London’s drop in HIV diagnoses is likely due to a combination of factors, including PrEP, PEP and faster treatment of STIs like chlamydia and gonorrhoea, a new report indicates. Ireland must follow suit and increase funding for sexual health clinics like GMHS, says Aidan Quigley.

There have been incredible advances made towards eradicating HIV in London, with one clinic, 56 Dean Street, reporting a 42% drop in HIV diagnoses since Autumn 2015. By contrast, Ireland has seen a staggering 30% increase in HIV diagnoses in 2015.

In the report, the clinic suggested that the significant reduction in HIV diagnoses “are likely to be multifactorial,” pin-pointing three key factors that are likely to have influenced the drop in HIV diagnoses: quicker treatment of other STIs, access to PEP (Post-Exposure Prophylaxis) in the clinic and online access to PrEP (Pre-Exposure Prophylaxis).

The report indicates that figures began to fall in late 2015, after the introduction of a significantly reduced time to treatment of STIs chlamydia and gonorrhoea, which are both “drivers of HIV transmission”.

“Diagnoses started to fall in the autumn of 2015 (figure). In 2014, we opened Dean Street Express, reducing time to treatment for chlamydia and gonorrhoea from 10 days to 2 days,” the report reads.

“Given that both these infections are drivers of HIV transmission, their early treatment may have played a part in the decline in new infections. Additionally, the opening of Dean Street Express was linked to a significant increase in HIV testing in high risk men who have sex with men (MSM).”

GMHS

For those unfamiliar with the British facility, 56 Dean St is London’s version of the Gay Men’s Health Service (GMHS) on Baggot St, which caters for the sexual health of MSM.

56 Dean St featured prominently in Chemsex, a documentary which focusses on the lives of gay and bi men who take drugs and engage in sex.

David Stuart, one of the workers in the clinic, spoke at the No Fats // No Femmes event last year “from the frontline of gay men’s mental health and substance abuse,” according to the event’s.

While 56 Dean Street appears to be on the cutting edge of sexual health treatment, Ireland is following closely in their steps.

But if Ireland’s sexual health services are akin to London’s, why then are diagnoses of HIV in Ireland still on the rise?

Treatment In 2 Days

The Dean Street Express clinic is similar to the recently launched Monday afternoon clinic in the GMHS Baggot St Clinic, which provides Rapid HIV testing along with tests for other STIs. Both organisations provide this expedited service for MSM who are symptom free.

However, thanks to Dean Street Express’s significantly reduced time to treatment of 2 days from first getting tested, men who are infected are less likely to pass it on.

A 56 Dean Street nurse revealed that in practice one could be tested and treated on the same day as results usually take 90 minutes for chlamydia and gonorrhoea.

Getting treated for chlamydia and gonorrhoea in the GMHS typically takes about a week, owing to the fact that clinics are only run on Mondays, Tuesdays and Wednesdays and results take a week to return.

Increased funding for sexual health clinics like the GMHS could help reduce time to treatment for Irish MSM, which in turn would help to reduce infections of chlamydia & gonorrhoea as the drivers of HIV.

PEP

PEP is another factor which is likely to have reduced HIV diagnoses in the UK, the report outlines.

“Other factors likely to have had an effect are that we prescribe over a quarter of the HIV post-exposure prophylaxis in the UK […] and the Dean Street Wellbeing Programme promoting regular testing in high risk MSM, including those practicing chemsex.”

PEP is currently available to anyone who has had a potential HIV risk in Ireland (whether that be from unprotected sex, a needle stick injury, or another incident).

The month long course of medication can be taken up to 72 hours (3 days) after exposure to the virus to prevent HIV from being contracted.

PEP is available in Ireland in sexual health clinics like GMHS, but it is also available in A&E’s in the event that these clinics are closed.

Better Public Health Campaigns

But having PEP available and ensuring that people know about it are two completely different things, and this is where the Department of Health needs to improve. The MISI 2015 Sexual Health Report revealed that 42% of respondents don’t know what PEP is.

If the condom breaks, or you were too drunk/high to use one or just didn't use one… learn about PEP. #HIV https://t.co/O5KNoSD0qj pic.twitter.com/avwmFJuV0w

— Man2Man Programme (@Man2ManIreland) February 17, 2017

What’s even more surprising is that this figure is within the MSM community –  a community which is disproportionately affected by HIV, accounting for 50% of HIV diagnoses in Ireland.

The current health campaigns to make the medication public knowledge are clearly ineffectual if almost half of gay men are not aware that HIV can be prevented after exposure.

PrEP

The 56 Dean Street report also indicated that their “support for individuals purchasing PrEP online have led to the substantial decline in HIV diagnoses.”

PrEP is a daily medication which is highly successful at preventing HIV from being contracted.

In the UK it is legal to purchase generic PrEP online, with websites offering guides to doing so. With regard to buying PrEP online in Ireland, the legalities are a little more complex, requiring a trip to the UK to collect the medication to remain within the law.

Apart from being able to purchase PrEP online and collect it from the UK, it is not easily accessible in Ireland.

Act Up Dublin have protested the Irish Government’s inaction on this matter which is coming at the expense of gay and bi men.

HIV diagnoses are at an all-time high in Ireland. PrEP could help bring those numbers down. It's time for PrEP. #rtept #PrEP4Ireland pic.twitter.com/FJH3FUFEPb

— ACT UP Dublin (@ActUpDublin) February 7, 2017

Eamon Ryan from the Green Party urged the government to prioritise rolling out PrEP in December 2016, but four months later they have yet to announce anything officially.

If Ireland is serious about turning the tide in the fight against HIV, our Minister for Health Simon Harris must take note of the practices in London which have drastically impacted the HIV diagnoses.

As Act Up Dublin highlighted, every eighteen hours there is another HIV diagnosis, which one can’t help but feel could be prevented if those in charge of protecting Irish citizens’ health would only hear the alarm bells and wake up.

If you want to help raise awareness then share this article on social media using the hashtag #PrEPnow.

Are there other things Ireland could be doing to help reduce HIV rates? Let us know in the comments below.