Seanad Éireann debate -
Thursday, 30 Nov 2017

Vol. 254 No. 11

World AIDS Day: Statements

Minister of State at the Department of Health (Deputy Catherine Byrne)

I thank the House for providing me with the opportunity to speak to Members on this important topic in advance of World AIDS day tomorrow, 1 December.

HIV is one of the most stigmatised conditions of our time. In September, I opened the national HIV conference hosted by HIV Ireland which focused on this stigma. The conference examined how the stigma of HIV/AIDS is an additional burden on the lives of people living with a diagnosis. People living with HIV can face judgment, rejection and hurt. HIV Ireland’s survey shows that one in four are not comfortable with their own HIV positive status, one in three have been rejected in a relationship due to their HIV status and worryingly almost one in five people living with HIV felt suicidal in the past year. The challenges for people living with a diagnosis cannot be underestimated.

Stigma can also be a barrier to talking about HIV and getting tested but when we create a safe space to talk about HIV, we protect everybody. The opportunity to talk to the House here today helps raise awareness of AIDS and helps us to confront the challenges of this disease. Sharing knowledge and information are important to our prevention and health promotion strategies that act to protect people from infection. The reality is that a diagnosis of HIV for a person has a long-term impact on their lives but we must strive to reinforce HIV education, awareness, prevention, testing and treatment. It is undeniable that these are all important aspects of dealing with the challenges of HIV.

I welcomed the recent publication by the HSE Health Protection Surveillance Centre of the HIV in Ireland report for 2016. It showed a reduction in the number of diagnoses by 6% in 2016 when those with a previous HIV diagnosis were excluded but there is always concern that accompanies chronic diseases such as HIV.

I remain concerned at the number of HIV diagnoses in 2016. Just over half of these 508 new diagnoses were among men who have sex with men and this group remains the most affected by HIV in Ireland. We must focus on dealing with the level of infection of this at-risk cohort.

The publication of our first national Sexual Health Strategy 2015-2020 provided the opportunity to ensure that all efforts across the entire range of sexual health - from awareness, education, training, access, treatment and surveillance - are co-ordinated, evidence-informed and based on best practice. We continue to implement our national sexual health strategy in this context. The strategy itself is set within Healthy Ireland, the national framework for action to improve the health and wellbeing of the country over the coming generation. Implementation of the strategy is in all of our interests.

The national sexual health strategy has been developed against a backdrop of a changing Ireland regarding sexual behaviour and sexuality in recent decades. This changing landscape is evident in legislation introduced in recent years, and more openness generally in attitudes and culture around sexuality and sexual health issues.

The strategy was developed based on three goals. Everyone in Ireland will receive comprehensive and age-appropriate sexual health education and information and will have access to appropriate prevention and promotion services. Equitable, accessible and high-quality sexual health services, which are targeted and tailored to need, will be available to everyone, and robust and high quality sexual health information will be generated to underpin policy, practice, service planning and strategic monitoring. The strategy recognises the diversity of sexual identities. It supports all expressions of sexual identity through positive sexual health and wellbeing outcomes. Governance structures for implementation of the national sexual health strategy have been established. The HSE sexual health and crisis pregnancy programme is the national programme charged with developing and implementing a national strategy to, among other things, improve the effectiveness and impact of sexual health services and preventative work. The programme is responsible for developing and implementing an action plan for each year of the strategy. A clinical lead for sexual health has also been appointed in the HSE.

The HSE sexual health action plan for this year specifies a range of actions being taken under the auspices of the national sexual health strategy. These include: actions related to clinical services such as completing and implementing outstanding practice guidance for HIV testing in various settings, including home HIV testing, point of care HIV testing; and the use of antiretroviral therapy in HIV prevention to include pre-exposure prophylaxis, known as PrEP, treatment as prevention and post exposure prophylaxis.

I am pleased to advise the House that a HSE recommendation on antiretroviral therapy for all people living with HIV in Ireland was signed off by the HSE leadership team on the 25 July. The HSE recommends that all HIV infected individuals attending HIV services in Ireland are offered antiretroviral therapy as soon as possible and informed of the benefits of antiretroviral therapy in improving their personal health and reducing HIV infectiousness.

