Information and Education Programme on AIDS: Motion.

Thursday, 25 February 1988

Seanad Eireann Debate
Vol. 118 No. 14

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Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  I move:

That Seanad Éireann endorses the Government's Public Information and Education Programme on Acquired Immune Deficiency Syndrome and [1827] requests them to further develop programmes with particular reference to IV drug users and school leavers.

Minister for Health (Dr. O'Hanlon): Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  I welcome the initiative taken by the Seanad to discuss the problem of AIDS particularly having regard to the serious threat which it poses, not alone in the at-risk groups, but in the community at large. It is heartening to see a high level of awareness and concern among individual Senators in relation to the spread of AIDS and I feel sure that we can anticipate a positive and worthwhile exchange of views from this forum on the many aspects of this complex problem.

By way of introduction to this debate, I propose to give a general outline of the extent and nature of the problem we are faced with, the measures taken to date to control the spread of infection and the proposals for future action in this area. As Senators are only too well aware there are only four proven ways in which this virus can be passed from person to person: intimate sexual contact with an infected person; injection or transfusion of infected blood or blood products; sharing contiminated needles and from a pregnant mother to her baby.

To date, there have been 36 cases of AIDS in Ireland. Seven have been haemophiliacs, one heterosexual, 13 have been homosexuals, 13 IV drug abusers and two babies born to infected mothers. While the 13 homosexual cases have occurred over the past six years, the 13 IV drug abuse cases have occurred in the past 16 months. These statistics represent infections that have occurred some years ago. The statistics from the Virus Reference Laboratory for HIV testing show that 60 per cent approximately of the 678 positive cases identified are IV drug abusers.

These statistics are not complete as certain groups are clearly more reluctant to come forward for testing. However, taken in conjunction with the breakdown of the AIDS cases, they clearly demonstrate that the future pattern of AIDS in Ireland will be dominated by IV drug [1828] abuse. This is a different pattern than that emerging from most Northern European countries where the great majority of cases are among homosexuals.

The most serious implication of this epidemiological finding is that the risk of spread into the heterosexual community is proportionately greater in Ireland. There is, in fact, evidence to show that the virus is already spreading into the heterosexual community, albeit slowly.

As this epidemiological pattern has emerged the Government's AIDS strategy has been developed to meet the situation. The first step in our strategy was to take measures to monitor the spread of AIDS in Ireland. In 1984, in line with international developments at the time, a monitoring system was established under which AIDS cases are reported to this Department on a voluntary and confidential basis. I am satisfied that everything has now been done to protect the blood supply and that people need not worry about having transfusions.

Since January 1985 all Factor 8 used in Ireland has been heat treated to kill the virus. Ireland will soon be self-sufficient in blood products produced from the domestic blood supply. In January 1986 a booklet on AIDS was prepared by this Department and circulated to all general practitioners. A number of seminars on AIDS have been held by the Eastern Health Board and also by the Health Education Bureau to provide health care workers with information about AIDS. The directors of community care and medical officers of health have also held seminars locally for health care staff and for other groups. A significant number of health care personnel have now been trained and will provide a resource in their local areas for further AIDS education. The directors of community care and medical officers of health are the key personnel at local level who have the responsibility for co-ordinating local measures.

The sexually transmitted disease service has been strengthened by the appointment of a consultant to the STD clinic at St. James's hospital and by the establishment of new clinics at Limerick [1829] and Waterford. A central strategy committee has been established to recommend strategies to the Government and to oversee their implementation.

I have just come back from the much publicised London AIDS summit where 148 countries talked in a uniquely open and frank way about the level of AIDS infection in their countries and the measures they have taken to control its spread. What I discovered is that all countries are following the same basic strategy. It was recognised that there is no one measure which will dramatically reduce the spread of AIDS. It is important always to remember that there is no vaccine and no cure for AIDS. The declaration on AIDS of the world summit of health Ministers recognised that in the absence of a cure or vaccine, the single most important component of national AIDS programmes is information and education.

