The Health Protection Surveillance Centre tells us: “The groups most affected by STIs were young people aged (15 to 24 years), and gay bisexual and other men who have sex with men (gbMSM).”
This should be no surprise. This rise in STIs among homosexual men is the entirely predictable result of the decision, announced by the Health Service Executive in Ireland in November 2019, to change strategy in its efforts to combat the spread of HIV. What used to be called the Safe Sex Message, i.e if in doubt, use a condom, would no longer apply to homosexual men, only to everyone else. For homosexual men the new strategy would be the use of PrEP, that is, PreExposure Prophylaxis. This involves giving healthy, HIV-negative people a combination of pre-emptive anti-retroviral drugs to protect against HIV infection. Homosexual men can now enjoy unprotected sex with each other. For everyone else there is condoms.
Announcing the initial Euro 5.4 million for the PrEP programme in Budget 2020, Taoiseach Leo Varadkar said the introduction of the programme “will reduce the number of people who contract HIV in future”. But the obvious fact that by facilitating unprotected sex that the spread of all other STIs would also be facilitated was not addressed by the Taoiseach, or by anyone else, at the time.
Of course, PrEP was not announced as a measure aimed at homosexual men. That was put in obscure, coded language. Dr Fiona Lyons, consultant in HIV medicine at the St James’s Hospital STI clinic, welcomed access to the medication “without charge to those who are at substantial risk of acquiring HIV through sexual contact”.
So who are these people eligible for free PrEP due to substantial risk of HIV infection? To understand this you will have to first of all unlearn everything you were taught about HIV/Aids for the first quarter century or so after it first appeared. Older readers will remember the campaigns telling us that “we are all equally at risk” and that Aids “does not discriminate”.
So if we are all equally at risk presumably we should all be getting treated with PrEP? But of course we all know that that was never going to happen. Women won’t be getting PrEP. The vast majority of people who will read this article won’t be getting PrEP.. To understand who this free drug is aimed at, it’s best to read the HSE’s own guidelines on the Man2Man.ie website. There you will learn that you will get free PrEP if:
“You are a man who has sex with men. This includes transgender men who have sex with men or a transgender woman who has sex with men, who meets any 1 of the following:
I can’t pretend to understand why the bit about transgender men I.e. women, is in there.. And there’s also a sentence about heterosexuals being eligible if an STI specialist says so, but otherwise, the meaning is obvious. PrEP is for gay men.
So now, four years into the rollout of PrEP, hopefully the incidence of HIV infection has fallen among gay men. We’ll see how the figures go. But the rise in STIs generally in that group has surely been the inevitable result of facilitating those who find the use of a condom too much of an inconvenience when they want to have sex with someone who they don’t know well enough to be able to ask them about their HIV status. The HSE told us initially that: “The full PrEP treatment… will involve the pre-emptive use of antiretroviral medication and regular monitoring and testing, as well as advice and counselling on safer sex practices.” This is dishonest. People who practice safe sex won’t be eligible for PrEP.
Monkey pox was probably the first post-PrEP manifestation of an STI, other than HIV, particularly affecting gay men. The HSE’s Man2Man.ie website advises that “Gay and bisexual men who have sex with men and trans people, with multiple partners who have not yet been vaccinated, are encouraged to visit the HSE website at hse.ie/mpox and arrange an appointment for vaccination, which is currently available free in some STI clinics.”
There’s no advice given that having “multiple partners” is a bad idea in the first place if you want to avoid monkey pox. The only advice is to get a vaccine and where you can get it for free. No doubt there would be a clamour for the same free treatment if a vaccine became available for all the other STIs which, the HPSC tells us in its most recent report “have disproportionately affected gbMSM. In 2022 (where mode of transmission was known), they accounted for: 100% of lymphogranuloma venereum (LVG); 99% of mpox; 84% of early infectious syphilis (EIS); and 71% of gonorrhoea.”
All of these infections have risen along with the rollout of PrEP. And all would be prevented by condom use. It’s time to bring back the safe sex message. If you’re a man or woman, gay or straight, then to prevent the spread of HIV, and all other STIs, if in doubt, use a condom. People need to be encouraged again to take responsibility for their sexual health.