This was circulated to clinical services and community organisations and is available on the Health Protection Surveillance Centre website. A patient information leaflet has been prepared in English, Portuguese, French and Spanish and has been sent to all clinics providing care to people living with HIV.

A HSE multisectoral PrEP working group is continuing to work on recommendations around the introduction of PrEP in Ireland. Work to date includes a report on the estimated number of people likely to avail of PrEP in Ireland in the first year, which has been submitted to the Health Protection Surveillance Centre, and the development of national standards for the delivery of HIV prevention and PrEP care.

I also want to mention the Know Now project, which is a community HIV testing project. It has been successful in reaching people, particularly men who have sex with men, who have never been previously tested for HIV. During the pilot in 2016, a total of 1,465 tests were conducted in Dublin, Cork and Limerick.

The report of the third annual Healthy Ireland Survey of 7,500 people aged 15 and over and living in Ireland is directly relevant to this. It gives an up-to-date picture of the health of the nation and reports on many lifestyle behaviours such as sexual health. The Healthy Ireland Survey reported that over the past year, 21% of respondents reported having had a HIV test during their lifetime, 12% of men who have sex with men had a HIV test in the past 12 months, and 28% of men who have sex with men have had a test during their lifetime. This is the first time we have asked about HIV and sexually transmitted infection, STI, testing in this kind of survey. I am pleased to note that most people were happy to answer these questions and give us this information. This is indeed a welcome development. We also know that younger people, especially men who have sex with men, are an important at-risk group, and the survey shows that these were more likely to have had a test. Again, this shows that the stigma around testing is probably reducing and that our work to make testing more accessible is having an impact.

Surveillance is also crucial for this infectious disease, and HIV monitoring and reporting have improved over the past year. This is in line with meeting Ireland's obligations to report on our national response to the HIV epidemic to the European Centre for Disease Prevention and Control as part of the Dublin Declaration Partnership to Fight HIV/AIDS in Europe and Central Asia, and to UNAIDS-WHO as part of the UN General Assembly Political Declaration on HIV and AIDS. The HSE has advised my Department that Ireland is in the top ten in Europe on achieving the target that 90% of those estimated to be living with HIV are on treatment. This is indeed welcome.

Actions related to communications and information in the HSE sexual health action plan include the provision of targeted information and campaigns to at-risk groups and a communications working group targeted at men who have sex with men is now in place under this heading. Members include representatives from the Gay Men's Health Service, the Health Protection Surveillance Centre, and the Gay Health Network. The latter is a network of organisations and individuals in Ireland providing the national resources, response, support and expert network for the promotion of HIV prevention and of sexual health and well-being for gay and bisexual men and for men who have sex with men.

We know that enormous progress has been made in the treatment of people infected with HIV. Earlier testing and treatment mean that life expectancy is similar to that of the general population, thus bringing it into the realm of chronic diseases. Such therapies aside, however, the key challenge is to prevent the disease from occurring in the first place. HIV-AIDS is, after all, a life-changing disease. We must work together to strengthen the prevention arm of our national sexual health strategy in this context.

I want to emphasise another point to the House. The close working relationship and engagement of voluntary and community groups with the HSE sexual health crisis pregnancy programme and its national clinical director have been central to the implementation of our national sexual health strategy. This partnership helps to strengthen the implementation of the strategy, which is having an effect on dealing with the challenges of HIV. We have more work to do in this area. We must protect our population and especially at-risk groups from infection. I assure the House that my Department and the HSE are working closely with our partners in the voluntary and community sector to deal with this. Efforts will continue in line with our strategic perspective and policy enshrined in our national sexual health strategy.

I will finish by saying that I have visited many services in my role as Minister of State with special responsibility for the national drugs strategy and I have been very impressed by the work being done on the ground, particularly by community groups, to remember above all those who, sadly, have passed away from HIV. I have also been impressed by the work being done to educate young people to protect themselves, especially when it comes to sexual activity. The celebration of World Aids Day tomorrow, first introduced by the United Nations on 1 December 1988, is very important to the Government, to the Department of Health, and indeed to all of us here. It is very important that we as a nation continue to do more than our best to make sure that there will be no stigma around HIV in the future. Above all we must protect those with HIV and ensure that they live lives as long and healthy as the rest of the population.