As a first step in our information programme a general leaflet on AIDS, which was simple and factual, was issued in mid 1986 to establish the basic facts in the public mind. In February 1987 a national survey on public knowlege about AIDS was carried out. That survey revealed a high level of knowledge of the basic facts about AIDS among the public. In May 1987 a major public information programme was launched which was specifically designed to reinforce public knowledge and to address the specific gaps which had been detected in the survey, particularly in relation to some of the myths about AIDS.

The programme which cost £500,000 was launched in May 1987. The public information programme was designed as a two-tiered strategy. At one level, it sought to reinforce public knowledge about AIDS through a mass media campaign and, on a more individual basis, the personal worries and queries of individuals were addressed through a detailed booklet and a freefone service.

A further survey was carried out at the end of 1987 to assess the effectiveness of the programme. The majority considered the programme to be very good in helping them to understand AIDS and their knowledge was further improved.

[1830] An important part of the campaign is the comprehensive AIDS information booklet and telephone advice service. We will be giving additional publicity to the booklet and telephone service this year. The booklet is very comprehensive. An analysis of the telephone inquiries which have been put by the public to the national AIDS telephone service reveals that the booklet answers all of the questions about AIDS and about how to avoid becoming infected.

Of course, some people will need more re-assurance. The one to one discussion of particular issues which a booklet cannot provide is available through the national AIDS telephone service being run under the aegis of the Eastern Health Board which will continue to be available. The information is there and it is the responsibility of each person to get the booklet if they have not already done so, and to make the small effort necessary to read it. There will be a further poster campaign this year designed to keep the level of public awareness of the facts about AIDS as high as possible.

A special allocation of £450,000 has been made available from lottery funds by the Government for special AIDS measures in 1988. Information to the general public will continue to be provided. However, special efforts are being made this year to reach particular groups.

In Ireland 60 per cent of HIV positive individuals are IV drug abusers. This is the group in which the infection appears to be spreading most quickly. It is also the category from which the majority of new cases are coming. One to one contact with addicts will, I feel, prove the most effective way of motivating personal behavioural changes. The drug agencies have been provided with extra resources to enable them to expand their outreach programmes and further substantial funding is now being provided for further expansion.

The most crucial part of the expansion in the development of an outreach programme is currently being developed which will be incorporated by the Eastern Health Board.

[1831] An element of this outreach programme will be research into the drug culture with particular emphasis on how the culture is responding to the AIDS threat. More important, the project is principally aimed at minimising the spread of HIV infection amongst intravenous drug abusers and from this group to the community at large, through one-to-one counselling, education and particular treatments.

My colleague, Deputy Mary O'Rourke, Minister for Education, and I have agreed that we should concentrate upon the educational system this year. I have just had a further meeting with my colleague the Minister for Education to discuss our plans for providing such a long-term AIDS programme in secondary schools. While that programme is being prepared and to ensure that children leaving school this year have the facts about AIDS, I have asked the directors of community care/medical officers of health to co-operate with local school managements in providing AIDS education to ensure that no child should leave school without being aware of the facts about AIDS.

We are also monitoring what is happening in other countries in relation to the availability of free needles for drug abusers and also the use of methadone. To date we are not satisfied that we should go in that direction but we are monitoring the situation very closely and when we are satisfied we will make a decision in whatever way we think is best.

In conclusion the Government's strategy is to do everything possible to slow down the spread of the AIDS virus while we wait for the development of a vaccine. We are in no doubt about the difficulty of the task facing us especially when dealing with a difficult group like intravenous drug abusers where it will take time and efforts to achieve anything. However, our strategy compares well internationally and is likely to be as effective as any other country's strategy. We will continue to pursue it vigorously.

Mrs. Fennell: Information on Nuala Fennell  Zoom on Nuala Fennell  I welcome the Minister [1832] to the House. I am pleased that he has come here to listen to this very important debate.

