Senator J. O'Toole has 29 minutes.
Information and Education Programme on AIDS: Motion (Resumed).
Debate resumed on the following motion.
That Seanad Éireann endorses the Government's Public Information and Education Programme on Acquired Immune Deficiency Syndrome and requests them to further develop programmes with particular reference to IV drug users and school leavers.
—(Senator Bulbulia.)
I will not be using all that time. First, I want to put on record my thanks that again the Seanad was first into the breach on this most important and controversial issue — the whole area of AIDS. Before saying anything else, I want to make it clear that AIDS is 100 per cent fatal and that there are no survivors of the disease. This needs to be written into the record and needs to be very clearly understood. It is important that we should have a look at how the disease develops and also the way in which we might do something about it. It is of absolute critical importance that at least we get rid of some of the mythology and folklore which have developed around the whole area of AIDS.
More than anything else, we need to understand what the disease is about. The definition of the word "AIDS" has been put into the record. It is a disease of the actual body defences and the body mechanisms. The virus itself has been isolated from almost every one of the body fluids I know of except, perhaps, perspiration. I am not sure that it has been identified in perspiration but it has certainly been seen time and time again in all the others. It has been isolated from the tears, saliva, urine and breast milk. However, the concentration of the virus in these fluids is considered far too low to facilitate the transmission of the disease from person to person.
Fluids in which the virus is present in sufficient quantities for transferral are the blood, semen and the secretions from the cervix and the vagina. The semen, blood and the vaginal fluids are the main areas of risk and this has made any activity that involves contact and exchange of these bodily fluids a risk. The sharing of utensils such as toilets or towels, kissing and that kind of activity, are not efficient transmissions and, therefore, are not the high risk activities they have been presented to us as being — quite regularly in the media. It should be seen clearly from what I have just said that the methods of contraction depend on either a blood to blood contact or a semen to blood contact, or a vaginal secretion to blood contact. Therefore, none of the other activities, where this does not happen, creates a danger in terms of AIDS contraction. It means in effect that it is not, for instance, sexual intercourse that causes the transmission of AIDS. It is sexual intercourse where semen and blood come in contact with each other at some stage. In other words, there has to be — in a sense — broken or bruised skin where the semen and blood can make contact with each other. To my mind women are more at risk than men in this area.
It is interesting that at a meeting we had on this issue some weeks ago, there were more women Oireachtas Members in attendance than male Oireachtas Members. I think it is a growing recognition of the fact that there is more danger to women than to men in the long term. I know that cannot be completely proven by the available data but it certainly has been proven in the case of male homosexuals that the receptive homosexuals have shown a far greater incidence of contracting AIDS than the penetrative homosexuals.
What activities cause problems, what are the various risks and how does the disease develop? The disease itself — and this is probably the worst part of it — can spend seven to ten years developing, with no outward symptoms of which people can be aware. When the infection takes place through whatever activity — normally it is sexual activity — it will not be detected in the body for a period of up to 12 weeks. At the end of that time, if the person has contacted the virus and become affected the body's immune system will develop antibodies to fight against it. The detection of these antibodies should always be possible within 12 weeks and, as far as I know, if the disease is not diagnosed within 12 weeks, it will not be diagnosed and there is no history of it coming through after that period. The question is then asked "What are the symptoms after 12 weeks"? When somebody is HIV positive, how do we recognise it? What are the symptoms? The answer is that there really are not any at that point.
One of the features of the virus is that it can be dormant in the body for from seven to ten years. Therefore, it is growing and ready to move on. After seven to ten years it can then develop in a number of different ways. It is considered that one-third of these people will develop eventually into AIDS victims. I have no doubt that figure will change over the years because we do not know enough about this disease. The first indication of this disease was in 1968 when a child died and the doctor kept some skin scrapings. It has been identified that that child did have AIDS. It was really into the eighties before anybody was looking seriously at this disease and doing any work on it. We have not had enough experience in terms of years to give a clear, absolute position on this but a third of these people will develop something further within the seven to ten year period.
The first way in which this can develop is in what is called the PGL where it attacks the lymph glands of the body and is characterised by a swelling of the glands, that is, under the arms or the neck. That is not AIDS but the disease called PGL.
The other manifestation that we can see is what is referred to as ARC, that is the AIDS-related complex. At that stage it affects the body through general symptoms such as weight loss, night sweats, diarrhoea, temperatures, growths in glands, blood abnormalities. Thrush for example can affect the body in an abnormal way. I have mentioned things which of themselves are common enough but the way in which they affect the body is completely different than would normally be the case. The other way is through full blown AIDS which is the most severe form. Eighty per cent of those people who get PGL or ARCs develop full blown AIDS.
It is almost inevitable that the person who is diagnosed as having PGL or ARC will develop full blown AIDS eventually. The most severe form of the infection is AIDS and it is characterised by a general poor functioning of the immune system with an absolute decrease in efficiency. When some antibody enters our physical system, whether it be a disease, a virus or whatever else, our defence system sends out, as it were, soldiers to fight against this disease, cells to go out and fight against the disease that has become part of the body. That is what normally happends and there is a clash. If our system is strong enough it finally defeats the disease, the illness or the virus.
