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Seanad Éireann debate -
Wednesday, 5 May 1993

Vol. 136 No. 1

National AIDS Strategy: Motion.

I welcome the Minister of State at the Department of Health, Deputy O'Dea. I call Senator Norris.

I move:

That Seanad Éireann pledges support for the Government and the Minister for Health in pursuing the most active campaign to contain the spread of the HIV infection, including measures to ensure open access to clear, specific, explicit and factual information on methods of transmission, availability of condoms to sexually active young people and support for the expansion of the free needle exchange programme.

I also welcome the Minister. I would have given an even stronger welcome to the Minister for Health, Deputy Howlin, because I address some of my remarks personally to him, but I am aware of the Minister of State's seriousness concerning this matter.

This is a serious debate on an urgent and important problem in Irish society. The motion is deliberately framed to avert conflict on a party political basis. I am pleased that the Government side decided not to amend or oppose this motion. For this reason the terms of the motion commend the direction of Government policy and urges Government to move rapidly in an already existing direction.

It is fitting that such a motion should come before this House as it was in the Seanad the first debate in either of the Houses of the Oireachtas was held three or four years ago on the subject of AIDS. I remember the seriousness with which this debate was conducted on all sides. In particular, I remember the then Senator Katharine Bulbulia who, in a remarkable and moving contribution, stated that as a Roman Catholic, a mother of children, convent educated and living in a rural constituency, she found the issues of human sexuality involved difficult and embarrassing to discuss in the kind of explicit detail required. Nevertheless, she felt a responsibility as a mother to her children and the other children of the nation to overcome this embarrassment and to speak as clearly, factually and explicitly as the situation required. If she could overcome her embarrassment, she asked rhetorically if the Government, charged with the responsibility for the lives and well-being of young people, could do any less? That question remains pertinent today.

I have framed one element of this motion in terms of information, but information of itself is not sufficient. An intensive media campaign is needed to refer clearly to the existence of AIDS in our community as a major problem and to provide explicit information for all sections of the community on how to avoid infection. The motion refers also to the need for easier availability of condoms although I recognise that this is an area which is being muddied by religious intervention. Such intervention may be well meant but it is certainly misguided.

In an experiment in a serious and scientifically validated Swiss study, vending machines for condoms were placed deliberately in locations to which the public had access and in particular where young people congregated. The survey was conducted over three years with a substantial follow up. It indicated, first, that the availability of condoms did not encourage young people to become sexually active at a younger age than they otherwise would have done and, second, it did not encourage young people to have more sexual partners than they otherwise would have. However, it did encourage those who were already sexually active to use condoms. It was interesting to note in this survey that there was a higher uptake of condoms among young females than males.

I repeat something I said in the earlier debate. I would be surprised to learn of a young person becoming sexually excited by the prospect of a piece of limp rubber. I am quite certain sexually active young people are entitled to the fullest protection available, especially access to condoms. Of course the availability of condoms is not sufficient unless accompanied by a well targeted educational campaign. For example, in Ireland more women become infected through heterosexual contact than men. Figure indicate that for heterosexual women the rate is approximately one instance of infection for 500 sexual acts and for gay men one in 300. Women and passive partners in homosexual relations are more inclined biologically to contract the disease venereally. Therefore a proper life skills preparation for women and young gay adolescents is needed so they may have the confidence to negotiate sexual practices and to be assertive in maintaining their individual right to engage only in safe sexual relations.

While I welcome the information programme embarked upon by the Departments of Health and Education I am somewhat concerned about the focus of these programmes. For example, the Federation of Irish Employers, now part of the Irish Business and Employers Confederation submitted its new guidelines to the Health Promotion Unit of the Department of Health for comment. The Federation suggested the unit should refer to the significant role condoms play in inhibiting transmission of the infection. Yet I understand the wording of the forthcoming poster prepared by the Health Promotion Unit states that condoms can reduce the risk of transmission. Why does this not indicate what the unit knows to be the case, that condoms significantly reduce the risk of infection?

It is also interesting that of the two posters currently in preparation the first transmits a generic message: "Think positive; stay negative". The visual image is a negative print of a photograph of a crowd scene. The general proposition is effective and useful. The second poster targets heterosexuals alone with its message and visual impact. The Department has never produced, as far as I am aware, any information targeting gay men specifically. This is at least a highly dangerous omission. If one were to seek a siniter motivation the omission indicates the existence of official neglect and perhaps an element of discrimination.

There has been a 20 per cent increase last year of newly registered infections among gay men. Among the 74 newly reported cases of HIV infection which was sexually transmitted, 41 occurred in gay men and 33 in heterosexuals. There are 243 HIV positive gay men, 175 heterosexuals. In England, shamefully, a mere 2 per cent of the AIDS budget has been spent on the education programme for gay men. I ask the Minister if he has any information regarding comparative figures on per capita spending on prevention especially in relation to gay men in England as compared to Ireland.

I now turn to the rôle of the National Aids Strategy Committee. This was convened in December 1991 to draft recommendations on how best to approach the challenges posed by HIV and AIDS in the Irish context. It focussed on four main areas, prevention, health care and management, discrimination and epidemiology. The committee's representations were presented to the Minister for Health on 13 April 1992. The committee has not met since that date, as far as I know. Many members of the committee have expressed concern about communication procedures. In one glaring example, in June of last year the then Minister for Health, Deputy O'Connell, announced the abolition of the post of national AIDS co-ordinator and stated that the NASC would oversee the area in future. The first knowledge members of the committee received of this was when the announcements were made in the media. No meeting of the committee was called then or since that time. This must be rectified urgently.

An independent and representative body of experts must be appointed to overview the implementation of NASC recommendations without further delay. This group should comprise of one representative from each of the non-statutory and statutory agencies working in the field of HIV and AIDS in Ireland. This would amount to approximately 15 people. Groups should not be overloaded with civil servants who are answerable to the respective Ministers and as a result are not always seen as independent observers: the Commission on the Status of Women, the Ombudsman and the Advertising Standards Commission are appropriate models. In addition to monitoring the recommendations of the NASC, this body could make other appropriate recommendations from time to time.

During the budget debate the Minister for Health stated that he would introduce any NASC recommendations on a phased basis. The independent body could prioritise these recommendations objectively and, based on quarterly review consultations with the Minister and the National AIDS co-ordinator, oversee the proper executive of these measures. Implicit in what I say here is the necessity for the re-establishment of the post of national AIDS co-ordinator. In this context I pay tribute to the remarkable work courageously undertaken without fear of political repercussions by Dr. James Walsh.

My call for the re-establishment of the post of national AIDS co-ordinator is neither controversial nor partisan. Should anybody instance the question of budgetary constraints in funding such an independent body and the position of national co-ordinator, let me remind the House that the cost involved would be minimal compared to the average annual cost of £17,000 which a symptomatically ill person with HIV infection incurs to the Exchequer. However, Government, although frequently wily, is not always wise in making economies.

I have repeatedly indicated the vital necessity for the re-establishment of the Hirschfeld Centre which was previously so extraordinarily effective in combating the spread of HIV infection in the gay community. On several occasions I informed the House about the experience of the Danish Government which made 750,000 Kroner available to the gay community in Denmark for its AIDS programme. A capital grant of 1.5 million Kroner was given for the establishment of a gay community centre in the heart of Copenhagen. The Irish gay community was uniquely responsible for releasing the energy which led to the revival of the Temple Bar area, yet it alone of all groups in society is being systematically deprived of assistance. Such an attitude is shameful and discriminatory and ought not to be continued by present Government.

