Deputy Yates to move this motion; the Deputy has 40 minutes.
Private Members' Business. - AIDS Policy.
I propose to give some minutes to some of my colleagues, Deputy Michael Creed specifically.
Is sharing the Deputy's time satisfactory? Agreed.
I move:
"That Dáil Éireann calls on the Government to immediately introduce a National AIDS Plan to respond to the AIDS epidemic in Ireland; to establish a national task force on AIDS with a specific budget; and to ensure that the medical, community care, accommodation, financial and other needs of HIV-AIDS patients are properly provided for now and in the future."
It is entirely appropriate, with next Saturday 1 December being World AIDS Day, that the Dáil has its first opportunity to debate in depth the AIDS epidemic in Ireland. I know we have discussed previously the problems of haemophiliacs with AIDS, but this debate goes further and deals with all those who have contracted the HIV virus. It is very important that this motion impel the Government into having a comprehensive national AIDS policy both in relation to the care of patients and the future control of the spread of the disease.
Last September Fine Gael published a national AIDS plan. We were the first party to address this issue in such a fundamental way. This matter is extremely urgent. AIDS is a killer disease of young people of tragic proportions. The growth of the disease abroad if reflected here will be a social disaster. If we look at the EC and America we see that between 1980 and 1990 that the numbers of AIDS cases have increased in a remarkable way. In Europe in 1980 there were 19 recorded cases of AIDS; in 1990, there were 28,920 cases; in America there were 78 recorded cases of AIDS; in 1980; earlier this year there were 132,436 cases. These figures do not take account of the hidden level of AIDS in so far as there is a total dependence in this country on voluntary testing to find incidence levels.
The second alarming factor is that within these figures there is a steady and continuous growth in the proportion of AIDS patients who have contracted the disease through non-drug using heterosexual orientation. Let me quote the figures in recent years. In Ireland some years ago, all of the AIDS cases were related either to drugs or the homosexual community. Now 5 per cent of them are non-drug using heterosexuals. In America the figures have gone from 11 to 14 per cent; in Europe the figures have gone from 3 to 10 per cent. This means there is a greater risk of the spread of the disease to the community at large and away from specific sections of the community such as the drug community or those who are homosexual.
The two major issues facing the Government and Irish society in the context of AIDS are the proper care, in all its facets, for those with the virus, and a comprehensive plan to control the spread of the disease. It is predicted by conservative estimates that there will be 20,000 people in Ireland who will be HIV positive by the end of this decade, the year 2000. This epidemic needs a similar response to that of the health programme dealing with tuberculosis in the forties and fifties. This means a departure from normal public health programmes. Unless a radical approach is adopted, Dublin may become the AIDS capital of Europe and AIDS patients may continue to suffer their sense of imprisonment through rejection by society of their illness on top of the trauma of dealing with a life-threatening illness. The most striking thing that I have come across in talking to AIDS and HIV patients is that not only do they face the threat of a life-threatening illness but they feel they cannot talk to their relatives, their friends and neighbours about it because of the stigma and attitude to AIDS in Ireland.
The first step that needs to be taken is to establish a national task force on AIDS. At present there is an internal Department of Health committee that reviews the disease and the State response. This is wholy inadequate. The Department of Education have a pivotal role in communicating to young people the nature of the disease itself, its spread and how it can be avoided. The Department of Justice have a vital role in relation to the known facts that prisons have been an incubator for this disease both in this country and abroad.
The valiant voluntary groups that have provided the frontline and often the core services for AIDS patients deserve greater recognition and it is vital that voluntary organisations would be represented on any task force. The medical personnel dealing directly with AIDS should form part of the membership also. Fine Gael are proposing that this task force would be charged with the responsibility of formulating national policy on AIDS on an ongoing basis both in terms of its control and care for patients. This group should be chaired by the national AIDS co-ordinator and will be empowered to pilot programmes in the public service which can later be adopted by the Department concerned on an ongoing basis.
To ensure that this will not just be a talking shop, we are proposing that a minimum annual budget of £2 million would be allocated to this task force. Expenditure would require the consent of the Minister for Health in any specific area. The scope of this expenditure could vary from educational or informational programmes to direct financial support and provision of care services. Both the work of the task force and its budget would be reviewable after two years by the Government and the Oireachtas on the basis of reviewing progress and presenting biannual plans for further policy and administrative decisions. Such a structure would be able to link with similar bodies established internationally and with the World Health Organisation which has recommended that each member state should establish such a vehicle for policy formulation and executive action. It is vitally imperative in the first instance of dealing with this disease that such a national co-ordinating body be set up covering all the different Departments of State involved and the people directly in the front line of dealing with this disease.
Life in this country for an AIDS patient can be particularly grim. It is common for patients who have been diagnosed as HIV positive to lose their jobs, to lose their accommodation and to experience a lack of access to some of the health and medical services. These factors have influenced many to either suppress the problem of AIDS under the surface of public awareness or simply to emigrate to London. This tragedy is totally unacceptable. AIDS patients do not have an automatic entitlement or access to a medical card or even disabled person's maintenance allowance. There is no special provision for their unique dietary, mobility and heating expenses. The community care services in health boards across the country are often ill prepared to cope with the home care needs of patients between illnesses in the community. The financial difficulties of such patients extend after their death by virtue of the fact that life assurance is not available for them. Medical services at hospitals are often inaccessible at week-ends resulting in patients ending up in different hospitals for different ailments. This is even more pronounced in the regions. All of this results in greater anxiety for the patients concerned.
There is only one consultant in the whole country dealing with AIDS. She is Fiona Mulcahy, the genito-urinary consultant in that department at St. James's Hospital, Dublin. There is no dedicated ward for AIDS patients so that they can receive their special intense nursing requirements at this hospital. There is a desperate need for a second consultant appointment either in this hospital or in an alternative unit on the north side of Dublin. It is incredible and, in my view, shameful that a north side Dublin hospital has not take up a second unit and I would be particularly critical of the role of the Mater Hospital in not coming forward with positive proposals to ensure the second consultant appointment on the north side.
