According to the latest figures from Ireland’s Health Protection Surveillance Centre, annual detection rates for all five of the STIs most prevalent in this country – HIV, syphilis, gonorrhoea, herpes and chlamydia – have shown an alarming increase since 2013/2014.

HIV cases, which had been steadily falling for a decade, are now on the rise. In 2018, Ireland recorded 530 new cases – up from 339 in 2013.

Detection rates for chlamydia, Ireland’s most common STI,  have soared from 6,246 in 2013 to 7,942 last year.

Particularly worrying is the spike in syphilis cases. Detection rates have risen by 88.2%, with 272 new cases in 2014 becoming 512 in 2018. One Irish hospital dealt with a case that had reached its tertiary, or final, stage, causing severe medical problems for the patient.

Cases of gonorrhoea have soared from 1,282 in 2013 to 2,407 last year, while herpes detection rates have risen from 1,127 to 1,594 over the same period.

These spikes in STIs are occurring despite major public health education campaigns by the HSE, and are causing major concern among health professionals. “It is very disconcerting that we are almost becoming accepting of this,” said HIV Ireland executive director Niall Mulligan last year. He added that the figures emerging in 2018 were the worst he had yet seen.

Sexual health centres across Ireland are now increasing their screening hours and encouraging those concerned about STIs to get checked as soon as possible.

The increase in HIV cases, in particular, has worryingly taken place amid continuing campaigns for the improved availability and uptake of PrEP, or pre-exposure prophylaxis, a medication taken by HIV-negative people to significantly reduce the risk of getting HIV from sex.

With PrEP currently unavailable through the public health system and even generic versions costing about €85 for a month’s supply, many people at risk of HIV infection find the cost prohibitive. Those in need of advice on how to source and use the drug can visit the website getPrEP.online, a community resource created by PrEP users and advocates, for help.

Over a third of gay and bi men in the USA now taking PrEP
Meanwhile, PrEP uptake in the USA has seen a major improvement in recent years. According to a new study from the Centers for Disease Control and Prevention, 35% of sexually active gay and bisexual men were using PrEP in 2017. This represents a leap of nearly 500% since 2014, when the CDC estimated that only about 6% were using the drug.

The study, based on 8,000 interviews across 20 American cities, was presented on Thursday at CROI, an annual HIV/ AIDS research conference.

It noted that, although the figures are improving, PrEP use is still too low. This is especially so among gay and bi men of colour: over 40% of white gay and bi men used PrEP in 2017, compared to 30% of Latinx men and 26% of Black men.

The cost of PrEP is likely a culprit here – there remains a troubling gap in rates of insurance coverage between white Americans and those of other ethnicities, and those who have to pay for the drug out-of-pocket are often forced to put it aside as something they cannot afford.

If the Trump administration is to follow through on its rather vague plan to end HIV transmissions by 2030, these cost issues will have to be addressed. In America as in Ireland, there’s still work to be done.