Ireland fared better than many other European countries in a recent men’s sexual health survey, but more HIV testing is still needed.
Last year, figures released by the Health Protection Surveillance Centre (HPSC) showed a dramatic rise in numbers of men who have sex with men (MSM) who were diagnosed with HIV. Dr Shay Keating, sexual health specialist and GP, told IMN that one in two gay men in Ireland don’t get tested for HIV, and never have. The HPSC data showed there was a 42 per cent increase in numbers of MSM who were diagnosed with HIV from 2008 to 2009, increasing from 97 to 138 cases in 12 months.
The majority, at 63 per cent, were born in Ireland and “most likely” acquired their infection here. Men under the age of 30 accounted for 35 per cent of new diagnoses and the HPSC said this trend reflected what is being seen in many other Western industrialised countries. Findings of the European MSM Internet Sex Survey (EMIS), which surveyed 180,988 gay and bisexual men in 25 languages across Europe, were published last month. The largest international study of the sexual health of MSM to date received a particularly high response rate in Ireland, Germany, Switzerland, Luxembourg, Portugal, Slovenia and Austria. Response rate was lowest in Turkey, Moldova and Russia.
It stated that in most European countries, sexual health check-ups for MSM do not include basic physical examinations that would allow physicians to diagnose conditions such as rectal gonorrhoea, chlamydia or genital warts. However, Ireland performed much better than other European countries in this respect, and this is down to its network of specialised sexual health clinics, the survey found. In the UK, the National Institute for Health and Clinical Excellence (NICE) last week released guidelines for sexual health services and advised that clinical staff in genitourinary medicine and specialist sexual health services should ensure all men who attend a specialist sexual health service for screening or treatment are offered and recommended a HIV test. It recommended that this should happen whether or not they disclose they have sex with men.
Dr Keating told IMN that he encourages opportunistic testing. He advised that if someone at high risk for HIV sees a doctor, the doctor should offer a HIV test whether it is requested or not. “If a diabetic goes in for a diabetic check or someone goes in for blood pressure tablets, and they’re in a high-risk group for HIV, they should be offered a HIV test,” he said. Dr Keating said the test should be offered “irrespective if they disclose sexuality or not”. EMIS revealed that in 32 European countries, less than 40 per cent of check-ups included an anal swab. In more than twothirds of the countries involved, less than one-fifth of checkups featured anal swabs. The researchers pointed out that in these countries, there is a high chance that anal warts, genital warts, rectal chlamydia and rectal gonorrhoea remain profoundly under-diagnosed.
As a result, men’s sexual health was likely to suffer, the risk of HIV infection or transmission would be greater, and comparisons of (STI) sexually transmitted infection rates in different countries are likely to be misleading. Ireland was one of the four countries, including the UK, Malta and Sweden, with a notably better performance in these areas than others. Each of these four countries has a network of specialised sexual health clinics. Dr Keating said that while there is something of a disparity in sexual health testing in rural and urban areas in Ireland, “it is improving”. “Historically, Dublin has been well served,” he said. There is a very strong network in Ireland, he said, adding that the Gay Men’s Outreach Project is well established, while other groups target youths and do excellent work in educating people about HIV and safe sex.
EMIS also showed that MSM in Ireland were six times more likely to have had a genital and anal examination during their last check-up than those in Germany. Furthermore, men in Ireland were eight times more likely to have had an anal swab, while men in the UK were almost 10 times more likely to have had one. Overall, 35 per cent of MSM involved in the study had taken a HIV test in the previous year. HIV testing in the previous 12 months was most common in Spain, Portugal, Belgium and France. In each of these countries, the most common place to test was with a practice-based physician, such as a family doctor. In several countries of central and eastern Europe, the most common place for MSM to take a HIV test was at a community service such as a testing site run by a gay community organisation.
In Bulgaria, the most common place to test was at a mobile outreach van. Currently, Ireland does not have such a mobile outreach policy in place. Dr Keating said: It’s important not to exceptionalise HIV. HIV is a very treatable disease once it’s picked up early. It has become a chronic illness and a very treatable illness.” However, he noted, “if you leave it too late and have a very advanced disease, it’s much more difficult to treat.” If diagnosed, Dr Keating said the patient should ideally be sent to special services within 48 hours. He further emphasised the importance of sexual health testing in general. "Test, test, test again, and then diagnose,” he said.