Voluntary funding through the AIDS fund and other voluntary organisations has paid for some of the essential medical staff in the genito-urinary department at St. James's Hospital. Funding for one registrar has been provided by the British Medical Research Council. The present situation of ad hoc and uncertain national lottery applications for both these staff and counsellors is unfair to all those directly involved. There is a shortage of nursing staff. It is common in Britain in an AIDS ward for there to be eight nursing staff while, in similar conditions here there are only two.
All the statistics show that there will be a steady increase in the number of AIDS patients who will require care and treatment in the years ahead. Yet there is no planning for the future growth and provision of services in this area. The immediate minimum requirement is a dedicated ten bed unit in St. James's Hospital, the appointment of additional medical staff and counsellors and the proper availability of equipment.
Accommodation is another basic requirement for the AIDS patient, 80 per cent of whose time is spent in the community. Tenants of private rented accommodation may suffer discrimination where they can lose their accommodation or, alternatively, not be able to maintain weekly or monthly rent payments on their flat. There is an urgent requirement for sheltered housing for some patients while they are still in the community.
Home nursing is vital. In the early stages it was up to a voluntary organisation, Cáirde, to provide this essential service. The health boards need to reorganise their services to provide for the specific needs of AIDS patients. There are huge emotional traumas attaching to this disease. This means a great need for counselling on a continuous basis. There are less than a handful of such professionals in this area which has been totally neglected.
Discrimination can also extend into the workforce, mainly due to ignorance. In 1988 a circular was introduced into the Civil Service to give a minimum level of protection for those patients in terms of their rights of employment. This set of priciples should be implemented not only in the Civil Service but in the general public service, semi-State bodies and in places of employment of a reasonable size, say, over 20 or 30 employees.
The largest single component of AIDS patients to date has related to the drugabusing community. There is a common agenda in terms of tackling AIDS and drug abuse, especially in our urban areas. This can often be manifest in the most marginalisd groups in society. These young people may be cynical and resentful of both public authorities and their services. Centralised bureaucratic facilities will not meet their needs. It is imperative that the Minister, in conjunction with other Departments, put in place on the ground, especially in certain urban areas, social workers and general practitioners to provide a range of services for these at risk groups. By this I mean the provision of clean needles, methadone maintenance, condoms, counselling and medication. This concept is based on the totality of care required by the patient and is exclusively client-based in a community setting. I am talking about the most deprived ghettos of urban Ireland where the people who suspect they may be HIV positive see the lack of care and treatment for those who are HIV positive and therefore take the determined decision to keep their own diagnosis undisclosed and away from the authorities. If they saw there was a proper level of basic human care they would come forward earlier for treatment, which would be in their own best interests.
Residential and respite care is increasingly becoming required for AIDS patients especially in terminal conditions. A new unit has been opened at Cherry Orchard Hospital. This must be extended immediately to the regions with a similar provision in Cork and Galway.
Fine Gael, therefore, are calling, in this motion, on the Government to immediately take the following decisive clear steps in the coming months through the forthcoming budget and Book of Estimates. These are: the appointment of a second genito-urinary consultant physician with specific responsibility to deal with AIDS patients; the immediate allocation of ten dedicated AIDS-related hospital beds in St. James's Hospital and a similar unit to be opened in a northside Dublin hospital; all HIV positive patients to have eligibility for a medical card if they satisfy a means test for a hospital services card; a programme of financial assistance through superintendent community welfare officers in each of the eight regional health boards to provide money for the heating, mobility, dietary and burial expenses of AIDS patients; and the introduction of an anti-discrimination code of practice in employment for AIDS-HIV patients.
In terms of planning for the future the Minister for Health should ensure that an AIDS forum group is established in each of the eight regional health boards involving the different components of the health board which deal with the areas of sexually transmitted diseases, community care services, relevant voluntary groups, representatives of the health promotion unit of the Department of Health and health board management. The purpose of each forum is to review the coordination of AIDS-HIV related services within each health board area and to ensure access to services on a seven-day week basis as well as planning for the future.
In relation to education and information, all post-primary schools should have available from this academic year onwards a structured AIDS-HIV education programme to specifically advise young students of the risk of contracting the disease, the avoidance of the disease through behavioural patterns, attitudes to the disease and an outline of services for patients. This should be coupled with a nationwide information programme through the availability of leaflets, advertising and other material aimed at the sexually active adult population, which would advise on the risks of contracting the disease as well as the behavioural patterns required to avoid the virus. This programme should also include a promotional campaign relating to the virus whereby the pubilic would be encouraged to participate in voluntary testing, which would be available nationwide and would have the back-up facility of pre and post-test counselling. Each health board would be obliged to make available such services and advertise their availability.
I mentioned earlier the role of prisons as acting as an incubator of this disease. It is remarkable that the prisons have not been targeted as playing a vital role in the spread of the disease by the Government to date. There is little or no contact between the health services, health personnel and health structures of the prison services. Medical facilities in prisons are deplorable. In Britain, each prison is visited by a genito-urinary consultant physician on a fortnightly basis. There is a need for proper medical centres in our prisons, with a visitation and consultation process on at least a fortnightly basis by a consultant or senior registrar. Further more, I believe the policy of segregation of HIV-AIDS prisoners in our prisons should be reviewed and ultimately abolished.
It must be assumed, in terms of a future code of practice, that all prisoners are potentially HIV positive, and the necessary health and safety procedures are then put in place for all prisoners. It has been totally inhuman and degrading to hear the first-hand reports of prisoners who have been put in the segregation wing of one particular prison. It should be an immediate priority of the task force on AIDS to ensure that everything from release procedures from prisons to the direct medical procedures and facilities therein are updated in a modern way that will not only provide a caring attitude but ensure that the disease is not unnecessarily spread.
Critical to the control of the virus is proper information. It is an essential prerequisite that maximum knowledge be available as to the prevalence of HIV. To date there has been a total dependence on voluntary testing. In other countries such as America and Britain, as well as across Europe, screening systems have been put in place that are based on anonymity, which will yield a purely statistical analysis or broad indicator level of the disease in society. It is vital that the target age group of 15 to 45 years is reached. I believe the best way to achieve this would be the testing of patients entering accident and emergency wards in our acute general hospitals. This would be done on the basis of the consent of the patient in question. If they did not give their consent the test would not go ahead, but whether or not the test went ahead the opportunity for voluntary testing whereby the people would be notified of the result would still be there in the normal way, as I have outlined earlier. The basis of the anonymity would be that all the blood samples would go to a central laboratory and all the statistics would be recorded without knowing whose blood it was. This would indicate the number of HIV positive people in the community at large. As is generally accepted people, having contracted the disease, register as HIV positive within two to six months. Therefore, we could get a rapid, up-to-date picture of a random group of people who are going through our hospital system.
