This week saw the release of “Miles to go—closing gaps, breaking barriers, righting injustices” the Global AIDS Update 2018 from UNAIDS. The report notes that the overall annual number of new HIV infections dropped from a high of 3.4 million in 1996 to 1.8m last year but that the “global AIDS response is at a precarious point—partial success in saving lives and stopping new HIV infections is giving way to complacency” and that “the pace of progress is not matching the global ambition.”

Closer to home, new HIV diagnoses in Ireland remain at their highest ever rates, with the Health Protection Surveillance Centres’ latest data revealing there has been no decline on 2017 figures. On average, Ireland sees a new HIV diagnosis every 18 hours, 10 a week, or over 500 a year.

With funding to Dublin’s Gay Men’s Health Service (GMHS) slashed over the last decade, highly inadequate regional resources, the lack of access to effective HIV prevention tools like PrEP, and a lawsuit threatening to force cheaper generic versions of PrEP out of Irish pharmacies, and persistently high levels of stigma, Ireland is in the midst of a HIV crisis.

Last night, ACT UP Dublin and Gay Switchboard Ireland, held an event at Dublin’s Outhouse LGBT Community Centre. The event, Preparing for PrEP, was billed as ‘a community building effort’, with a view that ‘community voices are heard with respect to how our health concerns and needs are met – or neglected – by the government.’ The event, hosted by ACT UP’s Dr Thomas Strong, was a packed-out evening, attended by over 60 people. Two guest speakers, Dr Pierre-Cédric Crouch and Dr Paddy Mallon spoke about HIV in San Francisco and Ireland.

Pierre-Cédric Crouch, director of nursing at Magnet, a highly successful nurse-led sexual health clinic in San Francisco’s Castro neighbourhood serving cisgender and transgender men, spoke on San Francisco’s ‘Getting to Zero’ strategy, and the non-judgmental way in which the organisation approaches to sex and sexual health.

Paddy Mallon, a consultant in Infectious Diseases at St Vincent’s University Hospital and Head of the HIV Molecular Research Group at the UCD School of Medicine has nearly 20 years’ experience in the clinical management of people living with HIV in both Dublin and Sydney. When showing a graph that demonstrated the rise in Ireland’s new HIV diagnoses from 2003 to 2016, Dr Mallon labelled the growing crisis and lack of effective action by the government in response ‘a disgrace’.

PrEP (Pre-Exposure Prophylaxis) is a safe and highly effective HIV prevention strategy where HIV-negative people take antiretroviral medication before and after sex. The World Health Organization recommends that PrEP be available to anyone at risk for HIV.

The term Undetectable = Untransmittable, or U=U, refers to the fact that a person who is living with HIV and on effective treatment, with undetectable levels of the virus in their blood, cannot pass on HIV to a sexual partner. U=U is true whether or not you use a condom or if your HIV-negative partner is using PrEP or not. As long as the medication has suppressed the virus and you continue to take your medication as prescribed, you don’t need to worry about passing on HIV through sex.

Currently, the US pharma company Gilead Sciences, which has operations in Cork, is in Dublin courts to stop other companies from selling affordable generic versions of HIV prevention medication in Ireland. Generic PrEP would cost around ⅕ of the price of Gilead’s version, which costs more than €400 rendering it inaccessible to many people who need it.

Gilead’s patent is one of the barriers to accessible PrEP globally. In Ireland, PrEP is not currently available through the HSE (the Irish public health system). Doctors can prescribe PrEP, and all of the necessary tests can be obtained from a GP or an STI clinic, but users must pay through the roof for the medication themselves.

Pressure has been mounting on Health Minister Simon Harris to do more to tackle the barriers faced by people trying to access a medication that prevents HIV. Founded in 2016, ACT UP Dublin’s branch has worked tirelessly over the last two years to engage with Minister Harris with a view to discussing how to tackle the crisis head-on, despite many tweets, letters, emails, calls and even a sit-in at this Dublin offices last week, a date has yet to be secured.

At the end of June 2018, Simon Harris tweeted a reply to a Twitter user who was asking about the roll-out of accessible PrEP, saying, “Fair and important point. Working hard on this. The plan is to roll out PrEP programme from the start of 2019. Will post updates here. Will get this done”.

Fair and important point. Working hard on this. Plan is to roll out PrEP programme from start of 2019. Will post updates here. Will get this done

— Simon Harris TD (@SimonHarrisTD) June 29, 2018

Speaking about this promise by Harris of a roll-out of accessible PrEP in 2019, ACT UP’s Will St Leger said:

“In order for that to happen, it needs significant funding, it needs to have community engagement… We want to engage with Simon and see the programme and the plan that they have for the roll-out of PrEP because the community needs to be involved in that roll-out.”

ACT UP also staged a protest on 12 July outside Dublin’s Four Courts “to let Gilead Science know that it’s time to stop blocking PrEP in Europe.”

Gilead is currently involved in litigation High Court (Commercial Division) to enforce its monopoly on the sale of Truvada in Ireland. If Gilead is successful and the cheaper generic brands are forced out of the market, PrEP will no longer be available in Ireland as Gilead are not primed to enter the market, are not engaged in the HSE drug approval process, and have not engaged with community pharmacies.

What this means for PrEP users is that their only option to access PrEP is to import it from online sources. If Gilead is successful this could jeopardise the PrEP programme role out for January 2019 promised by Minister Simon Harris. ACT UP Dublin, alongside many other community groups, are calling on Gilead to drop its patent and being one of the barriers to HIV preventative medication.