I pay tribute to the many heroic people living with HIV and AIDS who have, by their example, demonstrated how the human spirit survives in adversity. I think in particular of a valued friend of mine who, in the early days of the Hirschfeld Centre, ably assisted us both in the running of the discotheque and in providing counselling services to distressed gay people. From his hospital bed he has organised a group called Comfort AIDS which seeks to ensure that hospital patients with HIV, regardless of how they contracted the infection, receive sufficient practical assistance to enable them to continue their stay in hospital with an appropriate degree of dignity and comfort. I salute this true nobility of the human spirit and recommend such a humane attitude to those in Government charged with the responsibility to make decisions that so vitally affect the wellbeing of our community. I also pay tribute to the various organisations working on a voluntary basis and in particular to the work of Ger Philpott and AIDSWISE.

The reasons given by senior civil servants for not advising safe sex for gay men is because sexual relations between males remains a criminal offence in this country. Figures from the World Health Organisation clearly indicate the AIDS virus is transmitted in 70 per cent of cases by straightforward heterosexual intercourse; in the remaining 30 per cent transmission is by use of intravenous drugs, mother to infant transmission, incidental transmission through blood products and homosexual relations. Nevertheless the rates of infection in the gay community remain a cause for concern, especially in western countries. Moreover, the WHO has urgently called for decriminalisation of sexual activity between consenting males and equal ages of consent, not as a moral issue but simply as a health measure.

There is no doubt that political inactivity has contributed to the spread of disease in this country. However, I cannot find it in my heart to blame the present Minister who has shown energy and insight and I hope that these qualities will endure throughout his tenure as Minister.

In our last debate it was said that we needed somebody with the drive, energy and compassionate commitment of Dr. Noel Browne, who successfully combated the scourge of TB in the late 1940s. I believe that Deputy Howlin has these qualities and I hope I will be proved right.

Gay Health Action published a document in 1989 showing levels of unsafe sexual practices among gay men. The Government did not act. It was not until 1992 that the Eastern Health Board published similar data. One must ask why the Government waited impotently on the sidelines for three years and why the issue of the gay community is not yet sufficiently addressed. I welcome the recent recommendation for desegregation of HIV positive prisoners in our jails but the authorities still refuse to make condoms available to inmates citing criminal law in support of this evasion of reality. This is shameful.

There has traditionally been a focus on the spread of AIDS among intravenous drug users. This emphasis is appropriate but should not be exclusive. It is appropriate because the drug community forms a lethal bridge to the mainstream community. However, the drug problem should be addressed as a specific and separate problem which has, of course, an AIDS component. It should be treated comprehensively with a separate budget that does not drain resources away from other areas. We should establish a mobile unit as an arm of the free needle exchange to visit those areas to which the socially volatile drug community habitually resorts in order to provide clean needles and remove infected ones for destruction.

It should be remembered that alcohol is a drug and is a major factor in the transmission of the disease. Various eminent authorities, including Derek Freedman, have repeatedly indicated that when a major sporting event occurs in Ireland there is a subsequent significant increase in self-referrals to the STD clinics and in the incidence of STD.

I believe that the Department of Education should be prominently involved in this area. I appreciate the work done in this area by two courageous women ministers: the previous Minister for Education, Deputy O'Rourke, and the present Minister, Deputy Bhreathnach. The latter is to be congratulated on the factsheet distributed to post-primary students which frankly outlines the four principal routes of infection: (1) sexual, (2) blood products, (3) mother to child and (4) intravenous drug use. It is welcome that young people should be so informed.

We need, however, a better base of factual information on the epidemiology of AIDS if we are to mount an effective campaign against the disease. There has, for far too long, been a simple focus on AIDS and death. Perhaps the most significant figures are those in relation not just to full-blown AIDS but to the prevalence of HIV infection which would indicate the developing epidemiology of the virus. For example, figures on the spread of the disease are not available with a gender and age breakdown. We need to know how the situation is developing in order to target more effectively those groups at greatest risk.

Theoretically based mathematical models for the epidemiology of the virus have failed and this failure has given rise to unjustified optimism about the future course of the disease.

Acting Chairman

Senator, you have one minute remaining.

I have just two pages left if I could have the House's indulgence to finish them.

In fact, however, the future course of the development of the epidemic largely depends on our capacity to influence positively the pattern of sexual behaviour. The editorial in The Lancet of 3 April last year stated quite categorically that, despite the failure of the mathematical model and the consequent desire on the part of the British authorities not to face reality, if we do not act now as if there may be a heterosexual epidemic then there certainly will be one.

There is no cure for AIDS nor is there likely to be one in the near to medium term. AZT has, sadly, been demonstrated to be little more than placebo. A year or so ago I attended a lecture by Professor Luc Montagnier, of the Pasteur Institute in Paris, who discovered the AIDS virus. His contention was that HIV infection remains at its initial low level of concentration in the blood stream for a considerable time before converting to full blown AIDS. The mechanism which triggers the rapid increase in production of the virus is not yet fully understood but when this bio-medical nut is cracked it may then be possible to intervene with drug or chemical treatment to inhibit the triggering mechanism, thereby preventing conversion from HIV positive status to full-blown AIDS. As a result AIDS would become a disease like diabetes in which the patient would remain infected but control the illness to a satisfactory level on a constant basis.

In fact, I believe that as the situation develops we will see not an AIDS epidemic but an HIV epidemic. The incubation period is lengthening all the time —ten, 11, 12, 20 years. We do not understand yet the natural history of this disease. Even our figures for HIV infection currently are more like notional figures and represent a gross underestimate because they derive from link testing, something my colleague, Senator Henry will explain in greater detail. It is imperative that we develop an efficient methodology of response. AIDS, after all, may be only the first in a series of retro-viruses.

Disease challenges the status quo and, therefore, presents a uncomfortable dilemma for the bureaucracies involved. I will give one example from my own experience. A friend of mine, Jim Foster, whom I have known for over 20 years, was recently appointed health supervisor for the City of San Francisco. Because of Irish connections, his admiration for the work done in Ireland principally by the gay community in terms of AIDS and perhaps also his friendship with myself, he offered to make available free of charge £500,000 worth of aerosolised pentamidine which unlike AZT is undoubtedly effective and, used as a preemptive measure, can inhibit the development of pneumocystis cariniae in HIV positive patients. This extraordinary act of generosity was frustrated by the inability of the Irish health bureaucracy to respond appropriately.

In summary, I wish to make some further specific recommendations. First, an executive group should be established to implement policy on an integrated basis; second, civil servants should no longer be placed in the invidious position of making ultimate decisions in this area; third, a proper and distinct AIDS budget should be immediately established by Government; fourth, since it will not be economic to continue to rely on hospital services for the treatment of HIV positive patients, GPs must become educated and involved in the area; and finally, education is the most important element. Educational programmes must be sustained, and I quote Dr. James Walsh speaking recently in Cork: "Frenetic efforts from time to time do not work. There must be a sustained campaign." Moveover, in terms of sex education we cannot keep telling people only what they cannot do in their sexual lives. We must explain what they can do, and this means a clear, factual, explicit and easily understandable safe sex campaign.

I welcome the Minister to the House. I also welcome the fact that the present Minister for Health seems to have revitalised his Department's flagging interest in the campaign on AIDS.

This is one of our most serious public health problems. It is generally recognised that AIDS and HIV infection are grossly under-reported, not just here but internationally. I have figures for the most recent reporting of cases dated 19 March 1993. France has reported 22,939 cases to date while the entire Russian Federation has reported 111. With all due respect to the Communist system and the tremendous control it had over people, I suggest there is some curious under-reporting there, and that figures should be based on the incidence of either AIDS or the HIV virus.

I will begin with the free needle exchange programme. We have done well in Dublin with the free needle exchange programmes. In Dublin the incidence of the HIV virus among drug abusers is about 20 per cent. This is a figure with which many large cities in Europe and North America would be pleased. This is a great tribute not just to the staff who work in these clinics but also to the Eastern Health Board, of which I was a member when this was discussed quite some time ago. A similar programme had been set up in Liverpool which appeared to be successful, so the board took a practical decision rather than looking for the Utopia we all wish existing in the city, and decided because of the high incidence of intravenous drug abuse to set up these clinics.