I am very pleased that the motion is signed by three Senators from differing groups and parties. This serious matter of AIDS calls for unity, agreement and concentrated action. Political action and political interest have not, by a long shot, matched the media involvement to date. RTE have played a responsible role, as have the national newspapers here and in other countries. I mention in particular a recent series of articles in The Irish Times by Catherine Holmquist and Dick Alstrom which were informative and very helpful. There has-been very little hysterical, or alarmist, reporting about AIDS and it is one case where one could say the reality of the subject is worse than any fiction about it. It strikes down young otherwise healthy people, most of whom are under 30. It is a progressively wasting disease and, above all, the most horrific aspect of it is that there is no cure and no cure in sight.

Because we have had a lot of publicity about AIDS generated at home and from abroad there could be a perception among the public that that equates action and that things are being done. This is not the case as we discovered yesterday afternoon when a very useful short seminar was set up by Senators O'Toole and Norris for all of us in the Oireachtas. We were all invited to go to it and we met people there who were involved with the victims of AIDS. We heard the very real difficulties they are having on the ground and the worries and concerns were expressed to us.

The motion says that we endorse the Government's action to date on public information and education. While I am all in favour of agreement, co-operation and consensus I cannot say I will be endorsing the Government's information and education programme to date. I support the concept of an all-party agreement on a united approach to dealing with this major public health problem.

Ireland has rather late in the day woken up to the reality of AIDS, and the dreadful potential this virus has for public [1833] health for the future. As in so many other areas in this country, we seem to believe we would be immune from the AIDS problem, that as it is one that developed somewhere else, possibly in the United States, and because it was related to sex and sexual activity and had moral overtones it would not take hold in this country. Many people say that the first real impact about AIDS was when it became public knowledge that film star Rock Hudson was dying from AIDS. When people saw the photographs and the images of this man who had epitomised all the good looks and virility of the Hollywood image of 20 years or 30 years ago reduced to an emaciated state and a skeleton figure it brought the reality home to them. It shocked thousands and probably millions of people into accepting the awful reality of what the AIDS epidemic meant.

Now the matter is not at all remote given that we have had in this country 36 cases of AIDS, three of whom are women and of this number we know that 16 have already died. When we further realise that there are in the region of 694 cases of HIV positive reported and that the number infected but not reported could be something like a submerged iceberg there is a considerable challenge facing us in this country in terms of education, information, treatment and investment in research, all of which should be our objectives and deserving of our action and attention. Above all, we must concentrate on the treatment of victims.

Despite increasingly responsible reports about AIDS in the media, the disease remains, associated in many peoples' minds with three Ps, plague, powerlessness and panic. None of these is really justified as AIDS is a contagion which results from actions of unprotected sexual intercourse with an infected individual. It is contacted through the mixture of blood with infected blood or through intravenous injection of drugs with a non-sterile needle. There are ways whereby people can avoid catching AIDS, the most obvious being not having unprotected sex outside a monogamous [1834] sexual relationship and not using non-sterile needles. These are the only ways in which AIDS is transmitted apart from the other main area where a mother transmits it to her unborn child.

There is no justification for the kind of panic that can be seen because of public fear of the very word AIDS. For instance, in the United States with regard to Rock Hudson when his home was put up for sale the price had to be knocked down from $7 million to $2 million because people would not go in to view it for fear of catching AIDS. This is why any education or information campaign should emphasise that people cannot accidentally catch AIDS.

Haemophiliacs are one group of people who did inadvertently become infected. Haemophilia is a condition in which the blood does not clot normally and haemophiliacs, who are nearly all males, are treated with injections of a clotting agent obtained from other people's blood. Unfortunately some of this agent was introduced from the blood of infected people with the result that some haemophiliacs became infected. The Minister has assured us this can no longer happen. For a number of years now all blood products for haemophiliacs have been heat-treated to kill the virus. In the UK the Government there have recognised the special needs of people with haemophilia who have come in contact with HIV through their treatment and their needs in terms of life insurance, support for dependants, mortgage repayments etc. This recognition has been very welcome. Recently the British Government gave a grant of £10 million to the haemophiliacs in the UK.

