Vol. 399 No. 7
2 Mr. Yates asked the Minister for Health if he has satisfied himself that adequate care and support is being provided to patients with HIV and AIDS; if he has any specific proposals to provide specialist services for their needs; and if he will set out the Government's plans in relation to control of the AIDS epidemic.
AIDS Strategy in Ireland is being developed in line with the epidemiological situation related to AIDS in this country and in line with the recommendations of international agencies such as WHO and the EC and strategies being implemented elsewhere. In line with these recommendations the emphasis on the provision of AIDS related services is community based, in so far as this is appropriate, with the necessary input from the hospital services. Also as part of general policy persons suffering from HIV/AIDS are treated in the same way as persons suffering from other diseases so as to avoid discrimination.
The Government's AIDS Strategy consists of the following key elements:—
Monitoring Cases of, and Deaths from AIDS and trend in HIV Infection
Cases of AIDS are monitored by the Department of Health under a confidential reporting system. An AIDS antibody service is available on a voluntary basis, throughout the country. The level of HIV infection is monitored, as far as possible, by the Department of Health through the reports of the virus reference laboratory, UCD, where confirmatory testing is carried out.
Prevention through the Protection of the Blood Supply
All blood donations are screened for the AIDS virus, and only heat-treated blood products are used in Ireland. Ireland is the only EC member state not to have had a transfusion related case of AIDS or HIV.
Prevention through Information and Education
The Health Promotion Unit of the Department of Health and the Department of Education have developed materials for an AIDS programme for second level schools. Pilot testing of the materials began in September 1989 in various schools throughout the country and pending completion of the evaluation currently in progress, the programme will be available nationwide. In the meantime, DCC MOHS of the health boards are co-operating with local school authorities to ensure that information on AIDS is provided to pupils in second-level schools.
At the level of the general population, a public information programme started in May 1987 through television, radio and newspaper advertising and a booklet and freephone service. A revised up-to-date booklet on AIDS was issued in January 1990 and is available through pharmacies, health boards, the EHB's AIDS resource centre, voluntary agencies and the Health Promotion Unit of the Department of Health. The personal worries and queries of individuals are also being addressed through a confidential telephone service.
Care and Management of Persons Suffering from AIDS and from HIV
As I stated in the outset, it is my policy that persons with HIV/AIDS are treated and managed in the same way as persons suffering from other diseases so as to avoid discrimination. Towards the end, persons with AIDS are treated in general hospitals by the appropriate consultant depending on the nature of the symptoms from which the individual may be suffering. General practitioners also provide a source of care and counselling for people who wish to be tested and who have a positive test result and community care teams of the health boards, together with the voluntary agencies, play a central role in the provision of necessary services.
Also, the following have been provided as part of the development of the Irish AIDS Strategy: a capital grant of £380,000 has been given by the Department of health towards the further development of the virus reference laboratory, UCD; the participation by Ireland in an EC study of paediatric AIDS towards which a grant of £30,000 was made by the Department of Health to the AIDS fund; allocations totalling £1 million approximately have been made to date from the national lottery towards the funding of statutory and voluntary agencies involved in the provision of services for persons with AIDS and HIV. These include the Eastern Health Board's Outreach Programme — which is aimed at one-to-one contact with IV drug abusers — St. James's Hospital, Dublin, the Irish Haemophilia Society, the Anna Liffey Project, the Ballymun Youth Project and Cork AIDS Action Alliance; a drop-in AIDS resource centre run by the Eastern Health Board is providing preventative and risk reduction services for IV drug abusers with HIV — the services provided include syringes, methadone and condoms, all of which are done on an individual basis supported by counselling; the Eastern Health Board are currently developing a similar facility on the north side of Dublin city at an estimated cost of £80,000; a grant of £250,000 from national lottery funds was made available to the AIDS fund for the care and relief of distress in AIDS sufferers and £1 million was granted to the Haemophiliac Trust Fund, and training in the care and management of persons with AIDS and HIV has been provided for health care staff.
In view of the changing AIDS situation worldwide, the Irish AIDS Strategy is continuously under review and being adapted as circumstances require.
I recently reviewed the care and management element of the AIDS Strategy and as part of this process I am consulting with the Eastern Health Board, in whose area the main concentration of the incidence of HIV positive and AIDS cases is, with a view to the further integration of community and hospital based services progrmmes of which domiciliary support services is a major component.
I have also asked the advisory council on health promotion to consider as a matter of urgency the contents and direction of any further programme of publicity in this area.
As the epidemiology of AIDS is such that the virus can be contacted up to 15 years prior to the development of full AIDS, it has to be borne in mind that the cases currently being notified to the Department of Health are the result of infection acquired in the past and well before any of the measures taken here were necessary.
Deputy Yates rose.
As the time available for dealing with Priority Questions is exhausted I can only entertain a brief supplementary from the Deputy.
It is well exhausted.
I would again remind you, a Cheann Comhairle, that some seven minutes had elapsed prior to the commencement of Question Time. Is the Minister aware that for over three years there has been a demand for the appointment of a second genital urinary consultant, together with Dr. Mulcahy, to deal with the problems of AIDS? Will he sanction such an appointment in either the Mater Hospital or St. James's Hospital? Will he explain why the report referred to during the debate on AIDS and haemophilia a year ago — which was prepared by his then Minister of State, Deputy Leyden — has not been published and acted on? Does he have any proposal to introduce a national screening service for people attending A and E departments throughout the country on an anonymous basis in order to assess the exact level of prevalence of HIV in the community?
The question of anonymous testing is under review in conjunction with other member states. No final decision has been made on this issue as of yet — there are views for and against it. With regard to the appointment of a second physician, it was suggested a number of years ago that there should be a second physician and a second major unit established in Dublin. I have no particular problem with this suggestion if it is the correct way to go. There was a view that everybody who suffers from HIV and AIDS should be treated in one major unit. As I said in my reply, there has now been a change of view. The situation is changing on a regular basis and the view now is that patients, in their own interests, should be treated in the community where possible by the family doctor or in the local hospital by the general physician, dependent on the complication they have — for example, pneumonia, psychiatric illness or whatever. It is not necessary to have these high tech units and a single unit which everybody would attend.
As seven minutes had elapsed before Question Time began I should like——
Even on that basis, Deputy, time is exhausted.
Will you allow the Minister to reply to my question?
I am very sorry, Deputy, but I cannot. The Chair does its best in respect of questions nominated for priority, continuously advising Members of the necessity to complete the questions and the desirability of brevity. He can do no more. Question No. 5.
I should like to raise on the Adjournment the subject matter of Question No. 2.
I will communicate with the Deputy.