What happens with AIDS is that it affects the immune system and not only does it not send out cells to fight against the infection but it actually keeps reproducing infected cells and makes the disease worse. It then takes over the whole body. At that stage the whole defence system of the body is gone and some other disease like pneumonia which the person might contact then becomes a killer almost immediately. That is why it is called the Acquired Immune Deficiency Syndrome; it is a deficiency in the system of defending ourselves against foreign bodies in our own body.
I think 80 per cent of AIDS victims will die within two years. I say "I think", because that has been the indication from all the available evidence. A number of Senators gave us the numbers of deaths in Ireland over the last number of years. The significant thing about the people who died in Ireland is that they had been intravenous drug users, or they had been homosexuals in the main but not all of them. There have been two babies who contacted full blown AIDS in the womb from their mothers, and there has been one heterosexual non-drug using woman who died recently. She contracted it from a sexual partner. That is the start of it as a heterosexual disease in Ireland and that is why we need to be worried about it.
I want to address two matters: the area of the intravenous drug user and the contact through sexual activity. In terms of the drugs user, the big problem is this, that the people who know most about AIDS and the intravenous drugs user are people who have been working against the misuse of drugs and abuse of drugs for some time. They have immediately found themselves in a difficulty because their whole raison d'être has been to get rid of the abuse of drugs and to stop people using them. That is what they are directed towards. It is the intravenous injection with dirty needles etc. that causes the disease to spread. I know that if I could get every one of those drug users either to use a clean needle every time or to dip the needle into bleach or to take methadone or something that is ingested orally rather than injected, AIDS would not spread through the drugs community. However, putting forward that point of view you may seem to be in support of drugs misuse.
I think you understand the problems that those people have run into. Drugs abuse kills but it is not a 100 per cent killer like AIDS. We now have to make adjustments in our lives. If people are determined to misuse drugs let us try to get them to do it in such a way that it will not kill them. Let us try to prevent the intravenous drug user from using dirty needles. Let us try to persuade them to use clean needles, to dip them in bleach or to use methadone. I can advance arguments against all of those three proposals. I do not feel wonderful about proposing them. I am merely advocating that this would be a way of coping with the problems of intravenous drugs-users.
In terms of sexual relations — and we went through this the last day — it is not the act of sex that causes the problem but blood contacting blood, or semen contacting blood, or vaginal fluids contacting blood; it has to get into the blood stream in one way or another. This is why the saliva is not a problem and on the question, "Would you kiss an AIDS victim?", it must be said that you would have to swallow two and a half pints of saliva before being in danger of contacting AIDS, such is the level of disease to be found in saliva. Not only would you have to ingest the saliva but you would also have to come in contact with some part of the blood circulation system. In other words it is not taken in orally. Oral sex in terms of the ingestion of semen or wet kissing through the ingestion of saliva or whatever are not the high risk activities. The high risk activities are penetrative aggressive sex acts, maybe aggressive is the wrong word, but there has to be broken skin. There has to be a way in which the semen will come into contact with the blood stream. The risk begins where semen comes into contact with the blood stream. I want to make that clear. I am not proposing a policy of abstention.
Condoms, if properly used, will prevent the spread of the disease. In my script I had written that I would propose that we advise the use of condoms. I am not going to do that because when one does that it becomes the interesting part of what somebody has to say. I think people should know that the disease cannot penetrate through the latex covering of a condom. People should recognise that. What does that mean in terms of young people involved in sexual activities or old people involved in sexual activities? It means that they should know the means by which they can protect themselves and not just protect themselves but the population at large. We need to address it from that point of view and to say to people, "if you are going to have a multiplicity of sexual partners you certainly will need to be very careful and one of the ways you can be fairly sure of not spreading disease or contacting disease is through the use of condoms".
Having said that we came across a case only last week of a woman married to a HIV positive patient — an exprisoner — and they have used condoms all the time since he was released. She has now become pregnant. I make that statement for two reasons, not to say that condoms do not work because that is not the point I am making. Obviously it was not used properly or else it was faulty or damaged. The sad part of this story is that that woman refuses to be tested for AIDS, she does not want to know at this stage whether herself and her baby might be HIV positive or whether it might develop into a disease. The reason I make that point is that I know that both in the heterosexual and homosexual community there are many people who refuse to be tested.
Therefore we must have a huge general education programme which will allow us to identify those in the community who are carrying the virus. I do not know how we are going to go about that without changing legislation and without changing attitudes.
I want to talk about attitudes. There is a lovely book that I read recently on the subject of AIDS, and having read it I thought it was very useful and was well produced. I turned to the back of it to see whom I would ring to get extra copies and there I saw the logo of the Health Education Bureau. I said to myself: Is it not typical of the contradiction and the irony in Irish life that, at a time when the rest of the world is developing the whole area of health education — over the last number of years the US has spent more money on health education than in any other part of education and in doing so managed to raise awarenesses — we close down our Health Education Bureau. I know the Minister will have a lot to say about that because I can see him getting upset immediately. I will read his response with interest. I know all the answers already because we have discussed this before. We are not discussing cuts. It is significant that this is the way our thinking has moved. Instead of hyping up this area we have cut back on it. It is a blunderbuss approach to cuts when we should have a neat little chisel to work out where cuts should take place.
