AIDS in Ireland

The AIDS virus is now being passed around among Irish people and the disease is following a pattern similar to that followed in other countries. MARK BRENNOCK reports.

Eight Irish people have been diaggnosed as having AIDS in Ireland . this year. Five of these have died. Two of the survivors are living in Dublin, the third is in Galway. Prior to this year there were no diagnosed cases of the disease in this country. Within a few years, according to one gay rights activist, "all of us will know someone who has died as a result of the disease."

AIDS (acquired immunodeficiency syndrome) has come relatively late to Ireland, but is now following a pattern similar to that followed in other counntries. Our first eight cases have all been "imported" but tests carried out in Dublin's Virus Reference Centre show that the AIDS virus is now indigenous in Ireland and is being passed around among Irish people.

Haemophiliacs, intravenous drug abusers and homosexual men are the three groups most at risk. from the disease, and results of research recenttly carried out at UCD's virus laboraatory show cause for major concern. Of 256 haemophiliacs tested thirtyythree per cent had been in contact with the virus. Twenty-four per cent of the 101 drug abusers and thirteen per cent of the 139 male homosexuals attending VD clinics also showed a positive result.

Between five and ten per cent of those who prove positive in these tests go on to develop AIDS,' while a further twenty per cent will develop AIDS Related Conditions (ARC). Those who develop neither AIDS nor ARC can carry and transmit the virus to others. According to Gay Health Action (GHA), the disease in Ireland is at the same stage of development as it was in the United States four years ago and London two years ago. Without a large scale public education campaign on the prevention of the disease, it could spread at an alarming rate.

A IDS is caused by the action of a specific virus - known as HTLVIII - on the T4 lymphocyte, a cell which is central to the regulation of the immune system. People with AIDS suffer a severely damaged immune system, and cannot fight off' other diseases such as pneumonia and certain cancers. These diseases, which would not normally affect the body cause the deaths of a high proportion of the people who have AIDS.

The virus can be transmitted by sex of all types, and by blood and blood products. It is active in the blood, saliva and semen, and is easily transmitted during anal intercourse, as the blood vessels in the anus are often torn during such activity thus facilitating the passage of the virus.

Intravenous drug abusers sharing unsterilised needles run a high risk of transmitting the disease, and it can also be transmitted by a mother to her child in the uterus. There is no eviddence that it can be transmitted through social contact.

There is no cure, no vaccine and no test for AIDS. There is, however, a test for antibodies to the AIDS virus, generally known as the HTL VIII test. Antibodies are small particles in the blood which generally help to fight off infection, but in the case of the AIDS virus the antibodies are ineffective. If antibodies are present the result is said to be positive. This means that the perrson has been in contact with the virus, but only a very small proportion of those tested positive - less than ten per cent - go on to develop AIDS.

The Department of Health encouraages people in high risk groups to undergo the HTL VIII test so that they can assess the size of the pro blem, but Gay Health Action (GHA) - a group set up earlier this year to provide information to the gay commuunity on all aspects of gay health and to point out inadequacies in the mediical and social support services for gays - expresses serious reservations about the value of the test.

Firstly, the test is not completely reliable. A small percentage of people with AIDS or ARC give a negative result in the test. Secondly, because the antibodies take time to develop, it is possible to have contracted the virus and still show a negative result.

GHA say that the test puts unnecesssary stress on people who have been tested positive. Many feel that they have AIDS already and that they might as well die now - there have been some instances of suicide as a result of this kind of stress according to GHA. They also say that the existence of the test opens the way for discrimination against people tested positive as well as against people in high risk groups. Experience elsewhere, according to GHA, has shown that there is massive . discrimination against those. tested positive, that confidentiality has been breached and that there is uncertainty about the implications of the test.

If this testing is to be done on a larger scale, they demand that an inndependent testing site be set up, that confidentiality be absolutely assured through the use of numbers rather than names, and that information and counsellors be available to all those taking the test.

The few STD (sexually transmitted disease) clinics in the country now offer a confidential means for people to be tested for the AIDS antibody, but these are very poorly staffed and funded, and are hidden away in 0 bbscure comers of hospitals. In one Dubblin hospital, the clinic is found by following a line of green paint which runs along the walls and ceiling of a maze of corridors. At present there are STD clinics in Dublin, Cork and Gallway - there is no STD service in Waterford, Limerick, or anywhere else in the country.

Despite the poor funding, the staff in the clinics are almost all helpful and sympathetic, but fear of moral dissapproval prevents many people - esspecially gays - from attending the clinics. There have been some instances of hostility to gays reported to GHA - one doctor recently asked a homoosexual patient "can you not go and find yourself a good woman?" But in general, GHA have no criticisms of STD clinic staff.

With routine testing of blood donaations expected to start shortly, there is a fear that people will use the blood bank as a testing site, rather than atttending the STD clinics. The consequences of this would be disastrous 0a small percentage of those with AIDS show up negative in the test, and so AIDS contaminated blood could end up in the blood bank.

The lack of a cure or vaccine for the disease and the limited value of the test mean that the only action which can be taken to deal with the problem is prevention. Steps are being taken to prevent the spread of the disease among haemophiliacs. The immported blood product used by haernoophiliacs as a clotting agent is now heat treated to ensure that it is free of AIDS, and the Blood Transfusion Board is arranging to use only blood donated in Ireland for the preparation of this product.

Preventing the spread of AIDS among intravenous drug abusers is a much more difficult task. The pubblished evidence in Ireland is unusual in that intravenous drug abusers appear to be much more at risk than the gay community. The lifestyle of this group is such that they may not realise that they are running a high risk of contracting the disease, and even if they do they may not have a high regard for their future health anyway.

Prevention of AIDS involves pubblicity and openness about the disease and the means of avoiding it, so the prevention of the disease within the gay community is much more than a medical problem. Homosexual activity is against the law in Ireland, and there tends to be great secrecy among gay people about their sexual orientation due to the moral disapproval of homoosexual activity present in Irish society. As Mick Quinlan of GHA says: "How can the government ask gays to coooperate with them on the one hand, when on the other they are fighting a case in Strasbourg to ensure that homosexual activity remains illegal?"

The only way of preventing the spread of AIDS within the gay commmunity is through mass education of the gay community about what kind of sexual activity is safe and what is not. To this end, GHA has distributed 14,000 copies of a leaflet on "safe sex" giving detailed descriptions of what sexual acts are safe, and what acts involve a risk of spreading the disease. This leaflet is now available in family planning clinics, some public libraries and from GHA at 10 Fownes Street Upper in Dublin, or 24 Sullivan's Quay in Cork.

This is the only leaflet of its type which has been produced in Ireland, and it was funded by a grant from the Health Education Bureau. There is no other agency or group providing such information to the gay community. A recently established sub-group of GHA - Cairde - provides informaation and support services for AIDS affected people. Cairde's purpose is to deal with people who have a fear of contracting the virus, people who have been tested positive, and people who have actually contracted AIDS or ARC. These services are also available to lovers, friends and relatives of suffferers.

GHA estimate that they will need £20,000 next year just to cover printting and minimal administrative costs. They believe that the demand for their services will increase greatly in the near future, and say that they would need £80,000 to provide an adequate service. The Department of Health is not providing any public information campaign aimed at preeventing the spread of the disease.

Without a greatly expanded educaation and support service, according to Mick Quinlan, "people are going to be isolated, people will be made homeless and discriminated against." The probblem will get much worse before it gets any better. •