An Leas-Chathaoirleach

I call Senator Ned O'Sullivan. He has six minutes.

Senator Ned O'Sullivan

Go raibh maith agat a Leas-Chathaoirligh. I will not actually require that much time.

An Leas-Chathaoirleach

Is that right?

Senator Ned O'Sullivan

I welcome the Minister of State to House and compliment her and her Department on the very good work that they are doing in this very important area. I agree with her that this debate will help highlight the problem of AIDS and it is hoped it will assist people to come forward and not be afraid of any stigma attached. We had a very pleasant session here just now as we complimented our colleague, Senator Norris, on reaching a very important milestone as the longest serving Senator in the history of the country. He and people like him did fantastic work to remove the stigma that existed around homosexuality in this country and offered great courage and leadership at a time when there was not such understanding and tolerance as there is today. I am sure that there are thousands of people in this country today who owe Senator Norris the fine, open lives that they have been able to lead as gay people.

It is fitting that we should be discussing AIDS today. There should be no stigma attached. It is a disease like any other that can and should be treated and we should encourage people to come forward for treatment. I cannot pretend to be in any way expert in this area, but I have here a paper that was prepared by my colleague, Senator Swanick. With the Leas-Chathaoirleach's permission I will read it to the House, though I do not generally like reading scripts.

Fianna Fáil is happy to mark World Aids Day 2017 with its slogan of "Everybody Counts". In 2017 the World Health Organization is highlighting the need for all 36.7 million people living with HIV and those who are vulnerable and affected by the epidemic to reach the goal of universal health coverage. We commemorate World Aids Day to mourn the deaths of more than 35 million people who have died as a result of HIV, a number which rivals that of lives lost in the First World War, remarkable as that seems. This occasion also serves as a way to spread awareness and knowledge of the disease and, finally, as a mark of solidarity towards the tens of millions of people who are fighting the disease all over the world today, including almost 8,000 in Ireland alone.

Under the slogan "Everybody Counts", the World Health Organization will advocate for access to safe, effective, high-quality and affordable medicines, including medicines, diagnostics and other health commodities as well as health care services for people in need, while also ensuring that they are protected against financial risk.

At a national level this topic is as prevalent, if not more so, than ever. Record numbers of people were diagnosed with HIV in Ireland last year amid concerns that a growing ambivalence about the disease is putting increasing numbers of people at risk. Today we acknowledge all the progress that has been made in recent times. A recent study by The Lancet suggests that with modern treatment, a 20 year old who begins treatment for the disease may have a life expectancy as high as 76 years, marginally behind that of average life expectancy. In 2000, just 685,000 people living with HIV had access to antiretroviral therapy by June 2017, around 20.9 million people had access to the life-saving medicine. Such a dramatic scale up could not have happened without the courage and determination of people living with HIV demanding and claiming their rights.

Although we can celebrate such progress we must continue to work towards reducing the prominence of HIV/AIDS in Ireland. Newly-released figures from Ireland's Health Protection Surveillance Centre show that 512 people were diagnosed in 2016, of which 77% were male and 23% female. There are two sides to the continuous rise in the number of infections in Ireland. First and on a positive note, the rise in new diagnosis is partially credited to the improving screening process that has come into play in recent times. Although the main reasons for the rise in the contraction of HIV/AIDS are underlying problems that have been highlighted by international charities as well as experts in the field, such as the use of recreational drugs and engagement in unprotected sexual activity.

During the past number of decades, many people all over the world have been vocal in their efforts to raise awareness of this global problem, such as former world leaders, billionaires and celebrities. We are lucky to have our fair share of Irish representation, who are tirelessly fighting to end the global epidemic. Bono's thoughts on the matter, which were revealed in an interview in The Irish Times last year can be condensed as follows:

Battle against AIDS is not a last decade issue. It's going to be the next decade issue.