We need to educate the population and we need to educate the people in the media. I listened to a heart-rending interview one morning last week when somebody talked about working in the prison service and having a cupful of AIDS infected blood thrown over him or her and also about somebody else being spat upon. I have had the same problem with my own membership of the INTO. Those working in secure units have had the experience of being spat upon by young delinquents from AIDS infected families. I want to make it clear that having blood or spittle thrown over somebody is a horrible experience. In terms of contacting the disease there are two important facts involved. First, if blood is thrown over a person it has to come in contact with that person's blood. The disease is not taken in through the skin. Secondly, within 12 weeks one should be clearly able to establish whether the person was infected. I am not saying this in any put-down manner. I am trying to put this forward so that people will understand what is happening and the way it is developing.
Another area people talk about is accidental needle pricks or pricks given to nurses in hospitals and so on. There have been only three of four cases of people who have picked up AIDS through an accidental prick from an infected needle. The data in those cases are too small to make judgment on it. In general, that is not the difficult area. Also, drugs, sex education, health education and AIDS education are all bound into one. We need to look at what we are doing. We need to talk to our young people and to our old people.
I want to say what has not worked and what will not work. The "scare the hell out of them" technique will not work. Telling people not to have sex because they could pick up AIDS and die will not work. If young people or old people were afraid of risk, they would not be climbing mountains, going to the bottom of the sea, driving cars at night, or whatever. Risk is no put-off to anybody. Therefore, we must put that aside. We will not scare people into anything. Neither is it any good putting AIDS victims into something like a zoo. The zoo effect does not work either. It is no use showing people the damage it causes and telling them not to do it. It does not work. The old fundamentalist preachers long ago brought around alcoholics with them as a sort of a léirú corpartha for particular lectures——
They were discredited.
——because they were apparently doing other things. The third thing that does not work is the pure information idea, the idea of telling everybody everything about AIDS, drugs or sex and hoping that it will come right on the day or on the night. We must have a properly structured systematic approach in a proper context of letting people understand what it is that they are about, where the risk areas are and creating a sense of responsibility to themselves, to their families and to the community at large. That does not mean we say to people: "Do not do that." It means saying to people: "Think before you do that. Make sure you understand the consequences of what you are about. Make sure the choice you make at the end of the day is made with all the information at hand and with a sense of responsibility". That can only be done through a long process.
I have tried to deal with some of the safe activities. The safe activities are hugging, holding, cuddling, body rubbing, dry kissing — that sounds like a horrible concept but apparently it is safe — and mutual masturbation. Wet kissing is probably risky in terms of the transmission of saliva. People are worried about oral sexual intercourse but it is not a direct way of transmitting the disease. Certainly any kind of oral intercourse is, in the main, much safer than any other kind of intercourse. I am not making any proposals here or telling people what they should be doing in their private lives but it is important that we get these things right. Anal or vaginal intercourse without a condom is very risky. This is where the danger in sexual intercourse lies and people should be aware of that.
Dr. Freedman in his book entitled AIDS — The Problem in Ireland said that prevention was the only cure, knowledge was the only vaccine, and it was a matter of making the public aware for them to take the available steps necessary to prevent their own contraction of the disease, be it through abstinence or through the use of condoms. He also said that surely it was not asking too much of people to be somewhat choosy when it came to finding a person with whom to juxtapose their genitals. That seems to be a safe way of going about things.
A number of surveys have been done on what has happened. I will refer to one study of a full year's observation of 2,500 homosexual men. After the year 3.8 per cent became infected. One in every ten of those practising receptive anal intercourse with two or more partners became infected. Five per cent of the non-receptive but insertive became infected. I make that point because that is the man woman thing. Because they are the receptive partner in sexual intercourse women are more at risk. Our figures do not show at present because they are being distorted by the intravenous drug users and the homosexuals. If it were to become a widespread heterosexual disease this would certainly be the case.
It is also important to say for the record that flies or mosquitoes do not pass on the disease. We are quite certain of that now because Africa — I would recommend people to read this month's Trocaire magazine where there is a full page on the subject of AIDS in Africa — has proven it to be a heterosexual disease which is not spread through flies or mosquitoes. If that were the case, the children in Africa would be totally wiped out and that has not happened.
It would be easy to go on and on and put a lot more on the record. I have attempted to define the disease. I have attempted to talk about the methods of contact. I have attempted to go through the methods of infection and how the disease develops into full-blown AIDS. I have attempted to put on to the record that 100 per cent — every single one — of full-blown AIDS patients will die. In the first six weeks of this year we had four AIDS patients. That means that by the end of this year we will have roughly six or seven times that figure of AIDS patients. If we have, say, six in these two months we are talking about 36 cases in the year 1988. That is a doubling of last year's figure. Up to 3 February there were four cases and it looks as if we are heading for the magic number of 36.
