Martin Daly: From Stigma to a Public Health Game Changer

We have to recognise what has been done, you know, and that a framework has been created in which an awful lot more can be done with the proper investment. Because I'm looking at Adam Shanley's paper, you know, here, and, you know, just even in relation to what the issues he'd reviewed, you know, that in conclusion, you know, that Ireland has made substantial and commendable progress in strengthening sexual health services. I would recognise that. I've been in practice nearly 40 years, I'm aging myself now, but that's the reality of it. And certainly from the 80s coming through to now, this is almost unrecognisable. The culture is unrecognisable, which is hugely important, because if you don't have the culture right, you can't hang and develop these services onto the framework and develop them and seek funding in a meaningful way. And so the expansion of the HIV and STI testing, the innovation of the home testing of STIs, absolutely remarkable that Ireland is a first. The introduction of the PrEP programme, the increasing recognition of complex issues such as chemsex, I mean, something that wouldn't have been considered 10, 15 years ago. The strong integration of community leadership to demonstrate a system that's responsive, collaborative. Collaboration, absolutely brilliant. Grounded in public health evidence, which is, I mean, the basis for any service to be developed. And I suppose it's more a reflection that the issues, again, I think, Adam, you've said in your paper here, you know, the equity and choice and flexibility and equity has got to be going forward geographically in terms of access to PrEP and PrEP services. And also to the generality of sexual health services, because again, we don't want to get down this tunnel, because it has got to be in the broadest sense, and I think you talked about sexual dysfunction, sexual pleasure, we need to be able to talk about those things, and people need access to those services. My mother was a GP in the west of Ireland in the late 60s, and she described the absolute absence of knowledge of sexual function. And where, you know, and where there was no place to even go and seek that knowledge. So, I just want to commend your work, I recognise there's a lot to be done, and Cahir, look, you've said that as well in your comments, as well as the rest of the speakers of the committee, and you're pushing an open door, and I certainly would be advocating more funding to be pressed in, because it's such a huge, and the other thing, I think, again, recognising what Adam has said, what Cahir has said, what you've said, is the question of HIV, I mean, again, going back to the 1980s, when it, you know, people were treated like they had the plague, and, you know, where I remember a colleague of ours, a senior colleague who contracted HIV, was treated like a leper. That's just honest truth. And how we've moved to a situation which is a public health game changer in terms of prevention of HIV, the treatment of HIV, and the management of that condition, and I think we need to recognise how groundbreaking that is as well. If I may just add, we haven't, our work in terms of people living with HIV being made to feel like lepers is not yet done, and to commend the huge work that's been done by the PAS5 tribe in collaboration with the HSE on the You, Me and HIV to address the very significant and real stigma that people living with HIV in Ireland still experience, and we know that from the, since the launch of the campaign, that prior to the launch of the campaign, about less than one in three people were aware of the protective effect of successful treatment in preventing or transmission of HIV, and that is now almost one in two. So those, the brave, commendable, passionate voices that have come forward as the lived experience of living with HIV in Ireland have made a significant further breakthrough in addressing the stigma that our work is not yet done in respect of stigma for people living with HIV, and that is in the general population but also in healthcare settings as well. I accept that. I'll withdraw my comment about being treated like lepers because that's pejorative. I would say they were ostracised and treated with a complete lack of compassion and respect, and it was something I reflected in a senior colleague who contracted HIV, and was literally isolated in their workplace and died in the workplace isolated. So I think we need to reflect on those people as well. Thank you.