This quote aptly fits into our present social landscape where collectively the contraction of such diseases is not deemed much of a threat among the younger generation. This is a serious problem that must be addressed. Some weeks ago our colleague, Senator Fintan Warfield, and I commend him, held a briefing on the pre-exposure prophylaxis, PrEP. According to a recent article by Una Mullally in The Irish Times, public health experts in Britain are now forecasting the end of the HIV epidemic. Sexual health clinics in London are reporting a 40% drop due to frequent testing, rapid treatment and the game changing drug PrEP, a preventive medication which means that those taking it cannot be infected. However, this may not be available under the HSE payments scheme until 2019. This delay might see up to 8,000 new infections. Health groups have warned about this.

We should use today to praise the work done in efforts to defeat the disease but also to realise that there is a lot of work left to do. I ask the Minister of State, Deputy Byrne, and the HSE to continue to ensure that PrEP is available under the HSE payment scheme.

Mar fhocal scoir, many well-known celebrities who shared the fact that they were HIV infected deserve great credit. It was those people who made the likes of me aware of how serious this epidemic was. Many of them have passed to their reward. I think their courage was a good example for all of us. We have to stand together. Where there is an illness of any sort in any sector of our community we all empathise and worry about it. I have no hesitation in saying that my party will support the Minister of State and her Department in every possible way in her good work in this regard.

Senator Colm Burke

I welcome the Minister of State to the House. It is very important that we have a debate on this matter because it is a very important issue, where progress has been made in the past few years but we still have further progress to make. My colleague, Senator Ned O'Sullivan, and the Minister of State have highlighted that there has been an increase in the number of people diagnosed in the past 12 months, in particular in 2016. The number of cases in 2016 was 512, which is up from 485 in 2015. I saw figures up to June 2017, which would indicate that the figure of 512 may be exceeded in 2017. I suppose we need to highlight the issue and make people aware of the risk. The one good side, to which my colleague referred, is that life expectancy has totally changed in the sense that a 20 year old, who would have started treatment back in 2008, has a life expectancy of up to 76 years. That is a significant change from where we were at.

From the figures on diagnosis, 50% of the people diagnosed were from outside of Ireland. That is an issue in a multicultural society, if one considers that there are 800,000 people living in this country who were not born here. A change of population will always bring new challenges. I believe we are dealing with that in an appropriate way.

I had the privilege of going to Kenya when I was Lord Mayor of Cork in 2003. There were more than 250,000 people living in appalling conditions in shanty towns just outside Nairobi. At that time more than 40% of the residents in that town had HIV. The problem was that a large number of people were not surviving beyond their early 30s. At that time there were more than 700,000 children in the country where both parents had died. That was the challenges that the country had. Much progress has been made in all of those countries in the past few years, in the same way that progress has been made here in Ireland.

I wish to raise the issue of the drug Truvada, by a company called Gilead Sciences Inc. This drug is proving to be very effective. It is available in Ireland in pharmacies, but it costs €400 per month. It is not available under the treatment purchase fund. The members of Young Fine Gael had a meeting with the Minister of State in September and they raised this issue. They have raised this issue on a number of occasions in the past 12 months. My understanding is the company has applied for the drug to be included under the drugs refund scheme. There is a fast track process for any drugs that is coming on the market, where it can be examined by the appropriate authorities in the HSE. They decided, detailed in a letter of 18 September, that a full pharmaceutical economic evaluation be undertaken of this drug. What I am concerned about is that this process may take anything up to six months.

The 90 day clock has started to run and the company obviously has to provide very detailed analysis to the pharmaceutical economics evaluation authorities. I have met a number of drug companies in the past two years, where they are asked for all the documentation. They may have to submit a dossier of up to 300 or 400 pages for it to stand up to scrutiny. I do not understand that, in particular where this drug has already received approval from the European Medicines Agency. We should try to fast track the process because the benefits are there. The evidence has already been established that this drug is effective in preventing infection. I am concerned that it has not been available. The people most at risk are those whose partners already have HIV. It is important that this drug would be made available at the earliest possible date.

I ask that the matter is taken up with the Department so we can fast-track the process to see whether it is economically a good decision. All the evidence is already there. It can help people and help to make sure those who are likely to be exposed can be dealt with and provided the necessary treatment in a timely manner.