I want to put it on the record that there are no beds or facilities to deal with those patients in Ireland at the moment. This is a new disease, a new aspect of health life which has to be dealt with and it is unfair that hospital boards and health boards should be asked to deal with the AIDS problem with the same amount of money as they had up to now. Special provision must be made.
I propose that the Minister should do three things: first, make more money available specifically for AIDS, and that should be done on a national basis in areas and not just divided up amongst all the health boards; secondly, initiate a major education campaign through the schools in order that young people would understand the difficulties and, thirdly, that you would also put forward a major education campaign of the community on the whole AIDS matter, on sex, drugs and community responsibility. This should be done as a matter of urgency because while we speak about it and while we procastinate people die.
The first news of the AIDS plague must have been deeply disconcerting to the sex educators and so-called family planners——
Why so-called?
——who have worked so hard to tell adolescents, children and adults that no sexual activity of any sort can be morally wrong in itself provided a person, however young, freely wishes to do it and given that no unwanted pregnancy results. It certainly undermines their second message which is virtually that no kind of freely undertaken sexual activity can have adverse physical or psychological consequences if there is no pregnancy. AIDS has suddenly appeared as a dreadful consequence of particular sexual practices which the sexual libertarians have been determined to establish as just as valid as any other but humanity is ingenious in turning old or bad news to advantage and AIDS has been harnessed to the very cause it first seemed to threaten.
The permissive sex educators and the so-called family — not quite the right word when you come to think about it — planners have done their best through books, youth clubs, clinics and classrooms to place before our young people all the facts, including many which are morally squalid and morally suspect, about every conceivable kind of sex without one word about what might be called moral input. They take sex education out of the context of traditional values which, in the ideal at least, have related to marriage, fidelity and loyalty but that seems now to have gone by the board. The only taboo they accept has been against any behavioural taboos in sex.
Apart from the overriding insistence on contraception and abortion, their sex instruction is free of moral values and invites every young person to do what he or she wants or what they think they want. Children at a highly emotional and suggestible age are to have laid before them new patterns of behaviour which would not otherwise have occurred to them and which suggest that they are out of touch with their peer groups if they do not indulge in them. Fortunately, many of our young people have natural resources of character and family background which enable them to resist the propaganda emanating from TV programmes, so-called life skills programmes in schools and the irresponsible ramblings of some of our more deviant Senators. Some are less fortunate and more impressionable and they are the victims.
Initially the evidence that AIDS was spread by specific homosexual practices seemed to threaten the campaign by the libertarians, sex educators and the Leftwingers to establish that all kinds of sexual practices are equally valid but once it became clear that it also indirectly threatens homosexuals and people wholly innocent of promiscuity, the disease was quickly seen as providing a new opportunity by a conglomerate of sex educators, libertarians, some vested interests and those who go along unquestioningly and unreflectingly with the fashion of the moment. Thus, we now have a demand for what is called explicit advice in the schools about AIDS.
Soon the call will come, as indeed it already has come from some quarters, for explicit advertisements on television about the practices which spread the disease, about how to minimise the risk and, above all, for contraception, the last of which has long been an objective of the so-called family planning lobby. A recent programme for young people on RTE had the presenter showing how to fit a condom, using crude slang while explaining the process. The same was evidenced on British channels, particularly on Channel 4, where in a recent programme on AIDS a group of homosexuals explained in four letter words what everyone needs — that is their word — to do. This programme included a Swedish advertisement for condoms which nobody could say was not obscene.
In a recent issue of the British Medical Journal a Miss K. Wilding of the Family Planning Information Service called for a major information campaign for barrier contraceptives, clear instruction for their use and an attempt to improve the public image of the condom. I joke not about her words, "to improve the image". She said that there was a case for setting aside the sensitivities of any minority. In Britain also they had a Mr. David Sharpe, chairman of the Pharmaceutical Services Negotiating Committee, advocating free condoms with the reassurance that this will not promote promiscuity but will prevent the spread of a plague of biblical proportions.
The idea that the plague will be so prevented must be fantasy. The danger is rather of encouraging false security. Some of the people now deliberately using AIDS in their campaign for destroying any lingering moral standards for teaching children about sex, are those whose teaching encourage it. Books are available aimed at teenagers and younger children which describe many perverse sexual practices without any disapproval whatsoever. Is there to be no campaign? No, there must be a campaign. Adults and children alike must be informed of the facts but these facts must not ignore morality.
There are some schools in our community where parents, and indeed teachers, and other classes are being prohibited from knowing what is taught in those schools. The Congress of Catholic Secondary Schools Parents' Association have said (a) they do not want an explicit campaign and (b) they want to have maximum input into whatever campaign is organised. After all, it is their children and their organisation represents 53 per cent of the school-going population.
What are the facts about AIDS? The facts are clear and many Senators have outlined them. If has to be said homosexual practices, particularly sodomy, recourse to prostitutes and drug addiction are the basis for the spread of AIDS. That the innocent including the haemophiliacs, spouses of bisexuals and of drug addicts and even the unborn should be at risk is all the more reason to point the finger where the problem lies. The campaign should be aimed primarily at those at risk. The whole population is not at risk. Drug addicts and promiscuous people are at risk. Sodomites are certainly at risk. Church leaders are correct in saying that if people are serious in attempting to fight AIDS, a more responsible attitude to sexual morals should be a priority. It is surely time that society ceased to give free rein to those trendy proponents of permissiveness, promiscuity and so-called safe sex.
