Vol. 373 No. 4
asked the Minister for Health if he will respond to the vital questions posed by the "Today-Tonight" programme on 12 May 1987 on AIDS; if he will expedite a scheme of needle exchange and more readily available methadone to drug addicts as a preventative measure against the spread of the AIDS virus among addicts; and if he will make a statement on the matter so as to allay public disquiet.
196.
asked the Minister for Health if his attention has been drawn to the serious problem relating to the interaction between drug pushing, the use of needles for drug abuse and the AIDS disease in inner city Dublin, as reported recently on radio and television programmes; the action, if any, he is taking in the light of these developments; and if he will make a statement on the matter.
I propose to take Questions Nos. 2 and 196 together. I am very conscious of the interaction between drug pushing, intravenous drug abuse and the spread of the AIDS virus.
The situation in relation to drug pushing is being constantly monitored by the Garda Síochána and they are taking all steps open to them to curb this problem.
Intravenous drug abuse and the spread of the AIDS virus are clearly very closely linked and the Government's recent public information programme specifically addressed this problem. I did, however, recognise that drug addicts are not particularly receptive to general campaigns and that special measures were required to get the message into the drug community.
The AIDS information booklet and a special poster specifically directed at intravenous drug abusers were circulated to all voluntary drug agencies as part of the programme. In addition the poster has been erected at several sites in the inner city of Dublin.
However, I realise that, in relation to intravenous drug abusers, one-to-one contact and education remains the most important and realistic way of motivating personal behavioural changes. Having consulted the National Co-ordinating Committee on Drug Abuse it was agreed that a meeting should be urgently convened for personnel currently working on a one-to-one basis with intravenous drug abusers. That meeting has been held and the Central Strategy Committee on AIDS have been examining these suggestions, my Department will be responding on these to the relevant agencies in the very near future.
While the establishment of programmes of needle exchange and methadone maintenance for drug addicts was not advocated at the meeting it was considered that research done in other countries in relation to both of these topics should be examined to see if either would be appropriate in the Irish context.
In relation to free needles the situation is that no other country has yet got a general policy on their distribution to intravenous drug abusers. Some countries, including the United Kingdom, have experimental programmes in operation and will be evaluating the results over the coming months. Information on these pilot projects should, therefore, be available quite soon and it would seem prudent to await these results before making a positive policy decision on this matter.
Countries have also diametrically opposed views on the value and, indeed, ethics of methadone maintenance programmes. Many people regard methadone maintenance as a form of social management rather than medical treatment and find it very objectionable on that basis. It must also be remembered that methadone is a very potent and addictive drug in its own right.
However, both the National Co-ordinating Committee on Drug Abuse, and the Central Strategy Committee on AIDS, will be closely monitoring developments in other countries in relation to both of these issues.
Does the Minister agree that the highest risk group in the AIDS crisis here are the intravenous drug users and those in intimate contact with them? Does the Minister agree that for some time the use of infected needles has been the most common means of transmission of the virus among drug users and that it has meant transmission of very dangerous proportions? Does he agree also that this is a matter of extreme urgency because a virtual AIDS epidemic faces intravenous drug users here? In the course of a reply to a recent question the Minister informed me that there are at least 3,000 drug users in Dublin.
The Deputy is embarking on a speech. We should have finality in respect of these supplementaries.
Does the Minister feel that such a dangerous position requires immediate and urgent action? Does he agree that a pilot scheme, based on similar schemes in Britain under which needles are made available to drug users should be introduced?
I want to assist the Deputy in eliciting information but he may not proceed indefinitely. I have asked for finality.
In responding to my questions will the Minister set a time limit on when he will make a decision in this regard?
On the question of numbers, the Department's HIV testing programme shows that 369, or 19 per cent of those tested intravenous drug abusers, are infected with the virus. On the question of the use of needles I should like to tell the Deputy that no other country has yet adopted a general policy in relation to the distribution of free needles to intravenous drug abusers. Some countries, including the United Kingdom, have got experimental programmes in operation and will be evaluating those results in the coming months. Information on those pilot projects should be available quite soon but it is too early to make a positive policy decision on the matter. For instance, the question of legal liability pertaining to the distribution of free needles will have to be considered. It is felt by some professionals that the distribution of free needles would not necessarily make irresponsible drug addicts become more responsible. It should be noted that the Pharmaceutical Society of Ireland have left it to individual pharmacists to decide whether to supply needles in different circumstances.