Senator Fintan Warfield

World AIDS Day presents an opportunity for the global community to evaluate its fight to eradicate HIV and AIDS. In 2016, HIV transmission rates in the State exceeded 500 for the first time since records began, bucking a trend of reduction among our European counterparts. According to statistics from the Health Protection Surveillance Centre, HPSC, we are on course to have an even higher rate of infection in 2017. We not only live in a society that has failed to eradicate HIV but our response is allowing the infection to remain largely uncontained. It is no secret that those who are particularly vulnerable to HIV in Irish society are some of those who have been traditionally marginalised, such as men who have sex with men, migrants and sex workers. If this was an issue that affected the more privileged in our society or the elites rather than the marginalised and vulnerable, I suggest our historical response would have been much different.

The sexual health strategy 2015-2020 was launched by then Minister for Health and now Taoiseach, Deputy Varadkar. The strategy recommended the HSE provides accessible STI and HIV testing for all sexually-active adults. However, the only targeted and tangible responses in providing accessible testing are Dublin-centric and run on shoestring budgets like the Gay Men's Health Service, GMHS, which was recently found to be based in a condemned building on Baggot Street. The Minister's recent visit there would have confirmed that.

Another commitment in the sexual health strategy was to provide antiretroviral therapy in HIV prevention. Pre-exposure prophylaxis, PrEP, is a step forward in the fight against HIV. PrEP can provide near-100% protection from HIV. The High Court has ruled that generic versions of PrEP are now free to the market here, meaning that truly effective prophylaxis for many of those vulnerable to HIV infection is now within our grasp. It is within the grasp of the State and Government.

As part of the fight against HIV and AIDS, we need accessible testing in order that those who are carrying transmittable HIV unknowingly can be found and treated and those who wish to access effective prophylaxis can do so. When the Taoiseach addressed Dublin Pride this summer, he told the 30,000-strong crowd that "the time absolutely is now to act up to the sexual health challenges that we face". I welcome members of ACT UP Dublin to the Public Gallery. ACT UP Dublin is a diverse, non-partisan group of individuals who are united in anger and committed to direct action to end the HIV crisis. Ba mhaith liom fáilte a chur roimh gach duine go dtí an díospóireacht seo.

At Dublin Pride, the Taoiseach went on to commit to seeing the strategy come to fruition. Will the Taoiseach live up to his commitment and will the Minister, Deputy Harris, make available the necessary investment? Will the Minister comment on the Government's plans to deliver accessible and targeted STI and HIV testing to those who are vulnerable? Will he respond to the vision set out in the sexual health strategy and properly and adequately fund our sexual health responses? As generic manufacturers of PrEP now start to apply to the HSE for reimbursement, can the Minister give a commitment that the Government will provide generic PrEP in the near future along with sufficient clinical support?

Our bleak and somewhat embarrassing response to HIV rates has gone on for far too long. The Minister mentioned that HIV Ireland held a conference in Smock Alley to mark 30 years since its foundation. Well-known LGBT activist, Tonie Walsh, who joins us in the Gallery today, gave an insightful presentation on how similar memorials in Toronto and New York gave their respective LGBTQI communities a place to memorialise loss and grief, which allows them to better value and share the coping mechanisms and survival strategies of a previous generation. A physical site of remembrance will serve as a place to grieve and remember loss and give hope for the future in a time of significant advancements in treatment and methods of prevention. For the State to create and locate a memorial through appropriate consultation will be significant. It would signify a commitment to HIV prevention and will act as a tool of acceptance by the State of those living with HIV when previously it served on the side of stigma. I say all that with an expectation of this dream being realised. My experience and friendship with those involved in realising this dream has led me to believe they have been on the right side of history. People like Senator Norris, who this month has served 30 years and eight months in the Seanad, has been a constant inspiration. He has served on the right side of history and, along with many others, has waited around for everyone else to catch up. Will the Minister of State consider supporting the proposal of a HIV-AIDS memorial? Will she discuss it with us today and commit to having this conversation with the Department?