Whenever we meet a person with AIDS the overriding word must be compassion because if a person is afficted with AIDS, whether it is through irresponsible behaviour or just some curse of fate, that person remains a person who has rights, a bearer of those rights, and as such makes claims on every other person. We must never forget that. We must look at people with compassion.
My main reason for talking here today is that I want to see the campaign, particularly for school leavers, contain the facts explicitly stated but there must also be contained in that campaign the moral message that sexual permissiveness only leads to trouble and we must at some stage curb the behaviour that is going on at the moment. People say that that cannot be done. It can be done. It was done in various other ages before, it can be done again. There is no doubt that this disease would not have had the same frightening effect upon the general population if people's moral standards had not dropped quite so much. The campaign I would like to see would contain the facts explicitly stated but also one particularly for school children, in which the parents would have a large input into whatever was to be promulgated in the schools.
On a point of order, in the course of his contribution Senator Lydon made reference to deviant Senators, I think the reference was to "some deviant Senators". I consider this an imputation and a gross reflection on the calibre, character and standards of Senators in this House. I would like to ask Senator Lydon to withdraw that remark which I consider insulting.
Senator Lydon, you have heard Senator Bulbulia's comment.
What I meant by "deviant" was deviant from the norms that I adhere to. I think it is deviant to promote certain types of behaviour. We heard, for example, a Senator just a few moments ago encouraging mutual masturbation. I do not think that is correct. I think it is deviant. You can think what you like about it. I do not know if I have to withdraw this remark but by "deviant" I did not mean particularly deviant in their own particular orientation or their own views; deviant perhaps from the norms that I would subscribe to is what I meant.
In reply to that I do not consider that it is my function to speak on behalf of Senator Joe O'Toole but I listened carefully to what he said. I understood him to be describing methods of sexual activity which were risky in the context of the debate we are having on AIDS and methods of sex which were less risky. I did not in any way hear him advocating any particular form of sexual activity. Indeed, it is my understanding that he made it absolutely clear that he was speaking in a totally objective fashion. What Senator Lydon's standards are may be proper for Senator Lydon but I do not think he can use them as a yardstick against which to measure the character of Members of this House.
Before I call on the Minister, the record of what has happened speaks for itself and I do not think we can have further debate on this.
I have listened with great interest to the contributions made by the Senators and I would like to reiterate the remarks made earlier by my colleague, the Minister for Health, and congratulate Senators for their initiative in organising the debate.
I would like to express my thanks for the contributions made by Senators Fennell, Bulbulia, Norris, O'Connell, O'Toole, Lanigan, Ferris, Farrell, Fitzsimons, Lydon, Murphy and Doyle who have contributed to this very worth-while debate.
Before replying to the various points raised during the course of the debate I would like to make the point once again that we are very conscious of the current and the growing problem which AIDS is presenting.
As the Minister said earlier in the debate we have had 36 cases of full blown AIDS to date, 22 of which have occurred since January 1987. There are nearly 700 persons known to be carrying the HIV infection at present and those statistics represent a very worrying picture. It has been suggested that there is no planning being done by Government. I reject this.
The Government established the central strategy committee over a year ago to monitor the spread of the AIDS infection, to review all possible measures for controlling it and to recommend new AIDS strategies to the Government. It will continue to do this work, taking account of the information available to it from the World Health Organisation, Council of Europe and all international sources as well as the views of our own national experts and the views of this House today.
Some Senators were critical of the approach adopted in the public information programmes. I do not accept that criticism that the programme was vague and evasive. The information is medically and technically accurate. This is a critically important statement as far as the Government are concerned, relevant to the criticisms voiced by some Senators. We have not been coy, evasive or vague. In the AIDS information booklet, for example, the issues of safer sex and condom use are addressed in an unbiased, unemotive and factual way. This booklet was distributed to members of the public and it could not be said that the references, for instance, on pages 8 and 9, are coy, evasive or vague.
Would the Minister give us the references on pages 8 and 9, please?
On page 8, in relation to safer sex, we state:
If you have reason to believe that your sexual partner could have been infected with the virus, strong condoms with a water-based lubricant offer you increased protection.
Oral and anal sex increase the risk of spreading the AIDS risk virus. Anal sex is a high risk activity.
Sex with an infected partner during menstruation is risky as either partner could pass on the AIDS virus more easily at this time.
Any sexual act which damages the penis, vagina, mouth or anus is dangerous.
On page 9 a further reference is made to condoms which is:
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 cannot help thinking from some of the contributions that Senators have not grasped the objectives of the public information programme and the manner in which it was structured. It contained three key elements. These were:
TV, radio and newspapers including the students 1988 diary of which 10,000 copies have been circulated; a poster campaign designed to increase the level of awareness among the public about AIDS and to make it clear to the public that it is not a disease confined to at-risk groups but is a disease associated with risky behaviour which makes everyone who is involved in the identified risky behaviours vulnerable.