If we find it difficult to cope with the concept of AIDS, the dreadful suffering it brings, the anxiety and concern it brings to relatives, the fear in communities, the concern at how the virus is going to develop, we could cast our minds back to the TB epidemic in this country in the twenties and thirties and the statistics of thousands of deaths in Ireland from various forms of TB. At that time infection in that instance was more easily transmitted than is the case of AIDS at [1835] present, because we had overcrowding of families, bad housing, bad schools, inadequate health care and diet and it must have been very difficult to avoid infection. A terminal blow was dealt to TB in this country at that time. It took superhuman efforts and it took considerable political manoeuvring and conflict to see that, but with the politicial co-operation and expenditure for research the TB disease was combated. People who remember these years will recall that there was an element of shame and guilt associated with TB. There was a element of cover-up and denial on the part of the families of victims. We have to regard AIDS at best as a TB of the eighties and generate all the resources possible to combat it.

We are dealing with a disease that knows no barriers or boundaries. We know that this infection will not be contained in any one continent or in any one country. The most practical way forward is through international co-operation, with all countries committing financial resources and medical skills to a broad programme for the treatment of victims and, in particular, to research and locate a cure and prevention, to exchange information and experiences and to enable easy communication between countries regarding statistics and trends. There is no doubt that is happening as the Minister explained at the conference he attended in London. Let us hope that with a greater public awareness of AIDS there will be better attitudes to the disease and to those who suffer from it.

The elements of fear and ignorance that can cause AIDS victims to be isolated from the rest of the community is very sad. Whatever measures are taken to counteract the incidence of AIDS, the care of those who are ill must be of paramount importance. Our health and care workers are giving a fine lead in their dedicated care to those who are sick and dying from this disease but their concern and tolerance are not reflected in the public at large. It is particularly regretted that the incidence of AIDS should have caused discriminatory public attitudes to [1836] some groups, particularly the gay community, homosexual men. After all, it was the homosexual community which first experienced the awful effects of this very threatening disease and they are still disproportionately affected by AIDS.

It was the gay community which gave the lead in 1982 in this country in taking practical action. They realised the threat, understood the reality of it and pioneered the information circuit for public information. They saturated the country with information and developed a network of caring groups and information lines which have proved to be so useful and which are now the nucleus of what can be carried on. Indeed, one can say without the action which they took at that time, the problem would be an awful lot worse here.

In dealing with this problem there is no place for a wringing of the hands in despair, believing that the whole thing will be resolved by some third party and that it will not influence our lives or the lives of anyone close to us. Again, this is what was believed in the United States four years ago but that has changed very profoundly to the extent that the Americans have become committed and determined to combat the disease for the very reason that it has spread alarmingly and AIDS is now affecting family circles, people in the work place and people in the community. In so many instances Americans know first hand or second hand of somebody who has AIDS.

There is only one way to deal with this problem and that is to recognise it as a serious one, to adopt an open and honest approach to public education and information and to ensure that financial resources are directed to where they are needed in the country. I do not doubt at all that the people who planned last year's programme of public education and information meant well and took the line which they believed would have the maximum impact while having the least resistance in Irish society. However, I believe it was not good enough to be well meaning in this instance. The campaign of last year undoubtedly achieved a degree of awareness and a relative [1837] amount of response but it was not sufficiently practical in its approach. In my opinion it had all the hallmarks of officialdom protecting the community from what they believed would be morally unacceptable to them and in so doing they shrank from an issue of responsible action.

Let us take a look at the booklet which was produced by the Health Education Bureau called Aids Information Booklet which was probably the main circular or information book, if not the sole piece of literature, which most people will have seen on the subject of AIDS. It is very evasive in giving direct advice. Indeed, it asks questions but does not really answer them. For instance, on page 7 it asks how do you catch the AIDS virus and goes on to list four different ways. First, intimate sexual contact, heterosexual or home-sexual, with an infected person; secondly, injection or transfusion of blood or blood products taken from an infected person; thirdly, sharing injection needles with an infected person and, fourthly, from a pregnant mother to her baby.

Let us take the first answer. Would people see, for instance, intimate sexual contact as, in fact, meaning intercourse. Indeed, I question whether the answer is even accurate. Why can not the booklet say sexual intercourse when that is what is meant and not fudge the issue by calling it something else? On page 8 under the heading of Safer Sex it asks can condoms prevent AIDS and gives as the answer for sexually active people who are not in one faithful partner relationships that a strong condom correctly used is the single most effective defence against AIDS. Again, there is this fudging the issue instead of coming out straight and answering the question.