Senator Grace O'Sullivan

I pay tribute to Senator Norris, the longest serving member of the Seanad, and Senator Warfield, the youngest Member of the Seanad, who have both been the strongest advocates of justice and rights for groups facing AIDS and HIV. I compliment them on their work in the Seanad.

World AIDS Day has been a sombre occasion of commemoration and remembrance since its beginning in 1988. It has also always been about a day of anger and action and of calling for a better approach to the prevention and treatment of HIV, especially within high-risk communities. Its devastating effects during the 1980s through to today are obvious to all. We thankfully are looking upon a different vista today, one in which a diagnosis with the disease is no longer the death sentence it once was. Drug regimes and changes to the way we treat patients, as well as the disease itself, have helped to alleviate its medical implications as much as social change has relieved the stigma. Nonetheless, the fight continues on both these fronts. I echo the statements of Senator Warfield and others in their call for access to pre-exposure prophylaxis, PrEP, medication for people at a higher risk of contracting the disease in Ireland. We can see in the major cities of the United States and the UK, the immense impact that regular use of the drugs has had on HIV infection rates. Daily PrEP usage reduces the risk of contracting HIV by more than 90% and when used with other preventative measures can create even greater safety. Sadly in Ireland, we have seen no such progress. The drug remains difficult, if not impossible, to access for many people who would like to use it. This is combined with the staggering record high levels of new diagnosis here in Ireland last year, with 512 new cases of the disease. This reflects the increase year on year since 2011, a more negative aspect in the decline in stigma related to the disease. Despite the fact it has always been a disease that affects all parts of our society, the fact that it affects gay men especially cannot be contested, as 77% of new cases are male. This is precisely the community that can benefit from an increased access to preventative medication. The recent court finding in the case initiated by Gilead regarding the use of generic alternatives to Truvada is a huge potential boon to Ireland, offering the prospect of access to medication that is 60% cheaper than the brand name version. Irish trials of PrEP users have begun this month in Dublin but will not be providing the drug to participants. Access to the drug remains the preserve of those with enough money to access it.

That cannot continue. Any who need further convincing on this front should note that a recent UK study in the medical journal The Lancet has examined the cost-effectiveness implications of the use of the drug. Its conclusion speaks for itself. It states the analysis suggests the introduction of a PrEP programme for men who have sex with men in the UK is cost-effective and possibly cost-saving in the long term. It also states a reduction in the cost of antiretroviral drugs, including the drugs used for PrEP, would substantially shorten the time for cost savings to be realised. This drug saves lives, lowers infection rates, lowers the cost of treatment borne by the public purse and improves the lives of those at the highest risk. It will soon be 60% cheaper. What possible reason can we have left not to provide it?

An Leas-Chathaoirleach

I want to vary the order very slightly. I was to call on the Minister at 1.41 p.m. It is now 1.41 p.m. so I ask the Leader whether we may extend the debate for a few minutes.

Senator Jerry Buttimer

If it is agreeable to the House.

An Leas-Chathaoirleach

Is that agreed? Agreed. We shall extend the debate for five minutes.

Senator Jerry Buttimer

I will not take all the time. It is important to welcome the Minister of State and her willingness to be involved in this debate. As Leader, I believe it is important to have a debate on a day close to World AIDS Day, which is tomorrow. As former Chairman of the Joint Committee on Health and Children, of which the Minister of State was a member, I recall we always had hearings and meetings on HIV/AIDS on the most suitable date closest to World AIDS Day, both to raise awareness and to create a profile for the work being done by many in the LGBT community and society. I commend all those doing such work and who are very active in this regard.

I commend the Minister of State on her work and the role she is playing. Ms Deirdre Seery, who is now retired, was doing considerable work when employed in the Sexual Health Centre in Cork.

The age group we must educate and to which we must reach out is becoming younger. I am old enough to remember that HIV-AIDS was a life sentence. It affected many of our friends. Today we should pause to remember many of our friends and members of the gay community who died. It is important that we recognise that work is being done proactively.