The Minister referred to his recent publicity campaign and I should like to ask him if he accepts the criticism of it, that it is too narrow in a moralistic sense and does not, with the necessary emphasis, relate to the real problem in Dublin and elsewhere in Ireland which is the number of drug users who are affected by the virus and present a real threat to other people.
Surely that is more appropriate to the next question.
The Minister referred to his publicity campaign in the course of his reply.
Questions, including the next question on the Order Paper relate to this matter.
I do not accept that the AIDS information programme is too narrow in a moralistic or in any other sense. I am pleased to report to the House that at a recent meeting of the Ministers for Health of the other 11 countries of the European Community, it was unanimously agreed by all 12 that the public information campaign should be directed at the whole population and not specifically at those most at risk, the homosexual population and the intravenous drug abusers.
Arising from the Minister's original reply, while I welcome his indication that the review committee in the Department are moving towards a position where they are trying to develop a policy of one-to-one contact with drug users and the drug community who are most at risk, I should like to ask if the Minister has funds available — should a decision of that kind be made — for the deployment of sufficient numbers of workers to undertake the task?
The Government's public information campaign directed at drug abusers first appeared in the AIDS information booklet, in the newspaper advertisements to which I referred and by way of special posters in treatment centres and certain locations throughout the city. At the launch of the AIDS campaign, it was stated that drug addicts are not especially receptive to a general campaign and that special measures are required. Some of those special measures have been taken since the launch of the campaign. The National Co-ordinating Committee on Drug Abuse has been set up and is chaired by my colleague, the Minister of State, Deputy Leyden. They met on 5 May 1987 and considered what extra steps might be required to educate the intravenous drug community in regards to AIDS. As a direct result of that meeting, a special meeting took place on 13 May with drug counsellors, social workers and others who work with the drug community from the Eastern Health Board and from the organisations working with drug abusers in the Eastern Health Board area. I have a list of the organisations represented if the Deputy wishes to see it. At that meeting a wide-ranging discussion took place during which several matters were raised which might improve the delivery of information on AIDS and drug abuse generally to persons not yet addicted to hard drugs and to hard drug abusers. These measures include the need for improved structures co-ordination between the Department, the health boards and the voluntary agencies and the need for additional resources, mainly trained personnel. The Department will be responding shortly to the organisations on these points and as the campaign will be carried on mainly by people who are already working with drug abusers the question of extra funds does not arise.
3.
asked the Minister for Health the proposals, if any, he has to protect the public from the AIDS virus; when these proposals will come into effect; and if he will make a statement on the matter.
I have implemented, to date, the following measures aimed at controlling the spread of AIDS:
— a monitoring system was established in 1984 under which AIDS cases are reported to my Department on a confidential and voluntary basis.
—all blood donations are screened for the AIDS virus and those at risk are asked not to donate blood or organs.
—only heat-treated blood products are used here and Ireland is practically self-sufficient in blood products produced for the domestic blood supply.
—an AIDS anti-body testing service is available on a voluntary basis, throughout the country. The level of infection is monitored, as far as possible, by the Department through the report of the Virus Reference Laboratory, UCD, where confirmatory testing is carried out; 9,338 tests have been carried out and 590 have been positive for the virus.
—a capital grant of £250,000 has been given by the Department towards the further development of the Virus Reference Laboratory.
—all doctors have been circulated with booklets on AIDS and the Health Education Bureau have published a leaflet for the general public.
—a number of seminars have been held to train health care staff.
—cases of AIDS are treated in general hospitals by the appropriate consultant depending on the nature of the opportunist infection the individual may be suffering from. General practitioners are a primary source of care and counselling for people who wish to be tested and have a positive result. The community care teams will continue to provide general practitioners with a support service.
—Ireland is participating in an EC study of paediatric AIDS and we continue to co-operate with the international bodies, particularly the World Health Organisation and the Council of Europe.