Why can not the booklet say exactly what is intended and what is most useful when what we are addressing is probably the issue of a single piece of literature to the public at large? There are strong moral overtones and that is regrettable. An aspiration that people should have sex with one partner only and ideally for their entire lives is unrealistic in today's world. Whatever one's personal opinions [1838] may be about permissive sexual behaviour, they should be put aside for practical purposes. We are not dealing with a moral issue here; we are dealing with a health issue. Many people and particularly young people do not have one sexual partner only in their lives and, while the incidence of AIDS will perhaps change the behaviour of young people to some extent, it would be unrealistic to believe that it will make them return to the sexual morality of 30 years ago.

When the book asks can condoms prevent AIDS we again have the introduction of the notion of the one faithful partner. I challenge the answer used on page 9 which is that a condom is a useful protection for those who engage in casual sex with different partners. Instead I would like to suggest it should read that it is an essential protection for those who engage in casual sex with different partners. I feel that this information booklet should be drastically revised and amended to be a more explicit source of information. I recommend that the authors read and take note of the booklet brought out in the UK by the Department of Education and Science which was called “AIDS some Questions and Answers”. It is very clear and explicit, written in straightforward simple English. Let us not be shy about taking a leaf out of their book because, if information is needed and it is, it should be given in a comprehensive and honest and straightforward way.

Furthermore, a poster which was allied to the campaign last year carries the caution, and I am sure many of us here present have seen it, “AIDS don't bring it home — causal sex spreads”. I feel that this is a self-righteous notion that if we do not have AIDS at home nobody travelling out of Ireland could possibly bring the disease with them. I think the advertisement should say “AIDS don't forget your Condoms — casual sex spreads”. The cautious overtones which were a feature of the last public information campaign should be dropped and Irish people should be treated as adults and not as adolescent school children.

At least we can be very glad that the [1839] amendment to the family planning legislation which was brought in by the Coalition is now in place and enables people who are not married to each other to buy and use contraceptives. Indeed, there is a great deal of irony in the fact that if the Fianna Fáil Party who so vehemently opposed the changing of that legislation — that small amendment — had succeeded in what they wanted to achieve, we would have legislation which would allow the sale of contraceptives only to people who are married. They are exactly the people who are probably least at risk from AIDS than the other groups, young people and those who are not married.

In this regard perhaps it is time to make another change and consider having contraceptives available in men's and women's toilets. I have seen reports in some newspapers that publicans are stocking condoms either under the counter or on the top shelf and selling them. Again, it is all a nod and a wink; it is not good enough. If young people who are at risk and who will abide by the public information campaign want to have safe sex, let us enable them to have safe sex and make contraceptives more readily available. Indeed, I was very interested to see that the Taoiseach, Deputy Haughey, is on record as saying that Fianna Fáil would raise no objection to the use of condoms to combat AIDS. That is a very good thing. The Minister should to ahead with the necessary changes on that basis.

We know from the pattern of transmission of AIDS that there is now a move away from the homosexual group to transmission by the intravenous drug users. Indeed, two thirds of the HIV positives reported are drug abusers. It is known that the spread of AIDS among the hetrosexual population is largely due to the infection passed by the intravenous drug users. There is, therefore, concern to prevent an epidemic of AIDS in the heterosexual population and great efforts must be made to control the spread of the disease among intravenous drug users. [1840] Action to this end can include the provision of sterile equipment or clean needles, health education and, hopefully, identifying and diverting drug users into treatment.

Recommendations have been made elsewhere to make clean needles available for drug abusers and this has been endorsed by, for instance, the Scottish Home and Health Department in the British DHSS, the Italian health service and the Amsterdam local health service. Addicts are allowed to exchange used needles for new ones as part of a programme of outreach. Pilot schemes set up in a number of cities in England have shown that the availability of needles is not itself sufficient to control the epidemic — we would not suggest that it would — but some authorities suggest that the availability of needles may serve as an inducement for drug abusers to enter treatment programmes and have testing.

