Dáil Éireann debate -
Thursday, 2 Dec 1993

Vol. 436 No. 6

Adjournment Debate. - HIV-AIDS Information.

Ms F. Fitzgerald

I am grateful for the opportunity to raise the question of the collection of data and information on HIV infection and the implications for future Government policy. Yesterday was World AIDS Day, organised by the World Health Organisation, the theme of which was The Time to Act. More than 12 million people worldwide have HIV infection and AIDS will claim the lives of several million before the end of the millennium. Governments, unfortunately, around the world have been slow to act and this has cost lives. Our annual HIV reported cases are growing at a rate of 10 per cent since 1989. Many Irish families have to cope with the effects of this disease and many more will have to come to cope with them in the future. There are currently 1,421 reported cases of HIV infection, although the real numbers are probably far higher.

I would like to congratulate the Minister on the initiatives he has taken to deal with the current situation. I welcome the measures taken such as the appointment of a new consultant, the introduction of the family planning Bill and so on. However, I wish to raise one matter, the collection of data and information on HIV infection and the implications for future Government policy. What is the current method of collection, what information is collected and is there information on age, gender and region?

The first point to be established is that we need to focus on HIV statistics as opposed to AIDS diagnosis and AIDS-related death figures. We have cumulative data on HIV infection but we do not have an age, gender or regional breakdown of that data. I understand that the data collection forms have this information. I look forward to the Minister's comments on this matter. It is important that the Department not only reacts at a crisis level but considers the whole question of prevention. The breakdown of HIV figures as outlined is necessary to inform the design and implementation of targeted HIV prevention campaigns. That breakdown is crucially important to indicate in which population groups the virus is spreading most significantly. This data would give a more comprehensive picture of the developing epidemic and we would be in a better position to respond to it. If we have a real commitment to HIV prevention we would have this type of data collection system.

More information is necessary on women in terms of this problem. There should be a serious commitment to education programmes that target the needs of women, particularly in regard to negotiation skills and assertiveness training. For example, a staggering 77 per cent of the HIV positive heterosexuals attending St. James's Hospital are women. The biggest increase in the past 12 months in the level of reported HIV infection in any group was among gay men. All these facts point towards the urgent need for focused and targeted HIV information and prevention campaigns. Clearly, immediate action is needed in these areas. Strategic planning is necessary for the early management of the disease in terms of medical treatment, counselling and support.

The Government should encourage at-risk population to test for HIV antibodies at frequent intervals. If people know they are HIV positive they can access treatment regimes and can improve the quality and prolong the length of their lives. Advocacy to test must be given high priority. It makes no sense to spend limited resources on the medical management and care of a disease if sufficient attention is not given to prevention of the disease. In that regard we should start with a proper data processing system.

Many services dealing with the epidemic are overburdened. In the future increasing numbers of people will be infected. At present £2 million per annum is being spent on the care of more than 700 people with symptomatic HIV illness. What amount will we have to spend when this figure reaches 2,000 or more? The World Health Organisation predict that there are between 5,000 and 10,000 people in this country with HIV infection. When these people become symptomatically ill enormous demands will be placed on the Exchequer. It makes perfect sense to act proactively in the area of HIV prevention. This action must start with the breakdown of figures along the lines of age, gender and region.

Minister for Health (Mr. Howlin)

I hope you will bear with me, a Leas-Cheann Comhairle, and allow me to respond in a comprehensive way to the issues raised by the Deputy. I am pleased to respond to the issues so close to World AIDS Day. I welcome the opportunity to place on the record of the House the position in regard to HIV-AIDS surveillance in Ireland and to correct some of the inaccuracies which appeared in The Irish Times of 1 December.

The availability of information about the spread of HIV and AIDS is a fundamental component of the AIDS startegy and the surveillance of HIV and AIDS has been an integral component of the Department of Health AIDS strategy since the first case of AIDS was reported here in the 1980s.

The Department's surveillance programme consists of four components: the reporting of cases of AIDS; the reporting of deaths from AIDS; the reporting of HIV positive tests on the basis of confirmatory HIV tests, carried out by the Virus Reference Laboratory, UCD, which commenced in 1985; and the monitoring of the spread of HIV in the population through anonymous, unlinked HIV surveillance programmes which commenced in October 1992. Taken together, this surveillance programme is providing all of the information relevant to the planning, implementation, evaluation and development of programmes and services aimed at the prevention of HIV and for the care and management of those who have contracted the disease.

The surveillance programme provides the following information. In respect of cases of AIDS and deaths from AIDS: the sex and age of the person; the country of residence of the person at the onset of illness; the person's nationality; the current county of residence of the person in Ireland; in the case of persons living in Dublin, the Dublin postal code; the disease manifestations present at the time of diagnosis; and information about the mode of transmission of the infection. In the case of confirmatory HIV test results from the Virus Reference Laboratory: the area of residence, including the Dublin postal code; the sex of the person in the case of intravenous drug users and the classification of the category for HIV surveillance purposes to which the person belongs. In the case of the unlinked anonymous HIV surveillance programme, very detailed and comprehensive information is being collected at present through the analysis of blood taken for routine clinical purposes at ante-natal examinations and which is surplus to requirements. This information is classified under (a) six separate age groupings, from "less than 20 years up" to "40 years and over" and (b) area of residence as a basis for monitoring the spread of HIV in the heterosexual population.

As I indicated in my annual report on HIV-AIDS, which I issued yesterday, I will be expanding the unlinked, anonymous HIV surveillance programme to include GUM clinics and hospital outpatients and in-patients. The National AIDS Strategy Committee is currently working on draft Protocols to enable these elements of the programme to be put in place very quickly. It is envisaged that the information under the extended programme will be as comprehensive as that being collected under the first phase, including data on gender, age and area of residence also.

The surveillance of cases of AIDS and HIV and-or HIV demonstrate the following features of the epidemiology of the disease in Ireland: the greatest percentage, at 64 per cent, of cases of AIDS have occurred in the 20-34 year age groups; 85.5 per cent of cases of AIDS have occurred in male and 14.5 per cent in female, in all age groups. Intravenous drug users continue to be the largest single, reservoir of HIV infection at 52 per cent of infected; of the intravenous drug users, a total of 75 per cent are male and the remainder female. A total of 96 HIV positive children have been born to intravenous drug using mothers. Homosexuals, at 18 per cent, are the second largest reservoir of HIV infection and this proportion has remained unchanged since HIV testing began in 1985; and heterosexuals represent 14 per cent of those who are HIV positive.

The information available from the Department's HIV-AIDS database has facilitated the development and implementation of a rational AIDS strategy which is responsive to the evolving epidemiology of the disease in Ireland. We have been proportionate and relevant in our response, which has included both general programmes and services and those targeted at particular groups.

I welcome the Deputy's kind comments in this regard.

Deputy Fitzgerald asked about the implications for future Government policy in relation to HIV-AIDS arising out of the collection of data and information. Clearly, we have been successful to date in implementing a comprehensive national AIDS strategy which is relevant to our particular requirements, on the basis of the date and information available through our existing database. This has given us data and information about, inter alia, sex, age, area of residence and the at-risk groups and has enabled us to provide programmes and services aimed at particular groups in certain areas. I am, therefore, confident that the HIV-AIDS surveillance programme is appropriate for the rational planning and evaluation of the national AIDS strategy both now and in the future.