—a public information programme is being carried out. Public knowledge about AIDS is being reinforced through the mass media programme and, on a more individual level, the personal worries and queries of individuals are being addressed through a detailed booklet and a freefone service. The booklet is available through pharmacies, public health clinics and from doctors.
—the health boards are setting up local AIDS programmes. The necessary staff to do this are now in place in all the health boards following a series of training seminars which have been held over the last few months. Over 500 people from the health boards and voluntary hospitals have taken part in these seminars and these now provide a pool of experience and resource to develop and implement local programmes to ensure that the AIDS information element of our overall strategy is sustained.
—I have established a central strategy committee to implement the national AIDS strategy. The committee have available to them, and will, as appropriate, draw on the advice and assistance of other experts on particular aspects of the AIDS problem. The committee are reviewing further strategies for dealing with AIDS and are reporting to me on an ongoing basis.
—while the campaign addresses the problem of the spread of AIDS through intravenous drug abuse, addicts are not especially receptive to general campaigns and special measures are required to get into the drug community. The booklet and a special poster directed at IV drug abusers are being provided to all voluntary drug agencies. In addition the poster has been erected at several sites in the inner city of Dublin.
—however, we realised that in relation to IV drug abusers one-to-one contact and education remains the most important and realistic way of motivating personal behaviour changes. Having consulted the National Co-ordinating Committee on Drug Abuse it was agreed that a meeting should be urgently covened for personnel currently working on a one-to-one basis with IV drug abusers. This meeting took place on 13 May 1987.
I thank the Minister for his lengthy reply. Does he agree that the booklet to which he referred and the advertising in general in this area have been rather simplistic and moralising and thereby ineffective? They have been widely criticised by those directly involved with sufferers from AIDS and those at risk. Does the Minister further agree that the booklet pays very scant attention to those at present most at risk, drug abusers and some members of the homosexual community? Does he further agree that the lack of emphasis on the use of condoms as a protection against the virus and the use of a free needle exchange system between intravenous drug abusers is a serious omission? Will the Minister agree to provide funding for the voluntary counselling services which are at present doing excellent work in assisting those at risk and others who have been infected with the HIV virus——
The Deputy is taking a very long time.
I do not accept that the campaign or the booklet issued at the launching of the campaign are limited. The campaign is very well balanced and, as I said earlier, it confirms to the views of the other Ministers for Health in the EC. They agreed the campaign was being conducted satisfactorily and directed at the whole population and not specifically at the high risk groups such as intravenous drug abusers and homosexuals. One of the reasons the 12 Ministers of the European Community believe that it should be directed at the whole community is that there is more and more evidence that AIDS is spreading among the heterosexual community and is not specifically confined to drug abusers and the homosexual community.
On the question of condoms, the booklet made it very clear that the safest way to avoid AIDS is to stay with one faithful partner. On page nine of that booklet it is stated that for sexually active people who are not in one faithful partner relationships a strong condom correctly used is the single most effective defence against AIDS. I do not know how anybody can say the issue was avoided in the booklet which also gave the names of the various agencies who might be in a position to help those who are anxious or worried about AIDS or those who may have the AIDS virus. Included among those agencies is the Gay Health Action Group in Sheriff Street in Dublin.
Is the Minister aware of the very important need for anonymous testing services for AIDS victims and for those at risk? Is he also aware of the World Health Organisation's recommendation on the matter and that it is, in fact, the practice in both Britain and the United States that such anonymous testing services are available? Will the Minister set up such a service here with pre- and post-counselling services attached as they are very important? Such a service is not available and a test cannot be carried out anonymously at present.
The opportunity to have blood taken and a test carried out for the AIDS virus is available from a family doctor. I accept that that test is not anonymous. There are a number of sexually transmitted disease clinics, in Dublin, Cork, Galway and Limerick. They are available to anybody who wants to have a test for the AIDS virus carried out. There is a also a telephone service in operation in each health board area manned by an area medical officer who will discuss the problem with individuals who wish to remain anonymous.