I want to emphasise that this would not interfere with any individual's rights to have a voluntary test, and the keynote of the procedure would be total guaranteed anonymity laid down with statutory protection under strict procedures. It is vital not to be dependent on voluntary testing as the real level of current HIV positive people in the community could be as high as 3,000 and as low as the publicly recorded level of 1,000. The future growth of this disease will depend on the availability of accurate data and using that data to plan effectively.
There is obviously difficulty in terms of medical and moral arguments in relation to the control of any sexually transmitted disease. In the context of the sexual transmission of the virus, change in behavioural patterns will eliminate the risk of spreading the infection. However, all the information suggests that among these groups at risk, for whatever reason, behaviour patterns may not and certainly have not changed. I would instance the survey whereby 50 per cent of female HIV positive patients at St. James's Hospital some time ago showed that they were having unprotected sex. The issue, therefore, arises of precautions that would reduce the risk of spreading the infection. The present Family Planning Acts of 1979 and 1985 restrict the sale of condoms to pharmacies, clinics, hospitals and general practitioner surgeries. A recent court case saw a court conviction for the sale of condoms in an alternative retail outlet. This issue must be seen in the context of both the spread of the virus and the public health issue. It would be very wrong for the debate about AIDS to become a debate about condoms. However, the availability of condoms to target groups is essential in terms of public health. We therefore propose that one of the early duties of the national AIDS task force would be to propose a review in detail of the 1985 Family Planning Act to see what changes are necessary to ensure the availability of condoms to "at risk" groups.
There are many other areas that require further scrutiny, such as the proportion of expenditure spent on research, the way it is to be spent and the linkage with international research. There is a public perception among some AIDS patients that too much is being spent on research. That is not a view that I entirely share, but it is very important that money spent on research is linked with other international research because Ireland alone cannot pioneer research in this area. It must be based on mutual co-operation.
The whole question of fosterage of AIDS babies will be a major problem in the future — it is major problem abroad. Proper training must be put in place for potential foster parents of AIDS babies. Proper financial assistance is essential for the voluntary groups who are at the front line of action in relation to AIDS. I would single out for particular mention the AIDS Action Alliance groups throughout the country who have done valiant work. To outline the importance of voluntary groups, in conjunction with the Irish Family Planning Association, they paid for the production of a film, "Stories from the Silence" which I am sure Members of this House have seen. That certainly stimulated me into action on this whole area. I believe that such a public information and awareness campaign is vital to changing attitudes. It is essential that information or material that could potentially change attitudes is made available to the public at large to improve public awareness and understanding of the disease and its inherent problems.
There is a specific need for more dieticians across the country to provide guidance in relation to building up immunity levels for HIV positive patients. All in all, there is a need for the Government, and the Minister, to ensure that the whole AIDS problem is not swept under the carpet, that it is not dealt with as a disease which is unfashionable, that it is stigmatised and, therefore, should not be confronted in a political and public way. There will be a bitter harvest in terms of future deaths unless the AIDS crisis is confronted now.
Fine Gael, in this debate, are seeking to put the issue before the Dáil, and to obtain the support of all parties in the House, to ensure by a positive and constructive series of actions across a range of Departments in Government that the Irish response to AIDS is as good — if not better — than in any other country.
Since the Minister took office there has been an appointment of a Minister of State to chair a working party in relation to AIDS. I have seen a copy of that report and I very much regret that, despite the compelling information in it and the serious problems, the basic proposals have not been acted upon. Leaving aside the compassionate and human factors involved, the report stated that the estimated cost to the Department of Health of treating HIV patients was somewhere in the order of £12,000 or £12,500 per year and that the cost of treating an AIDS patient was somewhere in excess of £30,000 per year.
Looking at all the international research and all the possible projections of the numbers who will potentially contract the disease, and those who are HIV positive and will develop full blown AIDS, it is obvious that this will be a huge budgetary item in future. If for no other reason than sound health economics, it is vital that we plan now. We are behind in terms of the time-scale of events in America and in some parts of Europe. That is not to say that we do not have the same lethal potential for death and destruction through AIDS but it does give us the opportunity to learn from their experience. The time, therefore, to act is now.
I call on the Minister for Health and the Government, to ensure that this will become their priority area in terms of public health issues. Failure to do so now would be an utter and unadulterated tragedy.
I thank Deputy Yates, and the House, for allowing me to contribute to this debate. Next Saturday is the World Health Organisation's International AIDS Day which is part of the ongoing awareness campaign being waged internationally to raise public knowledge about this disease. It is a campaign which is also being waged by most national governments in their respective countries in an effort to come to terms with the disease, its spread, and promotion of policies which will control it. The World Health Organisation have projected that, by the year 2000, there will be six million AIDS sufferers and 20 million patients diagnosed as HIV positive. It is an alarming scenario and this country cannot escape carrying its pro rata proportion of same. The danger is, however, that due to culmination of certain factors we will end up carrying more than our fair share of the pro rata breakdown of those figures. These factors are basically Government inaction and our AIDS structure which sees large sections of our population in the sexually active age bracket of between 15 and 45.
It is important to remember — and to repeat on occasions like this — that there is no vaccine — no known cure — for AIDS. In the absence of a vaccine or cure the most important components of a national AIDS programme are information and education, which do not come cheaply. However, the cost of inaction, as Deputy Yates outlined in his closing remarks, will result in a huge increase in the number of full blown AIDS cases with all the cost implications which that entails.
The AIDS virus knows no boundaries and the school of thought which, thankfully, is waning, that suggests our different national moral ethos will mean that we have nothing to fear, is misguided. We are no longer — if indeed we ever were — the land of comely maidens. Our policy in respect of the AIDS issue must reflect this. Information and education in relation to the AIDS programme will not come cheaply yet the value for money to be derived from same will be unequalled. The formal educational structures need to be used effectively to this end but this avenue is also limited. We need a consistent media campaign directed at those sexually active in the community, going hand in hand with a programme which seeks to break down the ignorance and prejudice towards those suffering from AIDS and HIV positive.