Addicts come to the clinics because they do not want to be infected with the HIV virus. The clinics also try to get those who wish to get off drugs involved in suitable programmes and, from the public health point of view, it enables them to encourage drug addicts to lead a healthier life. It is well known that poor general health is a co-factor in the development of AIDS in people with an HIV infection.

It is essential, however, that there should be clinics near addicts' homes. It is no good having large numbers of addicts in one or two centres around the city. There are seven exchange sites at present but there should be more. It is important that these centres are easily accessible for addicts for the reasons I have given—not just the prevention of HIV infection but getting them off drugs if they wish and trying to improve the general state of their health. We can also encourage them to register with a GP— most drug addicts do not register with GPs. This is essential if we are to maintain the health of the general population.

Female non-drug abusers are at particular risk because they can get HIV infection through sexual intercourse and this can be passed on to their children. This is a very serious problem with which the maternity hospitals have to deal. AIDS cannot be tackled if we do not deal with the drug problem. In 99.9 per cent of cases AIDS is spread mainly by sharing needles and by sexual intercourse. The Commission on the Status of Women was extremely anxious that more attention should be paid to women with AIDS. There appears to be a significant under-reporting of the incidence of the HIV virus among women, perhaps because it is often not discovered until they are near death because of AIDS.

We will get a better idea of the incidence of AIDS in the heterosexual population because last autumn a non-linked programme was initiated to try to indentify the level of disease in the general population. I will explain what a non-linked programme is. In all maternity hospitals blood is taken to screen women for the rubella antibody—the German measles antibody. They now screen the throwaway blood for the HIV antibody. This gives us an idea of the incidence of the HIV virus in the heterosexual population and if it is done every year it will indicate the rise or fall of the HIV virus in the population. Since no names are involved, this is extremely satisfactory from an ethical point of view. This is most important. How can we provide treatment or set up prevention programmes if we do not have some idea of the incidence of the disease?

In 1991 Comhairle na n-Ospidéal recommended a minimum of four consultants in infectious diseases and genito urinary medicine in Dublin alone. St. James's has carried almost the entire financial burden of treating patients with AIDS in Dublin. Another consultant has been appointed to the Mater but what about the other two appointments? Has the Minister even considered appointing one for the north and one for the south of the city as recommended by the Comhairle?

Because of the very long incubation period of people who are HIV positive —ten to 15 years it is essential that general practitioners become involved. We cannot have people going to special clinics in hospitals for ten to 15 years to see what will happen next. The Irish College of General Practitioners should be involved in the monitoring of HIV infected patients.

As Senator Norris said—and he is learning a lot about medicine through sharing an office with me—AZT has unfortunately proved to be useless. As with viral diseases, people have to keep going until a vaccine is found. This is extraordinarily difficult because like the 'flu virus, the HIV virus mutates rapidly so that by the time a vaccine has been found, the virus has changed and a new vaccine is needed. There are two strains of the HIV virus of which HIV (2) is specific to Africa and countries associated with Africa. There is a long way to go before we develop a vaccine. Therefore, education and preventative measures are vital.

It is nice to say that never has faithfulness to one faithful partner been more important. The dangers are rather like those caused by syphilis in the pre-penicillin era. We forget the death toll from cardiac and neurological disease associated with syphilis. We should stop pretending that it is only teenagers who are involved in sexual activity. We are always talking about protecting the youth. It is ordinary everyday heterosexual adults who are at risk.

I recently chaired a meeting of RELATE, the marriage advisory services central body. Mrs. Maura Wall Murphy, the head of the mediation services here, who is not a woman noted for making dramatic statements, said that she could see, in pre-marriage courses in some years to come, one partner asking the other if he or she is HIV positive. I do not think that this was an overly dramatic statement.

Dr. James Walsh recently said that condoms do reduce the incidence of transmission of infection. I regret that some in the medical profession say that it does not. It is not totally effective but it greatly reduces the risk. He said the main cause of condom failure was lack of a condom.

It is virtually unknown for a patient to get AIDS or HIV infection from their doctor. There was a very curious case in Florida, where people were said to have contracted infection from their dentist. The president of the Irish Hospital Consultants Association said that he was misunderstood when he said that testing of patients may be needed. It has been known for health professionals to get AIDS from patients. In the US, doctors have told me that they consider a patient to be HIV positive until proved to the contrary and take precautions accordingly. We may have to take similar precautions here, with all the attendant expense.

The Minister has said in the Dáil that the last campaigns were low key. He used the word coy to describe them—indeed they were. I was looking at that advertisement depicting icebergs for a long time before I knew what it was, and I understand it was not clear to many others either. I hope that the Minister of State at the Department of Health, Deputy O'Dea, will tell the Minister for Health that I would like his next campaign to be far more explicit.

I listened to Senator Henry with great interest and I bow to her knowledge in this area. I want to comment on a few points that Senator Norris made. He regretted the absence of the Minister for Health, Deputy Howlin. I want to apologise to the House on behalf of the Minister, who is unavoidably absent on urgent Government business. It would have been his desire to be here if at all possible because he has a great personal commitment in this area. I feel confident that Senator Norris's high hopes of the Minister will be fully realised.

I did not mean my remark in any carping way.

I accept that. Senator Norris also made the point that many problems stemmed from the fact that sexual relations between consenting male adults is still an offence. I can assure the Senator that this will not be the case for much longer. The Bill has been prepared in my Department, is ready to go to Cabinet and we hope to see it in this session. I look forward in my other capacity, to taking that Bill through both Houses of the Oireachtas.

I hope the Bill will be initiated in this House.

I will bear that in mind. Senator Norris said that the National Aids Strategy Committee had not met for some time. It met in the last two weeks under the chairmanship of the Minister for Health, Deputy Howlin. Senator Norris also had a financial query about the percentage of the budget directed in a certain way. I do not have that information to hand, but I will obtain it and communicate with Senator Norris.

Thank you.

We are pleased with the terms of the motion and I would like to thank Senator Norris, Senator Henry and Senator O'Toole for tabling it and giving this House the opportunity to debate and support the Government's national aids strategy.

Ireland ranks well on an international basis, when comparisons are made with other countries in terms of population-rates for cases of, and deaths from, AIDS. In the EC in 1991, Ireland ranked eleventh of the Twelve member states with a case-rate per 100,000 population of 1.80. Spain tops the list with 10.40 cases per 100,000.

A total of 334 AIDS cases and 146 AIDS deaths have been reported in this country to date. The figures show, that of the 334 cases, 115 were homosexual or bisexual, 141 were intravenous drug users, seven were homosexual/bisexual/ IV drug users, 22 were haemophiliacs, 34 were heterosexuals, eight were babies born to IV drug users, one was a heterosexual mother (with no apparent connection with an at-risk group) and six were undetermined. Of the 334 cases, 146 have died and of the deaths, 47 were homosexual/bisexual, 53 were IV drug users, six were homosexual/bisexual IV drug users, 14 were haemophiliacs, 15 were heterosexuals, six were babies born to IV drug users and five were undetermined.

In addition, a total of 1,358 persons have tested positive for HIV. It is considered that this figure understates the true prevalence of HIV in Ireland and, on the recommendation of the National AIDS Strategy Committee, we have extended our HIV surveillance programme to include the anonymous, unlinked surveillance of HIV through the screening of bloods taken for routine clinical purposes at ante-natal clinics, which is surplus to requirements. We also propose to include in the surveillance programme, the testing of unlinked surplus bloods taken at STD clinics and at out-patients departments. This will be done on a phased basis.

The information from the surveillance programme shows that we must be vigilant and active in relation to AIDS/HIV and it is imperative, therefore, that the national AIDS strategy is responsive to the evolving epidemiology of the disease, in particular towards preventing its further spread. In addition, while we may rate favourably with other countries, statistics tend to hide individual human suffering and it is imperative that we have the appropriate framework available to care for and manage those individuals who have contracted the disease, and to ensure that they are not discriminated against or stigmatised in any way.