The AIDS information booklet from which I have just quoted passages relating to safer sex and the use of condoms was also made available — and continues to be available — for those who require detailed explicit information all of which could not be dealt with effectively and comprehensively through mass media advertising. It addresses a wide range of issues including the risk of spread by equipment used by doctors, dentists, people giving tattoos, ear piercers and others using sharp instruments. It is obvious that a booklet cannot cover every possible angle and certainly cannot calm the unrealistic fears and anxieties which are so often associated with AIDS. For that reason the booklet contains a comprehensive list of places where additional information and help can be got. In addition a telephone advice service has also been provided throughout the campaign and will continue to be provided as long as there is a demand. The telephone is manned by doctors. The evaluation of the programme which was conducted in October 1987 found that the emphasis was broadly acceptable.
The results of that evaluation also show that the programme was effective. In addition, the numbers who availed of the telephone service and who presented for the AIDS test also showed that the programme had increased awareness among the public about AIDS.
In this respect it was interesting to hear Dr. Fiona Mulcahy, who was not exactly a supporter of our public information campaign, state on the RTE programme "Cries for Help" last night that changes in sexual behaviour were almost impossible to achieve. I would venture to suggest that the fundamental objective of our programme to increase public awareness about AIDS was achieved. I should also state at this point that we are expanding the STD services which provide the means of one to one contact with the groups most at risk from sexual contact.
I will also be referring at a later stage to the information and education programme geared towards secondary school pupils. It was interesting also to hear Fr. Paul Lavelle, who is contributing greatly to the work of this campaign and who, apparently, briefed Senators last week about AIDS, state on that programme also that the policy which we are following relevant to IV drug abusers is the correct strategy.
Senators Norris and O'Toole made a number of interesting points, some of which were not entirely accurate. They suggested that there was a lack of resources for the treatment of AIDS patients. I reject this. All of the resources, both human and financial, are available for the treatment of persons suffering from AIDS. While dealing with the question of treatment I would like to emphasise that from a medical point of view there is no need whatever to treat patients in special hospitals or isolated units. People in this very tragic, difficult situation have enough problems without isolating them in this way. Neither would it be desirable socially, serving only to highlight the suffering of the patient and, arguably, leading to unnecessary and undesirable discrimination.
The Minister has on numerous occasions repeated his policy that every major hospital must play its part in treating and caring for AIDS sufferers. The Department are continually monitoring the situation and at this stage, are satisfied that adequate resources are available for the treatment of AIDS patients. If the Senator is aware of any cases where treatment was denied I will gladly have the matter investigated.
He also criticised the fact that the Minister in the course of his speech did not deal at length with the treatment question. While I fully appreciate the Senator's concern, he himself will have to accept that the motion before the House relates specifically to public information and education. Hence, the Minister's contribution was confined largely to these areas.
Senator Norris also implied that the Department of Health are dealing unfairly with the gay community. Again, I reject this. The Department have always acknowledged that organisations such as Gay Health Action and Cairde have made, and continue to make, an enormous contribution in informing and educating about AIDS. The Senator may not be aware that the Department have had regular contact with Gay Health Action and other frontline groups.
It is important, however, in devising national programmes that we do not sectionalise our approach unnecessarily which might serve only to discriminate against particular groups. The Government have to be pragmatic, however, and use the resources available to deal with the problem as it is presenting itself and indeed as far as is practicable to be ahead of the situation. The strategy is being devised accordingly. The public information programme so far has been aimed at the general public be they heterosexual, homosexual or bisexual. I am particularly pleased that the House has debated the particular problem associated with the rapid spread of HIV infection amongst IV drug abusers. The 13 cases of full blown AIDS among this group have occurred since September 1986. Sixty per cent of those tested positive of HIV infection are intravenous drug abusers and this group represents "The Bridge" which will transmit the infection to the community at large.
As the Minister has said, and as each Senator who has contributed has said, a special approach has to be adopted in dealing with this group. Senator Ferris hit it on the head — these people do not relate to Ministers or to bureaucrats. It is essential that we get to IV drug abusers on an individual, one-to-one basis and we are, in fact, addressing this problem. A pilot outreach programme is about to get underway in the Eastern Health Board area which includes the major Dublin area of course. In general it will involve a street approach to IV drug abusers by outreach workers to educate abusers about AIDS and to encourage them to come for treatment. A total of £450,000 has been allocated from the national lottery to fund the project and other activities relating to AIDS. I believe this is a major contribution by the Government on behalf of the public who have contributed to the national lottery to use £450,000 in this manner in this very worth-while outreach programme. The pilot project will include a methadone maintenance element. While AIDS represents the major public health problem at present and for the foreseeable future, we cannot lose sight of the overall problem of drug abuse. For this reason, we are considering the pros and cons of needle and "works" exchange.