The availability of needles does not appear to increase drug abuse in any of the areas in which it has been tried, but it would only be of value when used in conjunction with co-ordinated programming of assistance, education and, eventually, treatment for addicts. It would leave a lot to be desired if the campaign to deal with the AIDS problem among intravenous drug abusers were to focus only on whether to provide clean needles for them. Of course, we have to go a great deal further. They are a particularly sad section of society, already knowing great suffering and desolation in their lives. The fact that they do not act responsibly and are a difficult group to deal with when they contact AIDS is only symptomatic of their inability to cope with the disastrous state of their lives. For this group we do need to have a specially designed programme involving counsellors and care workers who are familiar with the behaviour and livestyles of drug abusers and can reach out to them in a meaningful way.

In this regard, I would commend Fr. Paul Lavelle for his work and his care of [1841] intravenous drug abusers. Any programme drawn up to counteract the disease within this community should use the expertise that he has because it is extensive. He would be able to give very important guidance and advice. One of the suggestions that has been made is that there might be reformed drug addicts attempting to outreach and to contact the victims of AIDS and to get through to them in a way that other people might not be able to do.

I welcome the fact that we are to build on the awareness already created and develop an education programme for schools. There is every likelihood that we could find that a lot of young people have only half formed ideas of the AIDS problem. They may have picked up some of the facts, but not all of them. In the Minister's speech I was glad to see he is seriously thinking about and plans to have an education programme for schools. I would be concerned that he has mentioned secondary schools only, because this programme should go into primary schools and no child should leave school without knowing the truth about AIDS. In his speech the Minister said no child should leave school without knowing the facts about AIDS, but I would suggest that many children leave school without knowing the facts of life. Maybe we should go back and deal with this problem at a very fundamental level.

This debate will be very constructive and useful and I am very pleased that the Seanad is the first House in which we are taking up this challenge and dealing with this very serious problem. Those of us who have been involved in it and who have had to inform ourselves of the broad parameters of the issue, have been a little alarmed. It has not been a good picture; it is very depressing. It seems that anything that has happened — I do not want to be unfair — has happened by default rather than by plan. There does not seem to be any long term plan or any assessment for the future to decide vital matters like the treatment of patients, what hospitals they will be treated in, what budgets will be given to those hospitals, what plans are [1842] made for the training of medical personnel who will be dealing with the victims and, above all, what about the extra costs? The cost for treating one AIDS patient with a special drug for one year is something like £7,500.

There are considerable costs involved, and there does not seem to be any management or planning ahead on this matter. What is going to happen when — as is likely — cases of AIDS spread outside the Dublin Metropolitan Area, where at present most of the cases are being dealt with? What are the plans for county hospitals? Again, many AIDS victims will die at home, they need a great deal of nursing and care but, above all, there is a need for resources to be put into helping the intravenous drug abusers. They are the most essentially needy group at present. If possible, they should be organised into a group.

This was something Fr. Paul Lavelle said yesterday. He suggested there should be what he called a junkies union. It is not such a bizzare notion, because if it is possible to get people into a group, there could be a common cause established, the issues facing them could be more readily identifiable and they could be better monitored, checked and helped. It may be an outrageous idea, but it is certainly worth looking at.

Anyone who gets upset by ideas like this should remember that the virus is passed in the drug community from mother to baby, and this is a particularly vulnerable and sad group: 36 babies have been born HIV positive and the likelihood is that 50 per cent of them will die. There are many facets of this health problem that require concentrated hopes of attention. There is a need for monitoring and for political input. It is not like measles or chickenpox. It is a very, very serious public health matter.

I should like to pay special tribute to the people who are working in the area of AIDS, whether it is in education, treatment, community work or in any other area. I commend them and wish to say how we appreciate them. The reality is that we need a great deal more than is [1843] being done at the moment in research and education but particularly in treatment.