The Minister for Health and I are committed fully to developing an AIDS strategy which is responsive to our needs. To ensure that this happens, we have in place effective planning, implementation and review structures, which are addressing the serious public health and social challenges which AIDS/HIV represent. The Minister for Health is directly involved in the development of a comprehensive and integrated national AIDs policy in terms of prevention, care and management and anti-discrimination.

In view of the significant impact of IV drug use on HIV in this country, I am also involved in the AIDS strategy in my capacity, as chairperson of the National Co-ordinating Committee on Drug Abuse, which liaises closely with the AIDS strategy committee. The National AIDS Strategy Committee, of which the Minister is chairperson, has developed a number of strategies to implement national policy goals on a priority and on a multi-sectoral basis. Senators will be aware of these strategies which concern the care and management of persons with HIV/AIDS, education and prevention strategies and measures to avoid discrimination.

The implementation of the strategies, which received a major additional investment of £3.3 million during 1992, is currently being undertaken by statutory and voluntary agencies. A sum of £4.4 million has been allocated specifically for the HIV/AIDS strategy during the current year. This has facilitated the delivery of a range of innovative services and programmes aimed at stemming the spread of the infection. These include primary care clinics for IV drug users at which preventative and risk-reduction services such as methadone, needles and condoms are available on the basis of individual counselling and assessment; the provision of a consultant-led HIV/AIDS service in the Mater and Beaumont Hospitals and hospice and palliative care for persons with AIDS.

This £4.4 million is, of course, additional to the general funding provided for the care and management of persons with HIV/AIDS through the mainstream health services.

Senators, in their motion, have pledged their support for the Government and the Minister is pursuing an active and explicit public information campaign on HIV/AIDS.

Preventative programmes by way of information and education on HIV/ AIDS are an integral feature of the ongoing work of the Health Promotion Unit of the Department of Health. This element of the national AIDS strategy will be developed further with the implementation of a multi-media campaign on HIV prevention which will be launched by the Minister this month. In that regard we will keep Senator Henry's suggestion in mind. This campaign will be very intensive and will involve TV and radio advertisements. The campaign will promote the need to practise safe sex and the role of condoms in this area. In this regard, I accept that previous campaigns have been rather coy in relation to the role of condoms and the need to practise safer sex and these issues will be dealt with openly in the new campaign.

In addition, the Government has decided to amend the Health (Family Planning) Acts to liberalise the availability of condoms and the Minister for Health proposes to bring a new Bill in this regard before the Oireachtas in the near future. The key feature of the Bill will be the removal of restrictions to supply condoms via vending machines and this will be a major and significant step in the fight against AIDS. The Minister indicated to the Dáil yesterday during Question Time that he hopes to have that legislation published to coincide with National AIDS Day.

Also in the area of prevention, the HIV-risk reduction methadone programme is being extended. This is aimed at intravenous drug users in line with the recommendations of the expert group established to draw up a protocol for methadone prescribing. The protocol will ensure that methadone is available to intravenous drug users in an accessible and controlled manner.

Intravenous drug users still represent the largest number of persons infected with HIV. Interventions aimed at both containing the spread of the infection and caring and managing infected individuals are, therefore, to a significant extent targeted at this group. This is particularly so in the Dublin area where the intravenous drug problems of the early 1980s have precipated the present intravenous drug-related HIV problem there.

In order to provide an integrated approach to the problem, the HIV and drug use services co-ordinate closely and these include needle exchange through the primary care clinics for HIV/AIDS/ intravenous drug use in Baggot Street and Ballyfermot. The health board has needle exchange programmes in five other locations also.

It is intended that the primary care clinic framework will be developed further to ensure that the appropriate risk-reduction services, such as needle-exchange, are available and easily accessible, in a controlled manner.

I would like to refer to the question of discrimination against persons with HIV/AIDS, in my capacity as Minister of State at the Department of Justice. The National AIDS Strategy Committee made recommendations in this area and I am pleased to report to the House that two of the main recommendations of the committee are being addressed. They are the descriminalisation of homosexuality and the segregation of prisoners with HIV. The Government is currently considering the former and the Minister for Justice, on Monday last, announced that the recommendations of the high-level committee established to advise on the question of HIV would be published and implemented on a phased basis.

The House will be aware from what I have said that the Government is active in the fight against AIDS and is introducing the measures proposed by the Senators to ensure that the spread of HIV is curtailed.

Again, I thank the Senators for tabling the motion which I support and commend to the House.

I welcome the Minister to the House and I support the motion moved by Senator Norris, Henry and O'Toole. In view of what the Minister said recently, we are witnessing a major change in relation to the fight against HIV in this country. The Minister for State at the Department of Justice chaired the recent strategy committee meeting on 22 April, an indication of how strongly he feels about the HIV and AIDS problems. He moved quickly after coming into office to ensure his proposals were implemented.

When I examined the numbers of deaths in this country from AIDS I found that from February 1993 to April 1993 18 new cases of AIDS were reported and there were three deaths. Any action we take to prevent a death in any sphere of Irish society is worthwhile. The 8 per cent increase in AIDS cases since the beginning of 1993 is serious and needs to be examined.

The number of deaths from AIDS when compared to other countries is not high but our national population level is lower than most. However, we have not been to the forefront in taking action to ensure that the disease itself is properly tackled. Anything we can do to avoid one death from AIDS is to be welcomed. Regarding the attitude to condoms in this country I have never heard of anyone dying from the use of a condom whereas many people have died because they did not use one. I knew people who died from AIDS and there is dreadful human suffering associated with such a death. Some of those I knew were very loveable people and it was not by choice that they died from AIDS. Much compassion needs to be shown to people with AIDS and we must do whatever possible to prevent further deaths.

I have sympathy for people working in hospitals because they do not know when someone who is HIV positive is going to come in for treatment. A HIV positive person may not have been indentified as such and staff are put at risk when dealing with them. Many people will not identify themselves as HIV positive to the authorities because of fear of discrimination and of social ostracision. The sooner a programme is implemented to identify people who are HIV positive the better.

Do people with AIDS get proper care, especially in the latter stages of the disease? They do not seem to have received the consideration they deserve. We should organise a service similar to the hospice movement to make life easier for AIDS sufferers. These people accept with dignity the fact that they have a horrible disease and we should do whatever possible to help them.

The policy announced by the Minister in relation to prevention, care and management of AIDS is to be welcomed. Not enough is done in the area of needle exchange and it would not cost a fortune to supply free needles. If it prevented one death it would be worth the cost. In addition, condoms should be supplied free to people infected with the virus because usually they cannot afford them.

The figure of £3.3 million in addition to funds allocated last year to fight the spread of AIDS is welcome. The extra £4.4 million this year is also to be welcomed. It is a small amount of money when compared to the money lost in recent financial scandals.

More education and training should be given to AIDS counsellors. One-to-one counselling is very important for people who have notified the authorities that they have AIDS. In counselling an AIDS sufferer may reveal the names of others with AIDS who are not prepared to come forward. Counselling is very important to make life easier for sufferers and to help them accept their situation with dignity.

The health education programme thankfully is to be very explicit; we have seen too many Irish solutions to Irish problems. Regardless of the attitude of some right wing people to the supply of condoms it is important that condoms be supplied through vending machines and that people be educated through television and radio about the spread of AIDS. We have sat behind closed doors for far too long doing nothing to intervene. It is very important that people be educated to practise safer sex through the use of condoms. I welcome the Minister's decision to allow the supply of condom vending machines. I am sure that if, in five or six years time, they have stopped the spread of AIDS or the number of deaths from AIDS in this country, this move will be welcome. As I said, if we can avoid one death it would be welcome. I welcome the Minister's commitments and I have no doubt he will honour them.