In Ireland, in the face of the world's single greatest health issue, we have no policy in place to contain the disease or to prevent its further spread. We have failed to put in place adequate community and hospital based services to cater for those already infected with the virus. Quite simply, there is no Government AIDS plan, no specific allocation in the Department of Health funding for same and, consequently, already inadequate funding is being dissipated further in its effect by the absence of an overall plan to be administered and supervised by a national task force.
I acknowledge the work being done by those at the coal face of the AIDS problem, either in a professional or voluntary capacity. These people deserve better from the Department of Health in terms of research, educational awareness and treatment. The haphazard nature of services currently provided by our eight health boards varies greatly and this form of discrimination in treatment is totally unacceptable.
I move amendment No. 1:
To delete all words after "That" and substitute the following:
Dáil Éireann endorses the Government's AIDS strategy which encompasses a programme for the prevention of HIV infection and the care on an integrated basis, of AIDS/HIV patients within existing services and which is responsive to the needs of persons with HIV/AIDS and is up-to-date with international developments in this field.
At the outset, a Cheann Comhairle, I wish to refute the allegation by the Opposition that the Government are not dealing comprehensively and effectively with the problem of AIDS.
Nothing could be further from the truth. We have a comprehensive programme for the prevention, monitoring, diagnosis, treatment and management of AIDS in line with international strategies, a programme which is being implemented in a caring and compassionate manner. The Government's AIDS strategy consists of the monitoring of AIDS and the trend in HIV infection; prevention through health education strategies aimed specifically at the young and at at-risk groups; the protection of the blood supply; the provision of services to reduce risk such as outreach and methodone maintenance and provision of condoms and needle exchange aimed specifically at certain at-risk groups and linked to counselling at individual level; research into aspects of the disease; the care and management of people suffering from AIDS and HIV within an integrated framework of services including community services, primary care services, respite services, hospice services and acute hospital services and the co-ordination of policy and its implementation at national and local levels.
Our strategy is in line with the strategies adopted in all advanced countries. It takes account of and comprehends the recommendations of the major international bodies and the declarations from major international conferences including the Paris Declaration on Women, Children and AIDS (1989); the Declaration of the London-Ministerial Summit on AIDS (1988); The Council of Europe recommendation concerning a common European policy to fight the Acquired Immune Deficiency Syndrome (1987); resolutions of the World Health Assembly endorsing the global strategy on AIDS; The Political Declaration (1989) of the Extraordinary Ministerial Conference on the Council of Europe's Pompidou Group as it relates to HIV/AIDS and drug abuse and the many decisions and recommendations of the EC Health Ministers, including those which relate to improved surveillance of the disease and early-intervention which I brought to the forefront in Europe during my Presidency of the EC Health Council. As I said at the opening it is a strategy which is flexible and responsive to the needs of patients and is being continually monitored and updated.
The epideamiological development of AIDS infection in Ireland is similar to that experienced in the USA and Western European countries. From 1981 to 1985 all cases reported were in people who were homosexual or who had haemophilia and the condition was considered to be a largely imported disease to this country. When zero-prevalence monitoring became possible in 1985 it was apparent that the HIV virus was indigenous in the country and that a particular problem existed in relation to the spread of HIV infection in intravenous drug abusers.
Since the disease was first identified we have had 174 cases of AIDS reported and 69 people have died. In addition some 1,005 people have been established as being HIV positive. In common with other countries in the EC the spread of transmission in homosexuals is slowing down. The percentage of intravenous drug-related cases is now 36 per cent of all cases as compared to 20.5 per cent in 1986 in the twelve EC countries. In Ireland almost half of the people at present infected with AIDS are drug-related. Almost 60 per cent of the people known to be infected with HIV virus are drug abusers. This movement of the epidemic towards the drug abuser has led to an increase in the number of heterosexual cases. In 1987 we had no heterosexual cases in Ireland. At the moment just under 5 per cent of Irish cases are heterosexual.
I would like at this stage to outline in detail the various components of our strategy. In relation to monitoring and surveillance, case reporting of the disease is carried out on a strictly confidential basis and there is ongoing direct contact between the national AIDS co-ordinator and the clinicians dealing with AIDS. In addition death certificates are monitored and deaths, in which deficiency of the immune system is recorded, are discussed with the clinician involved. As regards serological surveillance all positive HIV antibody tests are confirmed at the national virus laboratory which reports directly to the national AIDS co-ordinator on a weekly basis. All tests are carried out on a strictly confidential basis and in most cases there is pre and post-test counselling. A series of ongoing surveys of "at-risk" groups, which have enabled us to track the transmission of the virus from the initial cases in homosexuals and haemophiliacs through to intravenous drug abusers and on to heterosexuals have been of great value in identifying our main problem areas. Our strategies dealing with the disease have been based on the data obtained from these sources.
Our monitoring of the disease is as accurate as any Western European country. We maintain the closest contacts, through the national AIDS co-ordinator, with the EC AIDS centre in Paris. The latest figures from the EC countries show that the rate per million of AIDS cases in Ireland is 43.4. This compares with a rate per million of the population of 173.2 for France, 158.4 for Spain and 59.9 for the UK. In fact there is only one country in the EC, Greece, with a lower rate than Ireland. Notwithstanding these hard facts we have been subjected in recent months to attacks from foreign media programmes that have ignored both truth and facts and have presented a totally misleading view of the real position of AIDS within this country.
Careful appraisal of the data now available suggests two conclusions. First, the AIDS virus, HIV, is largely confined to certain behavioural risk groups and their immediate sexual contacts. Secondly, transmission of the virus in homosexual men has declined substantially.
As I have already mentioned, I raised the issue of improved surveillance of the disease during my Presidency of the European Health Council and this is being considered on both the European and domestic fronts. It is important, however, to ensure that any new system introduced, such as unlinked voluntary HIV testing, is ethically, legally and medically sound and takes into account the position of the person being tested, the doctor involved and also, the overall benefit to the community at large. As I have said, new methodologies for surveillance are being actively considered at the moment.