I believe that the contributions made in this House by the Senators will influence a change of attitudes possibly in this particular area. There is conflicting data emerging from abroad on needle exchange and the central strategy committee on AIDS and the National Co-ordinating Committee on Drug Abuse — of which I am chairman — are keeping this data under review with a view to considering whether a needle and "works" exchange element should be integrated into the pilot outreach programme. This is an area to which we are giving very careful consideration. A reason for not recommending to the Government would be on the basis that we are not satisfied at this stage from our research abroad particularly that it is effective. If we were satisfied that this would be of major benefit in preventing the spread of AIDS, certainly the National Co-ordinating Committee on Drug Abuse would certainly have no hesitation in recommending such action if required to the Government. As a first option, however, a methadone maintenance element is being included and it is important that this is given particular attention during the project.
I might add that the Government's fight against drug abuse will continue unabated. The Co-ordinating Committee on Drug Abuse is continuing with its work and I am currently in touch with the Attorney General about a Bill designed to seize the assets of drug-traffickers. The plight of prisoners affected by HIV infection has been mentioned.
The World Health Organisation has laid down a strategy for the treatment of HIV infected prisoners and this is forming the basis for a cohesive programme in this area, being developed by the Departments of Health and Justice.
At present, HIV positive prisoners are catered for in a number of ways — medically by the Department of Justice's prisons medical services and by the health services and also by the voluntary agencies — in particular the Ana Liffey project — who counsel prisoners, both inside the prison and after their release into the community. I would like to compliment them on the work they are doing.
Senators Fennell and Bulbulia mentioned the condoms issue specifically. I would have thought that references to the family planning legislation and the relevance of condoms in the whole AIDS context should be firmly behind us and that we should now be concentrating on future initiatives.
It is embarrassing to be reminded of it, Minister.
We must be prepared to deal with a situation as it is presenting itself at this stage and not rewriting or looking back at any particular issue at any particular time.
Are you not pleased the legislation is passed?
Let me say, however, that condoms are now widely available from a number of different sources. As I said earlier, the information given in the booklet is accurate and to the point about condoms and safe sex practices. Senator O'Toole highlighted the dilemma facing policy makers and advisers in the drug abuse and AIDS area in Ireland at central level. These are the same people who, while their ideal ultimate objective is to curb and eliminate drug abuse, recognise that there is an immediate problem to be addressed in relation to AIDS. As I have said, the pilot outreach programme for IV drug abusers will include a methadone maintenance element. We are keeping needles and "work" exchange under review as I have already stated.
I might add that the bleaching of needles as mentioned by Senator O'Toole, while good on paper, has not been shown to be completely successful. The bleach can mask the infected blood on the tip of the needle and this will indeed lull the addict into a false sense of security. The difficulty with the intravenous drug abuser is the whole cult of exchanging needles. Even if you provide an exchange programme you cannot be assured or guaranteed that they will not exchange the so-called clean needles and then again continue the spread of the AIDS virus. It is, at this stage, a vitally important part of our policy to reach out to those people. They are as a whole not a responsible group because by abusing drugs they are at a very high risk level as it is even aside from the question of AIDS. We will continue our fight against the drug pushers. We are not going to pull back from that situation but we are conscious of the problem in relation to the exchange of needles and we are giving this priority consideration. We are looking at other countries in which this policy has been adopted to see how effective this policy is.
Senator O'Toole also referred to the abolition of the Health Education Bureau. The clear implication was that the very valuable activities carried out by the former bureau were also abolished. This is not so. The new health promotion unit of the Department will take on board and continue to develop all those activities. I do not need to dwell on the particular issue but I want to put on the record of this House and to emphasise that health education will continue to be developed by the Department of Health. I am satisfied that under the new arrangement health education will have a greater profile than ever before. I am accompanied here today in this House by the officials of my Department who are now responsible for health education and health education promotion. There is now total cohesion between health education and my Department. This is a very worth-while development and it is something about which I have no apologies to make to any Senators or to this House. I am satisfied with the work of the new health promotion unit within the Department.
On the structure of the Government's strategy, this is directly in line with the recommendations of socially respected international organisations such as the World Health Organisation and the Council of Europe. We initiated a provision of information to the public in a general way and, with this, individuals can identify their own particular situation.
We are not naïve enough, however, to consider that this is sufficient. We recognise that it is essential to focus on particular groups within the population and, as I have said, we are concentrating on one to one contact with IV drug abusers and secondary school pupils as our next priority.
It must be stressed that the Government's public information programme is not simply a mass media strategy. The mass media have an important role to play but to achieve substantial changes in human behaviour, one to one contact is fundamental. I have spoken at length about our approach to IV drug abusers. As regards school pupils, the pupil/teacher relationship is perhaps the most fundamental way in which we instil the values of our society into our children and prepare them for the challenges ahead. It is in this context that we can effectively provide information on AIDS to a very important group. The Minister for Health and the Minister for Education have agreed that we should concentrate upon the educational system this year.
A further meeting has taken place with the Minister for Education to discuss plans for providing such a longterm AIDS programme in secondary schools. While that programme is being prepared and to ensure that children leaving school this year have the facts about AIDS, the directors of community care-medical officers of health have been asked to cooperate with local school managements in providing AIDS education to ensure that no child should leave school without being aware of the facts of AIDS. I cannot emphasise strongly enough the importance which we attach to the provision of information about AIDS to secondary school pupils and this area is a major priority focus.
