The World Health Organisation has declared mpox (until recently known as Monkey Pox) to be a global health emergency. Mpox in Ireland, like many other sexually-transmitted infections, particularly affects homosexual men. That these infections are on the rise should be no surprise. We have been treating gay men with Pre-Exposure Prophylaxis (PrEP) for nearly five years now, the net effect of which has been to facilitate unprotected sex between men.
PrEP is designed to prevent infection with HIV. To this end, healthy, HIV-negative people are treated with a combination of pre-emptive anti-retroviral drugs. Those treated can then enjoy condom-free sex. Announcing the initial Euro 5.4 million for the PrEP programme for Budget 2020, then-Taoiseach Leo Varadkar said PrEP “will reduce the number of people who contract HIV in future”. 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, nor by anyone else, at the time.
PrEP is given to gay men because gay men are at particular risk of HIV infection. Please disregard all that the medical profession and the media told you for decades about Aids being an equal danger to all of us. If “we are all equally at risk” and “Aids does not discriminate” then we should all now be getting treated with PrEP. But that’s not happening. Women don’t get PrEP. The vast majority of people who will read this article don’t get PrEP. To learn who this free drug is aimed at, you need to read the HSE’s guidelines which tell that you are eligible for PrEP if “you are a man who has sex with men… (who has) had anal sex without condoms with more than one partner in the last six months”. PrEP is for sexually active gay men who don’t like using condoms.
Critical mainstream media scrutiny at the time of the introduction of PrEP was non-existent. On RTE Radio’s lunchtime news, presenter Aine Lawlor introduced an item on PrEP by telling us “now we have a good news story about a measure that will not only save lives but save money as well”. Lawlor then interviewed a doctor who was heavily involved in promoting the use of PrEP. The claim about saving money was based on the vague premise that it would be cheaper to put people on PrEP for life than it would be to put them on anti-retrovirals for life should they become HIV-infected. Nobody considered the cost of treating, or vaccinating against, all the other STIs that would inevitably flourish in this new era of gay, male sexual liberation. Nobody considered the cost, or the ethics, of putting healthy people on a drug regime when the same end could be achieved by the much cheaper option of condom-use, or having a responsible sex life. The advent of PrEP was presented to the public as something that all right-thinking people in Ireland would welcome.
And now we have mpox. In its most recent report on mpox in Ireland, the Health Protection Surveillance Centre tells us that there have been 228 cases notified to date and that of these cases “sexual orientation is known for 208, 205 of whom self-identify as gay, bisexual or other men who have sex with men (gbMSM)”. Mpox in Ireland is overwhelmingly a disease of gay men.
The HPSC further tells us: “Among all 228 cases notified to date, gender for 226 cases is male and for 2 cases is female.” Don’t believe it about the two women. The public needs to see an immediate red flag when the medical profession uses the word “gender”. Doctors don’t use that word to mean what it has always been commonly understood to mean. The HPSC explains: “Gender is based on gender identity where it is provided, otherwise sex at birth is used. Gender identity refers to a person’s internal sense of themselves (how they feel inside) as being male, female, transgender, non-binary or something else. This may be different or the same as a person’s assigned sex at birth. Further information and resources can be found at the website of Transgender Equality Network Ireland.” So we have 226 men and 2 people who “feel inside” that they are women. It’s most likely that all those infected with mpox are men.
PrEP, I believe, is driving up the incidence of mpox. A recent study in the Irish Medical Journal shows a clear relationship between catching mpox and the prior use of PrEP. In this IMJ study, of 229 people infected with mpox over the previous twelve months, 132 test negative for HIV and, of those, 64, that’s nearly half, are on PrEP. (Men who test positive for HIV would not be getting PrEP as the horse has already bolted in their case.) So being on PrEP is a strong predictor that a man may soon get mpox. And when you delve further into the IMJ study you understand why this should be. PrEP facilitates condom-free sex and these men are doing that with a vengeance. The men report having had, on average, two sexual partners a day for the 21 days prior to their mpox infection. One man reports having had sex with an astonishing 75 other men over the previous 21 days. For a heterosexual man, having sex with three or four different women every day for 21 days would be something that he would only ever do in his dreams. Literally.
And the rise of mpox infections doesn’t give our health service any pause for thought about the wisdom of having helped these men to have unprotected sex with lots of other men in the first place. No. Instead the HSE has this advice: “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.” How about encouraging them to stop having unprotected sex with multiple partners and start to take responsibility for their sexual health?
We don’t have any studies, so far as I know, as to how many homosexual men with all the other venereal diseases that have been increasing in recent years might also be men who are on PrEP. The HPSC says that STIs “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.” That’s an impressive proportion of infection to have been achieved by the small percentage of our population that is gay and male. I can’t prove it but I would predict that studies would show that a statistically significant proportion of these infected men, perhaps up to 50% as is the case with mpox, are men who are on PrEP.
So has PrEP, for all the harm it has done, had any effect on reducing HIV transmission in Ireland? It doesn’t look like it (although it has to be said that data-collection became unreliable during the Covid years). The most recent HPSC annual report (that for 2022) shows that HIV rates more than doubled in Ireland in a year, mainly driven by immigration but Irish cases also rose sharply. As ever, infections in Ireland were mostly among gay men. And, as I have long argued, even these figures understate the true scale of the HIV problem among gay men as these men routinely pretend to be straight and now, in recent years, they use gender self-id to pretend to be, and be recorded as, heterosexual women.
PrEP may even be driving the rate of HIV infection upwards. A well-known actor, a gay man, in a conversation I had with him on the RTE campus in late 2019 when PrEP was first being rolled out, told me of his concerns. A condom, he said, is visible, verifiable evidence that a man is taking care not to spread infection. But you would have to take a man’s word for it when he tells you that he is on PrEP and, in the heat of the moment, a man intent on seduction might lie. (I wrote to that actor a few days back to ask if he would mind me quoting him by name for this article. He declined, saying “I would prefer not to have (the) abuse that would come at me from the gay community”.)
I’ll finish by going back to a word I mentioned earlier. Ethics. It’s not ethical to use our health service to encourage dangerous, disease-spreading behaviour. Women and heterosexual men are given the safe sex message that they should limit their number of partners and/or use condoms. Homosexual men, by contrast, are told that’s it’s okay if they don’t like condoms and that they can have unprotected sex with whomever they like once they avail of PrEP. We need to bring back the safe sex message and apply it to everyone, be they male or female, gay or straight.
And it’s not ethical to be spending healthcare money on people who don’t need it. Homosexuality is not an illness. Taoiseach Varadkar’s initial Euro 5.4 million a year outlay on PrEP could be a lot better spent on children who are on waiting lists for corrective spinal surgery whose condition is worsening as every day passes. There are, I expect, all sorts of better ways that we could all come up with for spending healthcare money before we would prioritise men who insist that they must be able to have sex with multiple partners without their pleasure being inhibited by the use of condoms.
We shouldn’t be encouraging or rewarding irresponsible behaviour. We need to tell gay men that if they want to have risky sex then they should use a condom like everyone else.