We can bookend this debate by examining the fact that today, whether one is in Panti Bar in Dublin or Chambers in Cork, there is rapid HIV testing taking place. This is a gargantuan change even by comparison with what was done five years ago. There is more work and outreach to be done. It depends on the model one wants to adopt in terms of bringing forward new, progressive thinking on eradicating HIV/AIDS from society. If when watching "Reeling in the Years" one compares how people with HIV/AIDS were treated by Ronald Reagan and George Bush in America with how they were treated in our State, which one may argue has a very poor record, one notes our State was much more embracing of members of the gay community. That said, the HIV survey shows that one in five men with HIV feels suicidal to this day. This figure is too high. All of us know people, including friends, who are suffering from the physical and mental effects. Stigmatisation continues.

As somebody who travels around the world - I am going to Washington DC next week to speak at an international conference - I note the issue of PrEP has been mentioned a lot today. On a personal level, I very much believe there is a need for it to be made available. I acknowledge it is available on prescription at a cost of €400 per month, but not everybody has that kind of money. This raises a question that I may not be popular for asking. Young men, in particular, have to question their own sexual behaviour. This might not be popular to say and it might be old-fashioned on one level, but saying it is about ensuring that everybody does count. I agree with Senator Warfield that there are those of a different socio-economic background who are more vulnerable, to whom we need to reach out more and for whom we need to do more work.

I have not spoken to the Minister of State for a while about this. I am very supportive of the concept of a national AIDS memorial, not least because it would be a visible reminder of those who died. I have been at the memorial in Toronto. I am not an artist so I cannot describe it properly. It is lovely but it reminds people in a very stark way of those who have died. The carved words, about remembering, life and death, are important.

Our debate today is partly about those who work so diligently. It is also about remembering those who died. It is about those who are battling with HIV every day, and it is about ensuring more people do not become infected. There is work being done. I do not agree there has been a failure to respond but I believe it is important that we work collaboratively to ensure we increase the profile and investment and that we work with communities and outreach organisations. I thank the Minister of State for attending.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I thank all the Senators who have taken time out to be here in the Chamber to speak about the importance of World AIDS Day tomorrow and in the years ahead.

I congratulate Senator Norris on opening our eyes and for the service he has given to the Seanad. He opened our eyes to the need for people to understand what is occurring and to be taught about people who have an illness. He opened our eyes to the possibility of speaking freely about AIDS and other sexually transmitted infections. We would not have done this in the past in this country. We now can, partly because of what Senator Norris has done in his time here in the Seanad.

I welcome ACT UP Dublin. I visited the GMHS service in Baggot Street Hospital. I was overwhelmed by the extent of the service being given but I was shocked at the conditions in which the staff have to work. I have raised this previously and will continue to do so.

My door in the Department is open to any group that wants to come and talk to me about a memorial or the drugs payment scheme. I have no problem with that at all. I am only too anxious to continue on this journey we started to help those who have been marginalised and stigmatised for so long in society. As Senator Buttimer said, we have to do a lot more work to be able to identify those affected. People are very reluctant to speak openly about their illness and to be identified, not only in their own communities but also in their homes and among their families.

None of us could stand in this room and say nobody cares about the plight of people with HIV and the journey they have travelled. I have known Senator Buttimer for a long time. We sat on the health committee together when he was a Deputy. He and I constantly debated certain topics. When I became a Member in 2007, I was struck by how comprehensively he could speak about the services being offered. He reminded us, including in our party, of what needed to be done. We all have a real opportunity, along with ACT UP and other groups, to continue to make life a little easier for people who for so long have been left in the wilderness. As long as I am in the position I am in, my door will always be open. I am willing to listen, engage in discussion and respect the fact that there are certain things we will be able to consider doing in the short term and long term. My invitation to the groups who want to come in stands. I am sure my staff will be able to facilitate them.

I hope we can continue on this journey together. To all the Senators who have spoken, and many who feel the same way, keeping this on the agenda is very important not only on World AIDS Day but continuously through our political lives. I thank the House.

Acting Chairman (Senator Gerry Horkan)

I thank the Minister of State for her thoughtful conclusion. We were both members of the regional authority together a long time ago. It is hard to believe that it was pre-2007 but it was and you are very welcome back to the Seanad. I thank the Minister of State and all the contributors.