I might say in this context that I am glad to see that Deputy Yates has pulled back from his previously held view that HIV testing should be compulsory, something he told the nation on a radio programme some months ago. The suggestion of compulsory testing would be completely inappropriate. I might also add that nothing can be gained by the alarmist, generalised statements contained in the Fine Gael policy document on AIDS regarding the possible incidence of the disease in Ireland in the year 2000 and repeated by Deputy Yates and Deputy Creed here tonight.
Time will tell.
The World Health Organisation has advised against projecting data beyond 1992 because of the unpredictable nature of the spread of the syndrome, both in terms of at-risk groups and geographical prevalence.
The medical consensus is that a vaccine to prevent the disease and/or the production of a fully effective cure will take between 5 to 10 years. Prevention of the disease in uninfected people and secondary measures to prevent the infection from spreading from infected people are critical therefore in the Government's strategy. As a major part of their strategy therefore, the Government have introduced a series of measures aimed at: informing the general public and in particular young people and people in at-risk groups, about AIDS; informing health professionals; protecting the blood supply; and informing people travelling abroad.
The dissemination of information to the general public and particularly to the young has been a major part of the Government's strategy to combat the spread of AIDS. In 1987 there was a mass media campaign just after I came into Government, a campaign that was sitting a long time when the Coalition Government were in power and which they did not introduce for some reason. We introduced it, using TV, billboards and newspapers to inform the public about the disease. This campaign was allied to the issue of a booklet by the health promotion unit which was made available through health centres and community pharmacists. Both of these methods informed the general public of the ways that the disease is and is not spread, and it is estimated that 400,000 adults have to date received a copy of the AIDS booklet.
The mass media campaign also used a billboard campaign advertising a telephone hotline to which members of the public could call and have their queries answered. This related to the national AIDS education programme for school going children.
A number of national surveys have been commissioned by the health promotion unit on public knowledge and attitudes to AIDS. The results of these surveys have been used to determine how information would be best targeted in the light of the public's knowledge of the disease and its transmission in the Irish context. A priority of our information strategy is to educate young people about the disease and to ensure that no person would leave school without being informed of AIDS and the HIV virus and how it is transmitted.
In 1988 the directors of community care and medical officers of health were asked by the Department of Health to liaise with school principals in regard to AIDS/HIV education. This resulted in area medical officers giving support to schools in their efforts to disseminate information about AIDS. This co-operation is continuing and the new educational materials are a further resource for schools in this area.
This programme of material for classroom use was developed jointly by the Departments of Health and Education. The aims of these materials are to: provide information on the causes, transmission and prevention of aids; help pupils explore attitudes to aids; encourage pupils to avoid behaviours that could lead to them acquiring the HIV virus; promote among young people a mature attitude in assuming responsibility for their own health and the health of others; and to inform students of community resources available for coping with AIDS.
The programme was piloted in twenty schools in the autumn of 1989 and a wide range of representative organisations were consulted for their views on the materials. Final revision of the materials has taken place and the materials are now available nationally.
These materials are viewed as a resource from which teachers can select and adapt in terms of the particular school context in which an AIDS education programme is taking place. Programmes are carried out in accordance with the school ethos and the wishes of parents, and where pupils have a prior understanding of sexuality and human relationships.
One-day training seminars for teachers on the use of the materials as well as giving them up-to-date information on AIDS are also an integral part of the programme. A special set of educational materials has been developed which is designed to appeal to a low literacy group which would be, generally speaking, early school leavers. This programme is still at pilot phase and has been well received.
While the public information programmes and the AIDS education programme for secondary schools addressed the problem of the spread of AIDS through intravenous drug abuse, drug abusers are not especially receptive to such campaigns. Like a number of European and American countries, Ireland has a particular problem relating to the level of HIV among intravenous drug abusers. This group is receiving particular attention in our strategy. Special measures are required to communicate the AIDS message into the drug community and, more importantly, to elicit a positive response from this group.
Towards this end, the AIDS booklets produced in 1987 and 1989, and a special poster directed at intravenous drug abusers, were provided to all drug agencies, statutory and non-statutory. This is continuing; the Eastern Health Board, since 1988, have been conducting an Outreach Programme designed to make one-to-one contact with drug abusers. Such contact is the most important and realistic way of monitoring personal behaviour changes and of encouraging drug abusers to attend services for treatment; an integral part of the Eastern Health Board's Outreach Programme is the AIDS Resource Centre, Baggot Street, which was established in 1989. This centre is a drop-in facility for drug abusers and provides a range or risk-reduction services, such as syringe exchange, condoms and methadone maintenance, backed-up by individual assessment and counselling. The resource centre has been a resounding success and between January and October of this year an increase of 160 per cent in attendances has been recorded.
The centre is currently the focal point for the provision of the health board's community based services for AIDS and it is nearing full operational capacity. In view of this, the Department of Health and the Eastern Health Board are currently planning the opening of a second AIDS Resource Centre. Ideally, this will be located on the northside of the city and will provide for liaison between the prison services and the health and welfare services for ex-offenders who have contacted the virus.
As regards providing information on AIDS for health professionals — all doctors and dentists were circulated with AIDS information booklets in 1985 and 1988; over 500 health professionals from the health boards and voluntary hospitals and others who were relevant to local AIDS programmes took part in an AIDS information and training seminar in 1987; these people now provide a pool of experience and resources to develop and implement local AIDS programmes and similar seminars to those held in 1987 continue at local level; all general practitioners are becoming increasingly involved in the care and management of people with HIV and AIDS at community-domiciliary level. The Department of Health and the Irish College of General Practitioners are currently developing a protocol to enable GPs to play their part effectively in this area, and in particular their relationship with the services provided by the statutory authorities.
In relation to the blood supply, measures were initiated in 1985 and continue to be taken to ensure that the country's blood supply is free from infection. I might add that these measures were introduced as rapidly as was possible and it is worth noting that Ireland is the only European Community member state which has not had a case of AIDS associated with a blood transfusion. Since 1985, when the HIV test first became available all blood donations have been screened for HIV. Only heat treated blood products are used in Ireland and we are self-sufficient in blood products including Factors VIII and IX for treating haemophilia. People at risk from AIDS are asked not to donate blood or organs and again it is worth noting that Ireland was the first country to implement the Council of Europe recommendation on this self-exclusion of at-risk persons.