These people should have some access to the Members of the Oireachtas for support. I suggest that there should be a cross-party group from this House and the Dáil which would maintain contact and have regular, informal meetings with people like, for instance, Dr. Fiona Mulcahy, Dr. Irene Hillary, Fr. Paul Lavelle and the many other people. This would ensure essential communication where it is important because we must not go back to leaving the people working with AIDS and the AIDS patients themselves in a wilderness. At the moment in Ireland there is a very definite sense of apartheid — them and us — and it is not good enough for politicians to accept that.

Dr. O'Connell: Information on John F. O'Connell  Zoom on John F. O'Connell  We should welcome the opportunity for discussion on this serious problem which I consider to be the greatest threat to the world since the bubonic plague. Despite the scientific advances in so many areas of health, we have been unable to produce a vaccine to help to prevent the spread of this disease. Perhaps the reason why we cannot develop a vaccine successfully is that the virus changes so rapidly and so often. We are faced with a strange phenomenon in this disease which was first reported in 1979. It traces its origin to Central Africa, to Zaire and it was spread from there by Haitian emigrants going back to Haiti from South Africa. Apart from that Haiti is a famous ground for homosexuals and from Haiti it is spreading to the US. How the virus appeared is one of the mysteries of science and nature.

Because of the great work being done in Britain and in Atlanta we know how the virus spreads and those who are most at risk. Ireland is rather different to the rest of the world in the spread of the disease in that there is a prolonged interval between infection with the HIV and the actual acquiring of full blown AIDS. We are unusual in that respect. We are also different in that the spread here by intravenous drug abusers is more rapid [1844] than in any other country. This is a big problem.

There was a survey by the Health Education Bureau in March 1987. Before the health education programme started we found that people were very well informed on AIDS. The survey showed that 61 per cent of the people surveyed realised that people with fullblown AIDS would die within two years. Two-thirds of the people surveyed knew about this About 97 per cent of the people surveyed were aware that AIDS is transmitted by sexual intercourse and 96 per cent were aware that it is also transmitted by intravenous drug abuse. Seventy one per cent of the people surveyed mentioned homosexuals and bisexuals and 66 per cent referred to drug addicts as being likely to become infected with AIDS. About 46 per cent of those surveyed said that they would be less likely to send their children to a school where they knew there was a child infected with the AIDS virus. That is a very worrying finding. Perhaps in that area we need more intensive education and perhaps the Department are not doing enough work. Perhaps those in the medical profession who are enlightened are not taking sufficient measures to make people more aware that one does not contract the disease through normal social contact. Perhaps we did not give enough attention to the findings in that survey.

The survey also showed that there is greater acceptance of condoms as an effective prevention measure, Seventy-five per cent of those surveyed regarded the use of condoms as an effective method of reducing the risk of contracting the AIDS virus. The public obviously were very aware of how one caught it and of preventive measures but 46 per cent of the people were worried about social contact in school. About 57 per cent of those surveyed said that there would be no need to worry if one stayed with one sexual partner. The replies to that survey were very important. The most important finding was that 71 per cent of people said that clean needles should be made available to drug addicts as part of a prevention campaign.

[1845] The educational programme being carried out by the Department is quite effective except in relation to social contact. We have the same type of attitude that persisted in this country previously about TB. While we all knew it was infectious we were afraid it might be inherited. Despite all the efforts made to explain it there was an inbuilt fear about it.

AIDS is a very serious problem. The mortality rate is 50 per cent in one year and 85 per cent within five years of being diagnosed. This problem cannot be treated lightly. Sometimes we are accused of over-kill and it is this over-kill which is responsible for slowing the spread of the disease, especially abroad. We had only 36 cases and 16 of them are dying. That is almost 50 per cent which correlates with figures in other countries.