An all-party committee in the House of Commons came to the conclusion that the best way to avoid contracting AIDS was to practise celibacy outside marriage and faithfulness in marriage. The committee said that everybody should strive towards this goal to which I subscribe. Unfortunately, many people cannot attain that goal and we, as legislators, must provide for their needs. In 1986 I voted in the Dáil to make condoms available to people over 18 years of age. As a result, I received appalling abuse from the public. However, we have come a long way since then. We have a more open society now and people are prepared to accept that there are problems associated with sexual behaviour, and the main one is AIDS.

The Minister said today that Ireland was lucky because it ranked eleventh of the Twelve member states in terms of the number of people who have died from AIDS. I attended a health conference in Bundoran last weekend and Dr. Joe Barry, who has responsibility for the AIDS programme in the Eastern Health Board area, of which I am a member, read a paper on the subject. He mentioned another league to which the Minister did not refer, that is, the list of the number of intravenous drug users. On that list we did not come second last but very close to the top. I see merit in this motion because intravenous drug users using dirty needles are a problem in society. I accept the need for needle exchange centres, but I agree with Senator Henry when she said that we need more centres. Indeed, these centres should be established throughout the country.

I wish to speak about the methadone programme to which the Minister referred. I wrote to the Minister yesterday on this subject because, at present, we have only two methadone treatment centres in Dublin, one in Ballyfermot and one in Baggot Street. We need more centres around the city. It is wrong that so many people can go to only one centre for treatment. Local communities must accept these centres. The local communities I addressed are prepared to accept treatment centres for people who live in their catchment area, but not for people from other parts of the city. I hope the Eastern Health Board will be able to open more methadone treatment centres and needle exchange centres in Dublin.

There is an interesting article in The Daily Telegraph today. I did not intend speaking on this motion. However, I saw the article by Geoffrey Wheatcroft and I read it with interest. The heading is: “AIDS: Much Better If We Had Been Honest From The Start”. In it he blames the British Government for spending too much money in an early campaign against AIDS. It reads:

The Government has decided to scale down its campaign against AIDS, which was aimed at everyone indiscriminately. In a reversal of policy, efforts will now be targeted at high-risk groups. This is an admission that the long-prophesied HIV epidemic among the general population has not taken place.

He also says that in the last year for which figures are available, the British Government spent £121 million in the fight against AIDS. This was only a little more than was spent on the programme to fight cancer. I do not know if the facts in that report are true——

They are not.

The Senator read the article too? I hope our AIDS programme concentrates on high risk groups. If Exchequer money must be spent, it should be in the fight against the spread of AIDS. I support the motion, especially while it calls for more methadone treatment centres and needle exchange centres around Dublin.

I welcome the Minister of State, Deputy O'Dea, to the House and congratulate the Minister for Health, Deputy Howlin, on the steps he is taking to combat this terrible disease. Unfortunately, in many cases this disease is self-inflicted. It is sad to see people inflicting suffering on themselves and, in some cases, infecting innocent, unborn children.

Thousands of years ago a wise man wrote 77 words in ten short sentences. For generations people of all religions in this country obeyed those ten sentences. However, I have not heard them recently and, as a result, our moral standards have deteriorated.

I agree with Senator Doyle and Senator Henry that the only way to avoid AIDS is to have sex with one faithful partner and to remain faithful to that partner. Unfortunately, we do not live in a perfect world and we must do the best we can. Although I welcome vending machines which make condoms available, I doubt if they will solve all our problems.

Recently, a priest told me that when he was a curate in Liverpool 30 years ago there were many unwanted pregnancies and people demanded that condoms be made available. Now, 30 years later there are still many unwanted pregnancies in Liverpool. I will not quote the figures because they might frighten Senators. Nothing is safe unless it is 100 per cent safe, and condoms are not 100 per cent safe. They may prevent unwanted pregnancies in some cases, but they are not 100 per cent safe.

We need better education programmes in our schools. Unfortunately, we show pupils the bright side of life — discos, girls drinking pints of lager, etc., but that is fantasy land. At present secondary school pupils are brought to the spring show, to museums or on cultural trails, but we should bring them to Mountjoy Prison to show them the inside of a prison and how people suffer if they do not adhere to a certain code of practice. Perhaps we should bring these children to rehabilitation and detoxification units in our hospitals to see how these young people are suffering. As the old saying goes the best gamekeeper is a poacher.

Perhaps it would benefit our young people if those suffering from AIDS talked frankly to them and explained how recklessness ruined their lives. It only takes one mistake to ruin a life. I spent years using a shotgun, but, in one split second, I left myself seriously injured. Many competent motorists have fatal car accidents. Often a person sitting in a bar enjoying himself does not realise that the horses and plumes are on their way to collect him. Death can result from one simple mistake. Although improvements have been made to cars and they are equipped with advanced brake systems the number of car accidents have not decreased.

If one were to ask young people whether they would want members of their family to engage in casual sex with different partners their answer would be no. People must learn to enjoy life but not to abuse it.

The abuse of alcohol is the forerunner of many of our social problems, including that of unwanted pregancies. Often women become pregnant because they were drunk and did not know what they were doing. In this way, people also run the risk of becoming infected with the AIDS virus.

We need better life skills programmes. People need to be educated but should not be told that if one uses a condom one can have sex every night of the week. That will not solve the problem. People cannot continue to live promiscuous and reckless lives. The human body can only take so much. In the words of the recitation one will end up "in the bughouse ward, with a life staked out on death".

I have been a member of a health board for 20 years and I find it sad to visit rehabilitation units where young people are recovering from car accidents that could have been avoided. Many of these young people are kept alive by machines and are unable to move. Their lives have been ruined because they wanted one more drink. In the words of a poem: "One for the road", the young man said, "One for the road that lies ahead".

People infected with the AIDS virus must become involved in education programmes to persuade young people that they must not lead reckless lives. If they do they must be prepared to accept the consequences which are a damaged immune system and the risk of infection.

The Minister for Justice must introduce severe penalties for those who threaten the public and, particularly, members of the Garda Síochána with infected needles. These people should be sentenced to 20 years hard labour. We must put an end to that behaviour. We have taken a soft approach for too long. The Minister must be encouraged to introduce the necessary legislation — and I am sure this House will support him — to forbid this type of blackguardism with a disease that is incurable.

I wish the Minister success in his efforts to prevent the spread of this disease. It is sad so much money must be allocated to combating a self-inflicted disease, money which could have been spent on other health problems.

I welcome this motion moved by Senators Norris, Henry and O'Toole. The tone of this debate has been more constructive and balanced than some previous debates we have had on similar matters. We are making welcome progress in that regard. The Minister's reply fits in well with the motion and with the tone of the debate.

There seems to be an assumption in certain parts of Ireland that AIDS does not exist. It is seen as an urban problem or as something affecting other countries and not holy and virtuous Ireland. That is not the case. Statistics reveal that AIDS is a problem in Ireland and that previous statistics have understated the situation. Perhaps we should ask questions about our ability to assemble statistics for example, not only in respect of AIDS but also for example, in relation to suicide where figures have been seriously understated for many years.

There is a stigma attached to the problem of AIDS and consequently people are reluctant to concede the extent of the problem. A Deputy said there was no sex before the invention of television which is not an original statement.

The key to solving this problem is education. Young and old must be made aware of the consequences of certain types of sexual behaviour, of unprotected sex, etc. It is disquieting to learn that AIDS can be spread through heterosexual sex. This would indicate to Government that there is an urgent need to ensure that sufficient education and information is made available to alert people to the gravity of the situation.

I share Senator Norris's view that sufficient information is not available and greater efforts must be made in this area. However I was encouraged to see that members of the Eastern Health Board visited Newbridge College, a school in my locality and assistance was also received from the Department of Education for AIDS education.

There is the suggestion, in some quarters, that it is undesirable for young people to be exposed to these realities. I do not subscribe to that view. It is necessary to expose them to these realities. Senator Norris, who is in frequent contact with students, will agree with me. Young people are more aware than we were at their age and are capable of accepting and absorbing information without some of the hang-ups we may have had.

