvenient opening hours for example). Having this service closed for the better part of a year means even more reduced access to essential sexual health and STI screening services.”

“Having services such as the GMHS open and operating as normal is really essential to making sure the people that need it most can access timely services and get linked in with care if necessary,” Dr Vaughan concluded.  

Accessibility In Progress

With the continued closure of the GMHS, demand for GBTMSM specific sexual health services has not disappeared. In January 2021, the HSE reportedly suspended a pilot scheme providing at-home STI testing services due to the overwhelming volume of applicants, with one provider commenting on the “unprecedented interest in the service, with thousands of orders” only a few hours after launching. 

Despite this demand being titled as ‘unprecedented’, activists and healthcare professionals have expressed that it’s expected, especially due to the lack of consideration for sex and sexual health in Government responses to the pandemic. As stated in Man2Man’s risk reduction guidelines, “Sex is a vital part of our lives and recognised as an important part of maintaining mental and physical health. Stopping or adjusting your regular sexual patterns may be challenging and problematic. The following guidelines have been created to help you to make changes to reduce your risk of getting COVID-19.”

Although data from the Health Protection Surveillance Centre (HPSC) shows a 25.5% drop in all STIs and HIV infections falling by 15.5% in 2020, many contested these findings as portraying an inaccurate picture of sexual health in Ireland based on the pandemic affecting testing services. Testing services such as GMHS are vital tools for a person to know their status and help stop transmissions.

UCD Assistant Professor of Nursing and ICU nurse John Gilmore-Kavanagh states, “Home testing is not a replacement for full sexual health services, it’s an addition and a really welcome addition but it’s not suitable for everyone. And it doesn’t provide other areas of sexual health services, such as psychological, emotional, interventions and health promotion aspects.”

Regarding access to testing and sexual health care, many LGBTQ+ people do not feel comfortable disclosing their sexuality or gender identity to GPs and as such a safe space like GMHS can alleviate these worries. According to Recognising LGB Sexual Identities in Health Services The Experiences of Lesbian, Gay and Bisexual People with Health Services in North West Ireland, “Deciding whether to tell practitioners about their LGB sexual orientation emerged as a major concern for most research participants in their interactions with health services. Indeed, it was central to all other themes arising in the study and was found to have consequences for the ensuing health care of LGB clients.”

Speaking on the benefits of specialised healthcare in overcoming these barriers, Gilmore-Kavanagh shared, “Previous experiences of homophobia in healthcare can really prevent people from accessing health services in the future. But having a service that is what it says on the tin, where you can access culturally competent care, is really important. The Gay Men’s Health Service is an essential health service. It’s also a really important touchstone for general healthcare services.”

While speaking about the GMHS closure, Gilmore-Kavanagh comments on how delaying its reopening signify a larger problem regarding current healthcare systems, “I think that’s a wider issue around sexual health services in Ireland and the prioritisation of sexual health. My view, as an academic working in healthcare practitioner education and research, sexual health is an essential part of somebody’s holistic health and it’s pretty important that people have access to that. […] Sexual health services aren’t just, or any health services, about provision and intervention, it’s about building therapeutic relationships to provide support for people.”

Before the closure of GMHS, the clinic found a new home in the Meath Primary Care Campus, where it began expanding its services to meet different public health issues. Looking ahead, Gilmore-Kavanagh acknowledges that a full reopening must be accompanied by the continuation of these expansions, “What we need to do now is not only open the GMHS to the level at which it was pre-pandemic but looking at how that’s going to expand to meet the needs of gay/bi men and the trans community to provide them with holistic sexual health care.” 

“Ireland has some of the best healthcare practitioners in the world, having worked abroad and within a national context, so committed, and empathetic, and person-centred doctors and nurses and therapists working in Ireland. Almost all of the issues relating to healthcare in Ireland have to do with access, this is no different, we really need to think about that and think about how we can expand access to this really wonderful healthcare,” Gilmore-Kavanagh concluded.