Senator Bulbulia referred to the prohibition on the advertising of services for sexually transmissible diseases under the Indecent Advertisements Act, 1899, and as amended by the Censhorship of Publications Act, 1929. The Venereal Diseases Act, 1917, however, permits health agencies to advertise without restriction services for sexually transmissible diseases and the Department have received legal advice which has confirmed that the 1917 Act may be applied without reference to the other Acts mentioned. This was communicated to each health board in 1985.
In conclusion the Government's strategy is to do everything possible to slow down the spread of the AIDS virus. We are in no doubt about the difficulty of the task facing us, especially when dealing with a difficult group like IV drug abusers where it will take time and effort to achieve anything. However, our strategy compares well internationally and is likely to be as effective as any other country's strategy. We will continue to pursue it vigorously.
I would like to say that there is so much research going on at the moment nationally, even in my own constituency with the Elan Corporation and other organisations, that we can only hope there will be a major breakthrough in relation to the fight against this most serious and killing disease. I am confident that with world wide concentration, with the most specialised and qualified people who are now considering the AIDS virus and the AIDS problem, a breakthrough will come and, indeed, must come for the sake of mankind. AIDS is a plague that is racing throughout the world and we are very conscious of that. We have a responsibility in our country to restrict and limit its incidence and to ensure, if possible, that nobody gets this disease. Unfortunately, it is a difficult fight.
I would like to compliment this House on its initiative in raising this issue over a two day debate which I believe has been very useful. I believe that through the media relaying the debate in this House nationally we are making people more conscious and more aware of AIDS. I believe this House deserves our congratulations. Everything said here is being noted very carefully by my Department and, where possible, where ideas have been put forward and can be used they will be acted upon.
I would like to thank the Minister of State for his contribution to this two day debate. There was nothing in his speech that would make us feel very enthusiastic. I know he and his Department mean well and I am sure they are looking at this as a very serious issue but I emphasise again the comments made by me and, I am sure, by other Senators about the moralistic overtones on——
An Leas-Chathaoirleach
I am sorry to interrupt you but the Chair can allow you to ask a question. The Senator has already spoken and I hope she would not abuse that facility.
I never do.
An Leas-Chathaoirleach
I will allow you to ask a question.
In asking the question I would like to suggest to the Minister of State that he should keep in mind the points made in this House about the restrictive and rather coy — I repeat — rather coy — approach to the information campaign. The continuance of an information campaign is vital. I do not think it is something that you can stop off and not have again. I ask the Minister of State to reassure me that children in primary schools will not leave school without knowing the facts of AIDS. He referred mostly to secondary school students. Given the kind of reaction — I was not in the House for it but Senator Lydon attacked the life skills course which is a very——
An Leas-Chathaoirleach
The Senator is putting the Chair in an embarrassing situation. It is very unfair. Therefore I ask her to conclude.
I would like the Minister to reassure me that this will not be just for secondary school children but that primary school children will also have access.
An Leas-Chathaoirleach
I am disappointed in the Senator.
Just a one sentence question. The Minister in his concluding remarks spoke about no child leaving secondary school without knowledge of the facts of AIDS. Could he perhaps indicate to us whether or not life skills programmes will be introduced in primary and secondary schools so that no Irish children educated in our Irish education system will leave school without a knowledge of the facts of life in addition to knowledge about the facts of AIDS?
Dealing with Senator Fennell's point first, the campaign ongoing and the advertising and the posters and this sort of approach have been earmarked for the high risk areas. The telephone service for advice on medical contact is available all the time and will continue to be made available.
In relation to Senator Fennell's and Senator Bulbulia's comments on the educational area, as I have already stated, the Minister for Health, Deputy O'Hanlon and the Minister for Education, Deputy O'Rourke, are in contact at ministerial level in relation to a programme for secondary schools, as I mentioned specifically. The primary schools area is a difficult one and I am not in a position at this stage to say what type of campaign will be provided. The point the Senators are making will be conveyed to the Minister, Deputy O'Hanlon and the Minister, Deputy O'Rourke, for consideration. I am aware of the Senators' concern in relation to young people who drop out after primary school. I appreciate their comments. These are not the highest numbers but there are numbers and they are in high risk areas.
This is an area that should certainly be considered. I emphasise that the highest level of drop-outs at primary level would probably be in the areas of high risk. The difficulty, of course, in an educational programme of any type, as parents are aware, is the age of the children involved. Television is playing a very important role in this whole area. There was a programme last night "Recent Plays, Recent Films". They helped the advisory section of the Department who are considering ways of making television producers and writers conscious of this whole area and bringing it in subtly into programmes where possible to make people very much aware of the dangers of AIDS.
As an antidote to "Dallas" perhaps?
I am not sure whether in Glenroe we will have Miley getting involved. The more we bring it down to real situations — and it is a real situation — the better. As far as the primary schools are concerned this is something which has to be very carefully considered. The Senators' views will be conveyed to both Ministers. We will consider how we will approach the matter but at this stage we are emphasising the secondary schools. The point made by the Senators is very valid and is worthy of consideration.
Question put and agreed to.
As there appears to be no further business I propose that the House adjourn until 2.30 p.m. on Wednesday, 9 March 1988.