Senator Henry made the point that sexual activity is not confined to young people. She conjured up visions of geriatric sex. If people can enjoy that, more power to them. This illustrates that education should be directed not only towards people at school or at third level institutions but at the wider community. The phenomenon is a relatively new one and people of an older age may not be as aware as they should be of the possible consequences of their actions.

The Minister's statement that the law applying to condoms will be changed is welcome. This move is long overdue. Condoms should be freely available.

On radio the other day I heard Ruth Riddick speaking about abortions. She explained that a recent survey found that a high proportion of respondants did not use protection when they knew they should. That needs to be taken into account. It is not true that because condoms are freely available HIV and AIDS will necessarily be reduced because, in practice, they will not always be used. This is not to suggest that the legislation should not be changed because the measures proposed are welcome. Reference has been made to methadone and the needle programmes and I support those measures too.

The idea that because one sins against a particular moral precept, one must accept the consequences and reap the whirlwind is something I reject absolutely and cannot understand. It cannot be said of these who are unfortunate to contract HIV or AIDS, that they deserve it because of promiscuity or the fact that they were drug addicts. Nobody deserves to be condemned to a future with HIV, and nobody deserves to be condemned to death from AIDS. That is not what I understand morality to be and it is important to make that point.

This is primarily a health problem and it should be addressed as such. Every measure should be taken to reduce the effects of the disease and to ensure that the cost to the State, apart from the health of the individual which is important, is reduced to the degree that it is possible to ensure that people are not condemned to a long stay in hospital and that we do not have to introduce an elaborate and expensive panoply which would be necessary in the event of the spread of this terrible disease.

I have a certain sympathy, however, with the remarks made by Senator Farrell. I have sympathy for the gardaí. It is horrendous that any person involved in protecting other citizens and in protecting the law should be subjected to these kinds of threats and the people who make them should be treated as the worst type of criminal. I would not confine them to bread and water because I do not believe that is the way to rehabilitate them. However, they should be put in prison for a long time to pay the penalty. There is an onus on us to ensure that the guardians of law and order are protected. We have reached the point where the balance of advantage has been taken from the gardaí and given to the criminals. As a university student I recall seeing Garda "Lugs" Branigan in the Olympic Ballroom. He parted the hordes like the Dead Sea to take three people who were in front of the band stand into the back alley and rendered his own justice. Nobody protested. I am not suggesting that we return to those days but I believe that the balance has gone too far in the other direction.

I welcome this motion and support it. I particularly welcome the language used in the motion — words such as "open", "clear", "specific", "explicit" and "factual". We need to use that kind of language and to adopt the kind of approach it implies. For years we have fudged sexually related issues and this does not serve the people of this country. I am pleased that we are treating these topics in a straightforward manner.

Like other speakers, I believe that the part of the motion dealing with education and information is important. I am pleased that later this month there will be a series of television and radio advertisements about condoms and other aspects of HIV and AIDS. As the Minister, Deputy Howlin, said they will not be coy; they will be direct and explicit, as the motion calls for. This is particularly important in relation to young people, although I take the point made by other Senators that it is not only young people who are sexually active and who are exposed to HIV and AIDS. However, young people often try to give the impression they they know more than they do especially when they are with their peers. Nevertheless they often do not know how to get the kind of information they need. It is important therefore that there is a programme of information in the media and in schools. Like Senator Henry, I am pleased that schools are acknowledging this and that a fact sheet for post-primary students is available. I am also pleased that, schools are providing information and education about HIV and AIDS.

I congratulate the gay community for all their work in this area over the years, not just at the Hirshfeld Centre in Dublin, but also around the country. When the authorities were slow to take action, the gay community were an example to the rest of us when it came to tackling the problems related to HIV and AIDS. I welcome the wider availability of condoms through vending machines, following the enactment of legislation. People should not have to go to chemists and doctors to get condoms. I agree with Senator Norris that the decriminalisation of homosexuality is as important for health as it is for civil liberties. When something is declared to be criminal it has certain connotations which would make it less easy to discuss the kind of issues we are considering today.

Regarding the use of needles and the provision of clinics, Members said there were only two clinics at the moment and that others are to be established. I hope they will not be based only in Dublin, even though the problem of dirty needles is largely confined to this part of the country. The need for people who suffer from AIDS to know where to go, wherever they live, must be acknowledged. I accept that there cannot be clinics all over the country. However, I support calls by other Senators that GPs should be trained and that there be an approach to the Irish College of General Practitioners in that respect. There are many dedicated GPs who treat patients who are HIV positive or have AIDS and refer them where necessary. However, not all GPs are so sympathetic. Regarding the NESC recommendations and the further development of programmes, Senator Norris spoke about using the knowledge of groups who are experienced and expert in this field.

I welcome the motion and support it.

I support the motion in the names of Senator Norris, Senator Henry and Senator O'Toole. I think it is a timely motion, especially in view of the reply given by the Minister for Health in the Dáil yesterday. I have read that reply and it has changed my attitude, in some respects, towards Government policy on the serious question of AIDS.

AIDS is a killer disease and the numbers who are HIV positive or infected with AIDS are growing in this country. Ireland has the unenviable distinction of having the highest proportion of babies born with HIV virus. The number of people who have contracted this deadly disease through heterosexual activity is also growing. The task facing us is to muster all possible forces to halt the spread of the AIDS epidemic. The motion is good in so far as it supports the initiative being taken by the Minister for Health, in that regard.

Some aspects of this issue are blown out of all proportion. One in particular which struck me recently was the idea that the medical profession should amend its ethical guidelines so as to require doctors who are HIV positive or who contract AIDS to report their condition to the director of community care in their area. There is no evidence to suggest that any patient has ever become HIV positive or contracted AIDS from a doctor, not is there any likelihood of this happening in a normal doctor-patient relationship. Some of the media reporting of the handful of cases involving doctors with the condition has been sensational but, given the public fear about AIDS, there is a need to reassure patients that there is no danger. The most effective way to do this would be to require doctors to report their condition in confidence to the director of community care.

AIDS became a major health issue in the late 1980s and will, unfortunately, be a health issue for the 1990s. People with AIDS are normal people who have contracted a deadly disease in a variety of ways. The Government must show that their response to this matter is not complacent but is active, preventative and caring. This motion aims to support the Minister for Health and for Government for the initiative they are taking.

I know there have been some policy changes but, as I have said previously, the introduction of a national AIDS taskforce would be an excellent and serious policy decision. There is no point in the Government saying that the Irish AIDS problem is not too bad and that the number of people infected here with AIDS or HIV compared with in other European countries, is not high. That is not what we want to hear. We want positive action in this serious matter which not only affects the people who have the disease but their families also.

Are we serious about tackling the AIDS epidemic in this country? If we are honest with ourselves, the answer at present appears to be "no". I say this since there is no good reason for not establishing a national AIDS taskforce. I was a member of the Southern Health Board for a number of years and the Cork AIDS Alliance made a submission to the board during that time seeking to establish a front against AIDS and HIV. They asked for integrated co-operation between voluntary and statutory bodies. We must recognise that tremendous work is being done by the voluntary bodies and should be given every possible support.

There is a feeling abroad that the Government's information and preventative programme is complacent and dominated by the values of one religious group. Information is preventative. Ignorance of AIDS and HIV kills and the publicity campaign of 1987 which included billboards, TV, newspapers and the local health centres was a good effort at imparting information. In the Minister's reply given in the Dáil which I have read he stated that:

A prevention programme by way of information and education on HIV/AIDS is an integral feature of the ongoing work.... The campaign will be very intensive and will involve TV and radio ads.

That is what we want to see. It amazes me that the Department of Agriculture, Food and Fisheries, can regularly rerun advertisements drawing the public's attention to the danger to farm animals from dogs on the loose, or that the Department of the Environment regularly advertises to warn the public of the dangers of drinking and driving yet the Department of Health confines its warnings on AIDS to small posters hanging in medical clinics.