A further part of the Department's preventative strategy is the provision of advice and information to people travelling abroad on the risks about AIDS.
Much of what Deputy Yates had to say this evening about AIDS in prisons was inaccurate and seriously out of date; the Deputy is clearly not familiar with the various statements on the subject which have been made by the Minister for Justice both in the Dáil and the Seanad.
The following facts, in relation to prisoners known to be HIV positive will be of interest to the Deputy: all of those infected are visited daily by a medical practitioner who specialises in dealing with the disease; all prisoners who, in the opinion of his her medical adviser, are in need of hospital services, or, indeed, hospitalisation, are provided with such services and hospitalisation where necessary; the Minister for Justice has announced that a special unit is being provided in Mountjoy for those with contageous diseases who need extra care. Plans are well advanced.
As regards "segregation", the Minister has explained on many occasions that this strategy was not adopted as a means of halting the spread of the disease within prisons as Fine Gael have suggested. It was introduced in the interests of protecting those known to be HIV positive and maintaining good understanding within the system. The Minister has established an expert group to examine all aspects of the problem of infectious diseases in prison and the group will, as part of their remit, look at the question of segregation.
Ireland is particpating in a European Community study on paediatric AIDS and continues to co-operate with international bodies, in particular the European Community, the World Health Organisation and the Council of Europe. We also contribute to the work of the European Centre for AIDS in Paris. Detailed epidemiological data is furnished each quarter to the European centre from this country.
The care and management of people suffering from AIDS and HIV is conducted in Ireland within an integrated framework of services including community services, primary care services, respite services, hospice services and acute hospital services. In line with international recommendations and good medical practice, the policy of the Department is that acute hospitals should treat people with AIDS from their catchment areas and that such people should be treated by the appropriate consultant. Deputy Yates cast a slur on the consultants in this country when he said there is only one consultant in Ireland dealing with AIDS.
I said specialising in AIDS.
There is any number of consultants in Ireland dealing with AIDS very effectively. They are well able to treat such people depending on the nature of the clinical presentation of their illness. This has been specified in departmental policy circulars on AIDS since 1985 and I recently approved a circular to be issued from the Department of Health re-emphasising this important aspect of policy relating to the care and management of HIV/AIDS. I am concerned that all general hospitals should participate fully in this aspect of AIDS policy. I am equally concerned that any hospital or individual consultant would become synonymous with the care and treatment of the disease, and I aim to ensure that all acute hospitals play their part fully and effectively in the care and management of people with the virus.
On the question of the provision of integrated models of care and management, health boards are providing services appropriate to their particular needs. An example of this is the initiative taken by the Eastern Health Board in opening a 22 bed unit in Cherry Orchard Hospital which provides respite care for AIDS sufferers.
In the Eastern Health Board many voluntary groups supported by the national lottery are complementing the services provided by the Eastern Health Board.
New STD clinics have been opened in Sligo, Limerick and Waterford. These clinics, in conjunction with those already provided in Dublin, Cork and Galway are an important element in the control of AIDS.
The virus reference laboratory in UCD, where confirmatory tests are carried out plays a major role in our strategy. Capital grants totalling £380,000 have been given by the Department towards the development of a new, modern virus reference laboratory which opened last year.
Product authorisations have been granted on the advice of the National Drugs Advisory Board for the use of a number of drugs in Ireland in the management of people infected with HIV. These are AZT and Ribovirin and it is worth noting that Ireland is the first country to licence Ribovirin for use in HIV. In addition, I recently approved the use of DDI for clinical trial purposes.
This is in line with my policy to make medical products available to people with the virus, as soon as they are assessed for their safety, efficiency and quality. In this context, Ireland has the broadest spectrum of medical products for HIV currently available in Europe. The use of any or all of these drugs is, of course, a matter of clinical judgment for each individual doctor. I am sure the House accepts that there has been criticism of the fact that a drug was licensed. The drug was licensed on the recommendation of the National Drugs Advisory Board but it is a matter entirely for the individual clinician as to when they would use a particular drug. As far as we are concerned we want to ensure that all the most modern treatment is available to people who are HIV positive or suffering from AIDS.
Research Studies in recent years have shown that early-medical intervention can decrease the frequency and severity of clinical symptoms and the mortality rate of patients who have been diagnosed as having been infected with the human immune virus. This would be a step forward in the fight against the virus. In adopting early intervention strategies, due consideration must be given to the possible toxicity arising as a result of prolonged use of any drug and the potential for converting an apparently healthy, asymptomatic person into a patient committed to long term treatment.
The Royal College of Physicians in Ireland are holding a major international medical symposium on early medical intervention in HIV on Friday next, 30 November 1990, which I will be addressing. This symposium will be attended by experts from around the world and it is the single, most important AIDS symposium dealing with early intervention to be held in Europe and arguably in the world. Hopefully, this symposium will progress our knowledge in relation to key early intervention issues and enable policy decisions to be made in these areas, on the basis of clear, factual findings and recommendations.
There is no basis whatsoever for Deputy Yates' contention that the Government's Strategy is not co-ordinated, nationally or locally. The facts are that the Department of health coordinate on a regular basis with other Departments, including the Departments of Education, Social Welfare and Justice. The Department of Health also co-ordinate with the health boards and with the voluntary agencies. Patients are treated appropriately to their needs through the wide range of services available in each health board area.
In addition the national AIDS co-ordinator is in constant contact with all agencies and groups, statutory and non-statutory, and with individuals, to assist them in the development of programmes and services.
I also reject the assertion that the Government are not providing the funds required to meet the needs of HIV/AIDS patients. In line with our general policy that people suffering from AIDS should be cared for as part of the mainstream health services, funding for such care and management has in the main, been provided through the agencies normal allocation. In addition a total of £2.2 million has been allocated from national lottery funds for AIDS-related projects. I would reiterate that it is our policy that patients should be treated within the mainstream health services and not, as Deputy Yates would suggest, taken out and discriminated against or treated in some different way.
