Working as a sexual health and HIV medicine consultant in St. James’ Hospital, Dr Dominic Rowley has to tell people about their newfound HIV infections every day and it breaks his heart

This interview with Dr Dominic Rowley was originally published in the December 2016 Sex Issue of GCN (Issue 324) which is available to read online here.

Dr Dominic Rowley is a consultant in sexual health and HIV medicine at The GUIDE Clinic at St James’s Hospital in Dublin, and Medical Director of Let’s Get Checked. With 3,000 HIV positive patients, 25,000 outpatient appointments for general sexual health, the GUIDE clinic is the largest provider of sexual health to all of Ireland. Currently the clinic is dealing with a sharp rise in HIV and other sexually transmitted infections among men who have sex with men.

Epidemic

We’re in the middle of an epidemic of all sexually transmitted infections among men who have sex with men (MSM) in Ireland, including HIV. Syphilis and HIV love to co-infect at the same time, so many people present with both. There’s a Gonorrhea epidemic too. There’s no one simple answer to why HIV infections are going up so much.

A lot of my generation and older have seen people die of Aids-related complications, and working in St James’s I still see Aids- related deaths very regularly. I think the younger generations haven’t ever lost a friend to HIV or an Aids-related infection, so it’s a very abstract concept to them.

I have to break the news to people about their HIV infection every day and it breaks my heart to see their reactions. They’re not devastated because they think they’re going to die, they’re devastated because of the stigma. And the LGBT community has been hugely at fault in this. It baffles me.

PEP & PrEP

In the last six of seven years we’ve had PEP becoming widely available, which gives you ability to prevent infection if you think you might have been exposed to HIV. If you get to a Gum clinic or an emergency department within 72 hours, you have a seriously good chance of not being infected.

And now PrEP (Truvada) has come on-line, which can be taken before exposure to prevent HIV infection.

I think someone who comes to me and asks for Truvada is taking good care of themselves. It got Irish medical approval this year. The really difficult next stage is getting the government to agree to fund it.

This happens with every drug; there’s no discrimination involved. Every new drug that comes on the market that is high-tech and expensive goes through a very rigorous process that can take up to 18 months.

Buying PrEP Online

People are buying their own PrEP online. The legalities, however, are very complex.

It’s illegal to source any prescription medications without a prescription, and it’s my understanding that a doctor can give a prescription for you to buy PrEP.

Yet it is illegal to buy medications over the Internet, and therefore customs and excise of cers may seize them.

Keep reading to see what Dr Dominic Rowley has to say about Chemsex, sexual consent and slip-ups.

To find out more about Let’s Get Checked, visit letsgetchecked.com

Chemsex

It’s early days, but we’re heading into a chemsex epidemic in Ireland, and especially in Dublin. If a lot of the guys who are going down the chemsex route knew the psychological fall-out, the anxiety and paranoia that most people experience, it would freak them out.

A fundamental problem is that guys who have a lot of chemsex don’t believe they have an addiction. They see the use of needles as totally different to heroin, they don’t even see the needles as injecting.

A lot of guys doing chemsex don’t associate blacking out with potential assault.

Consent

You often say to the guys coming in for PeP: ‘Do you think it was all consensual?’ and they say, ‘What do you mean? I don’t remember.’

Because they took the drug that made them black out, they think it’s entirely their fault. It’s not. It’s the fault of the person who chose to have sex with a person who is unconscious.

How can you tell people to have less fun? You can have warnings on cigarette boxes and alcohol awareness campaigns, but it’s not going to totally stop people smoking or binging on alcohol. It’s about informing and not being judgmental about chemsex, being realistic that they’re going to be doing this, so men can party and play in a safe way.

Slip-Ups

Anyone can have a condom accident; we’ve all been there.

Anyone can have an accident with too much drink or recreational drugs, but to constantly set out to have unsafe sex is hard to comprehend as a medic. But I wouldn’t never have gone into this area if I were a judgmental kind of doctor, so I do find it hard to get on the critical plane.

I think we spent so long trying to de-stigmatise HIV, we lost the public health ‘stay safe’ message. A national approach to prevention is needed at this point, with strong messages about self- protection.

To find out more about Let’s Get Checked, visit letsgetchecked.com

Want to learn more about the subject matter? Then check out this article exploring the HIV epidemic in Ireland at the moment.