There is a great need for information on this subject and it is the Government's responsibility to provide the most effective and sensible public information. If nothing else is achieved by this debate at least the Government will be informed that there is dissatisfaction with the manner in which the issue has been handled, and a demand for a new initiative. The co-ordination of voluntary and the statutory bodies is essential in this regard.

I welcome the Minister of State to the House.

AIDS is a reality and there is no turning the clock back 20 years and saying it never happened. It has happened. The statistics that the Minister of State has given us in the break down of cases show that AIDS is not confined to any one group, to any age group, to haemophiliacs, homosexuals or intravenous drug users but affects people throughout the community.

We must act now to halt the spread of the disease by doing everything we can to educate young people so that they will not fall into fatal traps. In many ways I agree with Senator Farrell's view that, although it may not be fashionable, the only remedy may be to be faithful to one partner. We have to face the reality that this is not what most young people do and as other Senators have said, older people are no saints either.

Senator Henry outlined the frightening fact that the HIV virus is mutable, in other words changeable, and therefore is resistant to a single remedy. It also seems that the incubation period of the virus is indeterminate and that it can lie dormant for many years before something triggers it to become full-blown AIDS. That means that many people in the community are carrying a dormant HIV virus and do not know that. They may have been infected ten or 15 years ago and the problem may not surface for many years to come. That is a sobering thought.

We must ensure that all GPs have a rudimentary knowledge of the disease. The limited treatment available at present to ease the suffering of those with full blown AIDS must be available to all. A person living in a remote area should have access to the same treatment as a person living in Dublin. Therefore, I ask the Minister for Health to ensure that each health board organises training programmes for GPs so that there is a GP available to anybody who is HIV positive or who has full blown AIDS, if not in their own immediate area, at least within easy travelling distance. It is unreasonable to expect a person to travel 40 to 50 miles when in poor health to avail of the limited treatment currently available. Such training programmes would not require much funding.

Geographical areas which appear to be at risk should be identified. Dublin and the larger cities stand out as areas prone to a high incidence of the disease. The same is also true of ports and other places where people intermingle. A previous speaker pointed out that following international sporting events there is a rise in the number of sexually transmitted diseases referred to STD clinics. The same would apply to rock concerts and other large gatherings of people. There is an equally strong likelihood of an increase in the numbers of persons infected with the HIV virus. Therefore, each health board should be aware that a three day event with 5,000 young people congregating in an area may result in an increase in the numbers infected with the HIV virus a few months later.

Another aspect referred to by Senator Sherlock which will have to be addressed is the rise in the number of children born with the HIV virus. Unfortunately, many of these children have died but more will grow up to be carriers of the virus. People will have to know how to deal with these children. They should not be ostracised but nevertheless, special care should be taken of them when they start school because of the risk, slim though it may be, of their transmitting the disease inadvertently to other children. Teachers and other carers have to be aware that this problem will worsen. We should not allow our religious beliefs to prevent us from having a practical approach to the treatment and curbing of AIDS. Condoms are a preventative measure and should be widely available to all regardless of age. Those old enough to be sexually active are old enough to use a condom. They should be told that it is not good to engage in sex with numerous partners and should be educated on the use of condoms. This would contribute to preventing the spread of AIDS.

I congratulate the Senators who tabled this motion. A Dublin publican recently installed a condom vending machine in a toilet on a Friday afternoon. However, there were no condoms in it as none were available. By Monday there was £60 in the machine but nobody had complained to the publican. The machine had been installed in a ladies' toilet.

We cannot plead ignorance on this issue. It is a sad reflection that we are only eleventh of twelve EC states with a case rate per 100,000 population of 1.80. The general public are under the impression that we are not even twelfth; they think it does not happen at all. There is one EC country with a lower rate than ours.

I am glad the Minister is supporting the motion. As a father of seven, I do not want to give the impression that it is acceptable to have more than one sexual partner simply because condoms are becoming more widely available. However, I make no apology for saying that condoms should be used by sexually active people. We had a major argument in this House and the other House no more than 18 months ago as to whether 16 or 18 should be the minimum legal age for using condoms and we decided on 17 years. We must face the reality that young people are sexually active and make condoms available to them as a matter of urgency. The growing number of single parents is a problem. Condoms may help to reduce this incidence.

It is a very sad reflection that we regard one group as different. How are they different? Their difference is in sexual orientation only. I am surprised at the numbers of people who have died of whom 47 were homosexual or bi-sexual and 53 were drug users. Those statistics worry me. As a former Lord Mayor of Cork, I was involved in tackling the drugs problem.

AIDS is a massive problem which could result in the extermination of 25 per cent of the population of some countries. We did not act fast enough when we saw what happened on the west coast of America seven or eight years ago. We are prepared to say anything to avoid giving the impression that we have a problem. We have many problems, such as unemployment, our health services and crime, but AIDS is a problem which is going to get worse. Even the Minister admits that the problem of people with HIV is only being dealt with slowly. We do not know, exactly, how many people are infected. Slowly but surely, the practice is emerging that if a person gets a blood test — for example, when applying for an insurance policy — the sample is checked for the virus.

Sadly, we, as a people, are not prepared to face up to the problem. We prefer to give the impression that it is a problem which only affects homosexuals. Homosexuals are, undeservedly, blamed for the problem. They have learned that it is advisable to stay with one partner. We should give homosexuals the assistance and recognition to which they are entitled because if we do not, we will be compelled to do so by the European court. As a nation, we should face up to our problems and give these people every assistance.

A needle exchange scheme has been introduced in Dublin and in Cork. Had we said, five or seven years ago, that drug users were to be given clean needles, people would have been shocked. Yet this is a fact of life; we have to do it.

I am glad the Minister mentioned prisons. There have been many deaths and other incidents in the prisons. I know the Minister is examining this and I hope this issue will be resolved shortly. It is wrong to say that what has happened in our prisons is not the Government's fault; it is. We must ask how the drugs and needles got into prisons and if enough is being done for people in prison. We must also ask if we are really committed to solving the drug problem. I wonder if it can be solved.

Cork is a small city; no more bigger than a decent town. I would probably be amazed if I learned the identity of those despicable people who are supplying young people with drugs. I cannot understand how these people never seem to be brought before the courts. I would emphasise the importance of ensuring a strong commitment to solving this problem.

I read with interest the commitments of relevant Ministers to solve problems in area of tax and social welfare areas. The same type of commitment should be given when it comes to dealing with drug pushers. Under no circumstances should young people be able to procure drugs for supply to others. Whole families can be involved in drug supply. People in the immediate area know what is happening and, understandably, are nervous.

"Access" is the important word in the motion. When we are giving access, will we get the people who are doing wrong? There is a shortage of staff in the Garda Síochána experienced in dealing with the problems of drugs or the HIV virus.

I congratulate the proposers of the motion. I am delighted that everybody wants to substantiate what has been said in the motion. The best people to educate us in this area are the homosexuals who were blamed for the problem initially. I congratulate them and I hope that, in the future, we have more constructive debates on homosexuality. It is important that we would always keep in mind that the greatest danger to our young people is drug.

I welcome this motion. I compliment the proposers for their bravery on putting down this motion. Had they done it 20 years ago, they would have been castigated as people with obscene minds and blasphemers.

We had problems two and a half years ago.

I was coming to that; I was starting from a historical base. Youth was mentioned and, as the youngest member of the Oireachtas, I want to add a word of caution. A parish priest once wrote that condoms were only 90 per cent effective. What consolation does this give to the 10 per cent who are either infected with the disease or faced with the possibility of infection or pregnancy? While condoms should be widely available and their use should be encouraged, education and information on the transfer and spread of this disease is vital if we are to prevent its spread. It is impossible to estimate how rapidly this disease is spreading. We know of approximately 1,360 cases. Sadly this disease is being transmitted on a daily basis.

I remember a heated debate about the sale of condoms in chemist shops. There are not many chemist shops in this country open 24 hours a day. Sexual activities take place mainly at night and people do not always go out with the intention of having sexual intercourse so it is vital that condoms are made available to people who intend to have sexual contact.