This funding has been distributed among a wide range of agencies, including the AIDS fund, the Irish Haemophilia Society, the Anna-Liffey Project, Cork AIDS Action Alliance, Ballymun Youth Project, Coolemine Therapeutic Community, St. James' Hospital and The Mater Dei Institute.
I let the Government's record on AIDS speak for itself, a Cheann Comhairle. Our strategy is rationally based, developed and adopted in line with the changing epidemiological situation and with international recommendations. It underlines a caring approach with the focus at all times being on the needs of patients and the protection of the general community. I regret to say that some of Deputy Yates' proposals show a distinct lack of understanding of AIDS, and of how patients suffering from the disease should be cared for and managed, both medically and socially.
The introduction of a special budget, dedicated hospital beds, and a policy of positive discrimination as suggested by Deputy Yates would only serve to highlight unnecessarily the plight of AIDS sufferers and could stigmatise and alienate such people and their families.
As if that was not the case already.
The Government are satisfied that the structures and services available through the health and welfare systems is appropriate and equitable in dealing with AIDS patients on the same basis as others who require medical and social services.
The position is being continuously monitored, keeping in touch with the latest international developments to ensure that the most up-to-date services are available and continue to be delivered to those who need them in a caring and compassionate manner.
I would add that both myself and my colleague, Deputy Treacy, Minister of State at the Department of Health, have attended a number of international seminars on the problems of AIDS. Both of us are satisfied that the treatment, the management and the programmes we have for prevention are in line with the very best available anywhere around the world.
I would ask the House to accept the amendment proposed by the Government.
On Wednesday of last week I ceased, after three and a half years, to have responsibility for health matter on behalf of my party.
The Deputy does not want to leave.
We regret very much that that is the position.
I did not really expect that I would spend this afternoon in the House on a Health Bill, on a health matter, in Private Members' Time. I must say that on reflection, after three and a half years——
The Deputy will be missed.
I thank the Minister of State. I appreciate his kind comments. I am glad to have the opportunity of making a few brief comments on what I consider to be one of the most serious health issues that not only this country but the world — the developed world and the third world — have to face in the coming generations.
I have had the privilege of visiting different countries and seeing the reaction to this problem in a developed society such as the United States and of witnessing the terror induced by the disease in a developing society like Zambia. This is a problem that we, too, must come to terms with. It has already been said that AIDS/HIV is not only a serious problem, that it is fatal.
The Minister has told us that some 69 people have died from AIDS in this country. Currently some 1,000 people have contracted the HIV virus in this country. Those people are a cross section of the Irish community, they include drug abusers, homosexuals, infants, haemophiliacs and people who need to inject themselves with medicines in order to stay alive. I acknowledge that the problem is worse elsewhere. In the EC there are 30,000 HIV cases while in the United States there are an incredible 130,000 cases. Numbers on that scale do not just occur in the United States because there is some fundamental difference between the people who live in the United States and those who live here. Potentially we will suffer that crisis. AIDS can spread and have a devastating effect on any population if it is not recognised and looked at intelligently, if it is not agreed that we need to have a co-ordinated and determined strategy and, most of all, if it is not agreed that we should act upon it immediately with whatever resources are required by the State to protect the people. The simple truth is that the more time we waste the more lives will be put at risk.
I have acknowledged in the past that the Government are making a serious effort to educate people and prevent the spread of the HIV infection. They are also making an effort in relation to the treatment of those who are already infected. It is encouraging that the Government recognise the need to keep up-to-date with international developments. However, it is not good enough to say that we must keep up to date if there is not allied to that a determination to make any new knowledge or technology which is recognised internationally available in the fight against AIDS in this country.
The Minister tonight indicated in general terms — I am sure he will take issue with me — that substantially the battle against the scourge of the spread of AIDS and HIV infection is to predominantly take place within existing services. That is a pathetic response. It is acknowledged — this has been part of the sparring between the Minister and me for three years — that since 1987 our health services are inadequate to cope with normal problems much less to cope with the specific treatment of AIDS.
The Minister has indicated that virtually every consultant can combat AIDS. That sounds good in a ministerial speech but it is not a reality.
It is.
Neither is it a perception that the people who are faced with HIV infection have. I know that like me the Minister has spoken to AIDS groups and their representatives. They have pointed out that only one hospital in this country specialises in the treatment of AIDS — St. James's Hospital — and in that hospital, and the Minister took issue with Deputy Yates on this point, there is only one dedicated specialist consultant who is focusing exclusively on the problem of AIDS.
We should not try to score points off one another. We should make a realistic evaluation of existing resources and of their efficacy. We should recognise that this is not a political problem; it is a health and human problem. We should, on a consensus basis, provide whatever resources are required to increase the treatment available for people who are already infected and put up the maximum possible defence against further infection.
It is a dreadful mistake for the Minister to think that we can get away with the treatment which is available now. The Minister must recognise and acknowledge during this debate that additional resources are required, that additional investment must be made available, that additional facilities must be provided, and that additional personnel must be hired, trained and put into the field. In addition, I hope the Minister's statement regarding developments all over the world will indicate that we are genuinely in touch with what is happening and that we are genuinely committed to putting state of the art practice into place here.
Deputy Yates's motion is very realistic. I do not think it is outlandish and I do not think the check list he put before the Dáil tonight is extravagant. He has recognised that a more open progressive policy must be outlined to deal with the HIV scourge. He proposed the introduction of a national AIDS plan and referred to education as a means of prevention. I am not suggesting that that proposal is new, but I want to focus on what is required in the context of education.
Education is acknowledged as the paramount weapon in fighting the problem of the spread of HIV infection. The plan proposes a minimum AIDS education programme. This is essential: we should aim to educate every young person in the country. I use the term "young person" advisedly because we must focus particularly on the young. It must be our objective to ensure that they will be armed with a minimum knowledge about how AIDS and HIV are transmitted, how they can put themselves at risk and how they can be treated. Without such a minimum approach on an across the board basis, without it being mandatory and without it being standardised for all our schools, we will be failing in our duty to prepare Irish people and, in particular, our young people on how to deal with this real hazard.