Rallying Behind The GMHS

Amid mounting pressure to reopen the GMHS, ACT UP Dublin campaigned for the service’s restoration throughout the past year. Members Orla Keaveney, Pradeep Mahadeshwar, Andrew Leavitt, and Michael O’Dea are spearheading an online campaign #OpenGMHSNow in which they mark each day of its absence by highlighting the urgency in reinstating “safe, judgement-free, and culturally appropriate sexual healthcare.”

Speaking about creating a visual identity for the #OpenGMHSNow campaign, designer Mahadeshwar shared, “I created the visual according to what ACT UP is. ACT UP is a passionate place, they like to talk loud and bold. They talk openly about sex and sexual health and that is really important for a community to have these conversations around HIV, PrEP, and around STIs, and testing.”

“I put everything visually in such a way that it will give a nice dark, retro feel. […] As a designer and an activist myself, and as a queer person living in Ireland for eight years, I think talking about LGBTQ+ issues is not only about rainbows and glitter and Pride month. It is a 365-day process we live in, we come across different problems and issues every day,” Mahadeshwar concluded. 

Illustrating what the GMHS means for him, Mahadeshwar said, “When you are a travelling immigrant as a gay person, you come across different situations and putting yourself in healthcare vulnerabilities is the last thing that you want to happen to you. I keep myself always aware about wherever I will live, what kind of sexual health I can access easily. The GMHS is one of those platforms that say the staff are always good, they communicate with you well and don’t make you feel awkward.”

As a sign to show the importance of these services, ACT UP Dublin are appealing for the LGBTQ+ community to contact the Chief Officer of HSE Community Healthcare East, Martina Queally about the continued closure of the GMHS, and demand that the clinic be reopened. On Twitter, they wrote, “The GMHS has been closed for a year now. Other sexual health clinics are open. Why is Ireland’s only sexual health clinic for gay & bi men & trans folks still closed? Take action: go to Let the HSE know it’s been long enough–it’s time to #OpenGMHSNow.”

While speaking about the #OpenGMHSNow campaign, activist Leavitt expressed, “Coming up on a year, it’s time to get louder.”

Leavitt went on to speak about how these services go beyond testing and provide up-to-date community-driven research data as well as counselling services. In regards to a reopening, he said, “There’s a lot of potential in the GMHS beyond swabs and blood draws and test for STIs [that] the HSE doesn’t seem to be enthused or recognise the potential for.”

On March 9 2020, the Man2Man programme shared an update on the GMHS, which reads, “A phased reintroduction of STI services is currently underway and will be delivered in accordance with current Public Health COVID guidelines. […] PrEP Clinic: open for returning GMHS PrEP patients only.” After a year of closure for the GMHS, this step forward was welcomed, however many also acknowledge that it still does not go far enough in addressing the current issue. 

In response to the phased reopening, Leavitt stated, “There’s no change for people in the community who have been denied access to these services. The phase reopening language, it’s just a meaningless way to suggest to people that the clinic is reopening, whatever that means. It’s incredibly slippery and vague.”

Further highlighting the need to fully reopen GMHS, the Gay Health Network (GHN) released a powerful statement urging the HSE to take action in late 2020. They wrote, “We are especially concerned that the closure, coupled with the continued increase in diagnosed STIs will have a negative impact particularly on the more vulnerable members of our community who relied on the service, including younger men, sex workers, migrants, trans people and non-binary people.”

Numerous other LGBTQ+ driven organisations joined GHN and ACT UP Dublin in their call for the reopening of the GMHS. Community leaders, such as Amach! LGBT Galway, BeLonG To, Bi+ Ireland, Dublin Lesbian, and TENI, published an open letter, in which they state, “GMHS is a key health service catering specifically to the needs of GBMSM and many members of our community rely on it to receive appropriate healthcare in a safe setting. Yet, it is also the only sexual health service in the country that has not reopened.”

For more information on the continued closure of the GMHS, you can check out GCN and ACT UP Dublin’s special edition of In & Out down below:

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