As regards education I know of a person who recently contracted the HIV virus having slept with three girls and he is not sure from which one he contracted it. That is the sad reality. This man is university educated yet he did not have enough information. The current educational programme is not getting through to young people. A recent Sunday World article said the young now see AIDS as an old homosexual's disease. That paper might be called a rag newspaper but it does research its information. While condoms may be the route to solving this problem, people must be educated on how the disease is transmitted, and contracted and how it can be avoided.

AIDS can definitely be avoided by not having homosexual or heterosexual intercourse. Unfortunately in the real world people have sex on a regular basis. It is vital that people be discouraged from having sex with partners whose sexual background they do not know. Condoms will solve most but not all of the problems. We must spend more on the provision of education and information. The use of condoms is the most direct way of slowing the spread of the disease but it will not stop it.

I call on Senator O'Toole. I understand you are sharing Senator Norris' reply time. Is that agreed? Agreed.

I am delighted and amazed this debate has produced so much consensus. Our first debate on this subject was about two and a half years ago and it was a difficult debate because one had to speak in specific and explicit terms about sexual matters. At that time Senator Norris organised a briefing session for Members of the Oireachtas in Buswell's Hotel, which was fully attended. Whatever differences there have been among Members we have always been united in concern about this question.

I would like to pick up on some of the points made by Senator Kelleher. AIDS education is the joint responsibility of home, school and State agencies; it is not the sole responsibility of any.

In recent times my own organisation, the Irish National Teachers Organisation responded to the Green Paper "Education for a Changing World". In its proposals it indicated to the Department of Education and to the Minister that there was a need for teacher education on AIDS. The current response is inadequate. Teachers have not been educated to deal with AIDs which is sensitive area and one in which parents must be fully involved. The tackling of the problem must be directed and controlled by State agencies with the appropriate information, research and statistics.

Certain conservative forces in society will oppose AIDS education but this is to be expected. Parents, teachers, people in authority and public representatives are concerned and it is rare to find this degree of concensus. We must formulate an initiative.

Girls are reaching puberty at a younger age than some years ago, many reaching it at primary school. This may be reflective of world trends. Sexual activity is starting at an earlier age and so is experimentation with drugs. We have had difficulties in Dublin with certain people offering easily obtainable drugs to the young, trying to create dependency. Those two facts require information about AIDS to be available to the very young. It would be a major mistake not to tackle this problem before early adulthood or late adolesence.

In order to educate children about AIDS we begin with information, develop awareness and create confidence. Scare stories do not work. Danger attracts. There must be a long slow education process on sexuality, personal development and physical protection. The child must be told it has the authority to say no or yes, depending on the context. The child must be able to make an assessment. If a child learns to judge he or she will be able to do so in adolescence and in adulthood.

This process must begin at school and in the home, with a real contribution from State agencies. They have not done so to date. Agencies are saying the right things but there is no evidence at primary or at post-primary level of the preparation of teachers through in service education to tackle this problem. Parents must be encouraged to accept this development, which is for the protection of pupils. I welcome the consensus on the motion and I thank Senator Norris for making his time available to me.

I have been moved by the quality of the debate here this evening, particularly as it is a matter close to my heart. I hesitated in putting down this motion when I discovered my Private Members' Time was scheduled. I had put it down before and I have also spoken on sexual morality on a number of occasions in this House. On the last couple of occasions when I have had Private Members' Time I raised the question of the establishment of a foreign affairs committee. By now I have a reputation for speaking on numerous subjects, sometimes perhaps ad nauseam, some Members may feel. In that context my view of the importance of sexuality will not be considered unbalanced. I speak with feeling because I am burying friends of mine at the rate of about one every six weeks. AIDS is impacting directly upon my life.

It was pleasurable to hear the excellent contributions from all sides of the House. This has been one of the best debates in which I have been privileged to take part. I should not single out any speaker but the contribution that gave me the greatest pleasure came from Senator Farrell because I frequently disagree with him and his talent as a colourful storyteller has been used in ways I do not always approve. This evening, although I disagreed with some of the emphasis, particularly on those whose infection was self-inflicted and so on, he dealt with the topic in a sensitive way. He used his storytelling talent to register concern about the tragic human cost of this disease.

I welcome the Minister's clear speech and his commitment in a number of areas. It is noticeable however, that there is a lack of assistance for the gay community, except in the area of law reform. I applaud what the Minister said about the decriminalisation of homosexuality. I hope this comes about. The Minister for Justice indicated in her appalling memorandum that there were two options, one of which was not decriminalisation and was exactly what the World Health Organisation has indicated would be a complete catastrophe for this country. It is the kind of lunacy propounded by the self-styled Family Solidarity. I did not grow on a tree. I am part of the human family, whatever they think. That organisation has not shown much solidarity with me, nor much common sense.

The other option is the decriminalisation of homosexuality. I was glad the Minister said this was what the Government was considering because that way lies real common sense.

I am glad the surveillance of HIV through the screening of blood taken for routine clinical purposes at anti-natal clinics will commence, as will the testing of unlinked surplus blood taken at STD clinics and out-patient departments. It is important to say that as a gay man because sometimes gays are seen to be opposed to this kind of testing. I have no mandate to speak for the gay community, but I speak as a gay man who has taken a responsible position for the past ten or 12 years since this virus was first identified. Not only do I not object to this development but I welcome it. It is a positive step.

I do not need the Minister's assurance that gay people will not be stigmatised by this Government. Even when Mr. MacSharry was Minister for Finance the Government introduced a marvellous protocol which protected people against discrimination on the basis of sexual orientation or HIV status and allowed them to work if they had full blown AIDS. That demonstrates that Ireland is not a nasty, backward little country. The Irish have a proud record of compassion, tolerance and decency and they should be given credit for it.

With regard to Ireland's ranking in Europe, Greece is twelfth and just beats us. It is not something to be proud of because that is in the context of the European Community countries only. There are 33 countries in Europe and although we are in the first ten, we are not as good as we think although we are not as bad as other people may imply.

I acknowledge the presence of Dr. James Walsh in the House; he has played an important role in combating this disease. Dr. Walsh pointed out that the media campaign must be a sustained one. It is not sustained: a two week media programme is not a sustained programme and we need more than that. I am delighted that everybody, from the youngest Member of the Oireachtas, Senator Kelleher, to the oldest, about whom I will not speculate, indicated their support for the Government's action and I join in that support.

There is ongoing research into AIDS in St. James's Hospital and Dr. Fiona Mulcahy has done wonderful work in that area. Gerard Philpott, of Aidswise, who is in the House this evening, has produced the best information sheet I have read. Perhaps the Minister would like a copy. It is clear, accurate and explicit. It also contains some of the advice offered by more conservative Members:

Celibacy — Abstaining from sex is a sure way of avoiding this route to HIV infection; the more partners you have, the greater the risk of having intercourse with someone who is infected with HIV.

It is full of common sense and genuine morality.

Education is vital. There is no cure for AIDS but prevention is better than cure and the way to prevent the spread of this disease is to educate people about it. Condoms are effective; I believe they are 98 per cent or 99 per cent safe.

This idiotic notion that the AIDS virus can somehow squeak through a hole in the latex is absolute nonsense. The virus exists in the molecule of water and it cannot travel without that. The molecule of water is considerably larger than the virus. Let nobody say that the virus is 100 times smaller than a sperm and thus can squeak through the latex; that is idiocy and it should not be promulgated. People should be warned.

Senator Farrell said that we still have car accidents despite safety features like disc brakes and safety belts. Is that an argument for throwing out the safety belts and disc brakes? We must use the sexual equivalent of disc brakes and safety belts. I thank the House for this evening's superb debate.

Question put and agreed to.

When is it proposed to sit again?

It is proposed to sit at 10.30 a.m. on Thursday, 6 May 1993.