The dissemination of information should not be done through schools alone; it must be done through a public information campaign. Again, a minimum set of standards should be laid down so that we will know exactly what we want to get through to every individual. Holding back information for any reason will be seriously damaging. The Minister spoke in terms of what has been done by way of education and trying to bring forward knowledge to people. He said there was a campaign in 1987. Most of us, on reflection, believe there was a huge public awareness of the problem of AIDS, that somehow it started in and came from America and that it was going to threaten us all. There was a national campaign at that time — as the Minister rightly said when he came into office it was ready to be launched — but we have done very little since then.
I have gone through the Minister's speech in which he talks about informing health boards and issuing circulars. I am talking in terms of reaching out to the general public. We have taken the issue of AIDS off the front burner since 1987 and consigned it somewhere else. The Government believe that because they have given the information once it is not necessary to analyse how effective it has been and how aware ordinary people are of this problem. Has any qualitative research been done by the Department?
I spoke about that.
There is no current advertising campaign.
The Deputy is talking about research.
I am talking about two aspects. I do not want to be adversarial on this issue — I do not think there is any merit in that. There was a major campaign in 1987 but we virtually stopped after that. The Minister spoke about some qualitative research. Is monitoring being carried out on a nationwide basis ensuring that young people, married people and at-risk groups have the necessary degree of information about this disease? How much is being spent on this research? Where is the information? Will the Department publish reports? Are reports available to be put before this House?
It is clear that basic information should be included in any preventative programme. This information should include the basic facts on the methods by which AIDS can be spread and it should rubbish the misinformation which is current; it should recommend the means to prevent infection and should identify the areas where treatment is available.
Of course, our society should instruct citizens about the advantages of having stable sexual relations, thereby minimising the spread not only of AIDS but other sexually transmitted diseases but we must also acknowledge that our society — other Deputies have spoken about the move from the society of the comely maidens — is no different and no more morally superior to any other country in Europe or elsewhere and that many people will indulge in sex with more than one partner. We must prepare to educate them on how to minimise the risk of transmission. Condoms, especially latex condoms, have been recommended by the World Health Organisation as a method of reducing the spread of AIDS. The promotion and supply of condoms should be viewed as a specific disease control measure, no more and no less. Condoms should be seen not only as contraceptives but as a method of actually preventing the spread of disease. We have to consider that sentence in the context of a case where a retailer was taken to court for selling or making available condoms. If we honestly believe that the law should be updated, we should have the courage to bring the necessary amending legislation before this House.
A list of specifics was put before the House by Deputy Yates. I think we can have consensus in relation to what is necessary. He talked about the need for extra specialist consultants dedicated exclusively to this problem. The Minister said that every consultant in the country is an expert on it. Realistically we need more people to dedicate themselves specifically to it. I do not think there can be any disagreement on that. Deputy Yates proposed two ten-bed hospital wards on the northside of Dublin to be used for treating this problem. Is there any disagreement on that? Let us quantify the cost and put it in the Estimates. He suggested some modification in medical card eligibility and I do not believe there would be any fundamental difference across the House in relation to people who have contracted HIV. He talked about using the community welfare officer system across the country to target financial resources to those people who are HIV positive.
One of the things which struck me when I visited treatment centres in New York was the importance of the very basic things. People who are HIV positive or who have AIDS are often stigmatised and vulnerable. We should ensure that they have decent accommodation, adequate heating, adequate food and clothing and specifically we should target resources through the community welfare service. I do not think there would be any major disagreement on that issue.
The final issue which Deputy Yates raised was that of specialist anti-dis-crimination legislation. I hope the Labour Party will put forward before too long — at our next Private Members' Time, perhaps — a comprehensive anti-discrimination Bill. However, we should consider the specific point that there should not be discrimination against HIV or AIDS sufferers in their employment. This might not be a matter for the Minister for Health but it is something he might bring back to the Government.
The tone of the Minister's contribution I would best sum up as complacent. He listed the minimal things we have done and said we are as good as somebody else.
As good as anybody else.
We have to look at the reality of the problem and to decide what new measures we need to take, in consultation with those who are not only at risk but have contracted the disease already. Let us have less of the self-congratulatory tone that we are on top of the problem and instead let us acknowledge that there is a serious problem to be addressed which all the visits to international seminars will not redress. We need resources, personnel and an attitudinal change in relation to this issue.
I do not accept that all is well in the prison service with regard to AIDS. In quoting his colleague, the Minister for Justice, the Minister does not re-assure me. He indicated that plans were well advanced. It is time that plans were implemented and proposals put into effect on the ground. Whatever the view put by the Minister to this House in regard to AIDS in prison, there is a general perception among prisoners, and among the general public, that prisons are dangerous places to be. This is a perception we have to remove.
Overall the proposals that Deputy Yates has put before the House are encouraging. It is important that this issue should be addressed periodically in this House. It would help steer Ireland's approach to the next phase of tackling the problem of HIV infection. I am not suggesting that there is a comprehensive answer but we need to refocus on this issue. It is not a political or even a health issue exclusively; it is a human issue that affects all society and all peoples. On that basis let us work in a consensus way to put realistic proposals into effect and decide that collectively we will vote through whatever resources are needed to make sure we minimise as far as possible the spread of this terrible disease.
I have a certain sympathy with Deputies Howlin and Yates who show a remarkable degree of caring. We are dealing with quite a problem. However, most of the points raised have been adequately covered by the Minister in the most comprehensive speech on this matter for some time. Being a member of the medical profession, albeit a little far removed from the AIDS epidemic in the Dublin area, it is good to see that the issue is being dealt with in this manner.
Deputy Howlin asks for specialist consultants and specialist beds, but the Minister has pointed out that quite a number of our consultants are able to deal with the care of AIDS patients. The AIDS virus attacks the immune system and it is the secondary responses such as pneumonia which have to be dealt with. Consultants are quite capable of treating them. The Deputy also mentioned that HIV and AIDS are not confined to a specific category and he referred to haemophiliacs and babies born with HIV. Unfortunately, these are the real tragedies of AIDS, especially the babies who usually have secondary infection. I disagree with the Deputy in his assertion that they do not come within the categories mentioned by the Minister.
Deputy Howlin mentioned discrimination against people with HIV infection but I believe the incitement to hatred legislation covers much of this area.
Debate adjourned.