I wonder why no reference to the provision of clinics and services within a hospital was made in the Minister's reply even though he has now referred to them. It is indicative of the lack of seriousness with which the need to have back-up services available in hospitals is taken. The hospitals bear the brunt of the testing services because of people's desire for confidentiality. Has the Minister visited any of these facilities and seen the circumstances in which they operate and, if not, will he undertake to do so? He would then become more aware of how understaffed they are, of the lack of space and equipment. A very expensive drug which may halt or, perhaps, cure the disease may become available later in the summer and is the Minister going to leave the decision to the medical personnel who will be fighting for some of the limited provisions as a result of the cutbacks as to whether they will order this expensive drug? I would like the Minister to comment on the adequacy of the financial provision which has been made to face this medical crisis.
Let me say before the Minister replies that I asked for the co-operation of the House in dealing with as many questions as possible on the Order Paper today. You will observe that we have now been dealing with questions for over half an hour and have only dealt with three questions. If that is the way Members want it, that is fine with the Chair, but I am anxious to make some progress on other questions and I am again seeking your co-operation and asking you to be relevant and brief. I can do no more.
First of all, on the question of the availability of a drug in the summer, my information is that a drug to combat AIDS will not be available for four years. We are keeping the situation under review and any drug which becomes available for the treatment of AIDS will be made available to those who suffer from that illness in this country. I am reviewing the facilities which are available in each of the health board areas, such as sexually transmitted disease clinics, to ensure that facilities will be made available and that people can go anonymously to them to have a blood test carried out if they so desire.
In his initial reply the Minister said that notification of the AIDS virus is not compulsory but voluntary. If that is so, would the Minister not accept that it is now necessary to give a directive to the health boards that this disease is a notifiable one and that it should be compulsory for the health boards to report back to the Department of Health as a matter of urgency?
There are varying views on the question of compulsory notification and I am one of those who believe that there should not be compulsory notification at this point in time as there is always the danger that people who should turn up to have a test for AIDS might not come forward for investigation and treatment if the disease was compulsorily notifiable. This is the practice in many other countries.
Can the Minister tell us why there is a contrast between the explicitness of the booklet as to the use of condoms — a booklet which will not be read by the overwhelming majority of the people — and the phraseology used in the public notices and advertisements in the newspapers which indicates that in the context of AIDS and the use of condoms they should consult with their medical practitioners? Could the Minister tell us what the reason for that particular form of advice is and could he also state whether it would not be preferable for the advertisments to state explicitly that the use of condoms provides a barrier to the catching of the AIDS virus? I make the point to the Minister and ask him to comment on it. It is a rather circuitous route to suggest to people that they should consult with their doctors about using condoms when, for anyone over the age of 18, there is no need to consult with a doctor or to obtain a prescription in order to obtain condoms?
It is very important that the public should be aware that condoms are not 100 per cent safe in preventing AIDS any more than they are 100 per cent safe in preventing pregnancy. As I have stated many times in public and particularly during the launching of the campaign, condoms reduce the risk of contracting AIDS but they do not eliminate the risk. It is important that the public should know that.
Can I get on to——
But they reduce the risk dramatically and would it not be more sensible to make that point in the advertisements as opposed to suggesting to people that they should consult with their doctors?
A final question from Deputy Stagg.
In view of the general opinion which has been expressed here and elsewhere, would the Minister agree that the money he has spent so far, about £500,000, has been wasted on fairly useless advertising? Can he tell us what extra provision of funds he has made available to provide the extra special beds and the extra special staff which are required to deal with this crisis? I also asked earlier about——
And funds for the counselling service.
That should be adequate. The Deputy has had a good innings.
I do not accept what the Deputy said about the campaign being useless. I believe the campaign has been very successful in making people aware of how AIDS is contracted and how it may be avoided. It is important to stress that as of now there is no known cure for AIDS. We are depending on a public information programme. As I said earlier in reply to a question, we have a central strategy committee who are monitoring the situation. Now that the campaign is coming to a close, I will be asking them what further steps need to be taken.
The Minister has not answered my question.
Order, please. Question No. 4 from Deputy Naughten.
I specifically asked what funds the Minister was providing. He did not answer that question.