The fact that 30 per cent of AIDS cases are intravenous drug abusers and 60 per cent of HIV positive cases are intravenous drug abusers must make us look at this area above any other area. That is the one area to which the Minister has failed to turn his attention in his speech. Even though the Minister said a few weeks ago that the Government were examining measures such as needle exchange and methadone maintenance, which might serve to reduce the serious risk of AIDS, he did not mention a word about it in his speech. This is very disturbing. It is important to have energetic preventive measures targeted at this high risk group. It would do much to ensure that the epidemic here is controlled. I can understand the dilemma of the Minister and his Department. It is a very serious thing as to whether they should conspire in illegal acts, but free needle provision and methadone maintenance must be seriously considered by the Department. Dr. Jonathan Mahon of the World Health Organisation said that time is one commodity which is running out fast in respect of this disease.

For drug abusers, the easiest way to avoid the risk is not to inject drugs. However, these drug abusers are not particularly bothered by the risks nor are they preoccupied with the future. [1846] Certain people tend to adopt a moralistic attitude and say that the drug abuser can reap the whirlwind of his own antisocial habits. Leaving aside the morality aspect, that is a very shortsighted attitude. The larger the pool of HIV drug addicts the greater the risk of spread to the general population. In other world centres the advice is that injecting drug addicts should not share their needles. The addicts are advised not to mix their drugs in bowls or implements used by others and to destroy the needles they have already used. If you are to have this policy of containment the only thing you have to do is ensure a ready provision of free needles.

Here the objections are raised. If you are going to provide needles, like methadone maintenance, it looks very like collusion with illegal activity and you will be accused of that. I suppose it is a form of collusion with illegal activity, but with AIDS we are facing a problem of such enormity, such potential disaster for the human race that collusion is amply justified. I urge urgently on the Minister to make a decision on it as fast as possible.

Maybe the number of Irish people with AIDS is not large, 36 cases, but there is a steady growth and I think we have no reason to feel complacent. We should bite the bullet and face up to the fact that we need to direct a campaign at intravenous drug abusers, encouraging those who cannot abstain — by all means try to encourage those who can to abstain from it — at least to adopt safer drug use practices and promise them a more nonjudgmental health service response, learning particularly from the Dutch experience in this respect. The Dutch, though they have a large drug problem, find the AIDS epidemic a greater threat within the homosexual community than among the drug abusing population. That is the significant result of the free availability of needles for drug abusers. If we adopt this policy we might ensure we stay relatively free of the AIDS epidemic. Given the apochalyptic possibilities if we do not, however difficult for the Minister and the Government, the choice is obvious, that we must make them available. [1847] Response from that survey would indicate that there would be public acceptance of such a policy.

Mr. Norris: Information on David P.B. Norris  Zoom on David P.B. Norris  Like the previous speakers, I regard this as an intensely important debate, in fact a historic debate which I have a particular interest in welcoming because as the House is aware, the first thing I did on entering Seanad Éireann was to place a motion on the Order Paper dealing with precisely this subject. It is to an extent that motion which has been partially replaced by the present motion. I did so because I felt it was something which had to be addressed. I welcome the very serious and balanced contributions of the previous speakers. In particular I support Senator Nuala Fennell's suggestion that there should be between Members of both Houses of the Oireachtas a continuing degree of dialogue with those people so directly involved in terms of fighting this infection. The briefing session held yesterday which was addressed by Dr. Fiona Mulcahy and Fr. Paul Lavelle was a most useful experience, bringing to the Members of both Houses access to information which is invaluable in discussing this extremely difficult area of policy.

I support strongly what Senator John O'Connell has said. It is most notable that from all sections of this House the problem of acquired immune deficiency syndrome is being treated with such seriousness that old shibboleths are at last being thrown out the window and we are showing some signs of facing directly into what is unquestionably the greatest crisis facing this country, a crisis not only in terms of health but in terms of the economy. I do not know how, when we are winding down hospital beds, hospital wards and whole hospitals, we can imagine we have the capacity without planning. Let us be under no illusion, there is no adequate planning in existence at the moment, no proper projections, no analysis with regard to the ultimate cost of this disease, the way in which it is going to multiply. We simply do not know. There has been no specific or [1848] realistic apportionment of funds to deal with this.

The Minister spoke about education and of course I must agree with him here. Education is important, and I will return to that, but there was virtually nothing whatever about the treatment of those who already have the disease. It is most important that allocations be made for that because if we do not provide these services we are simply helping to guarantee that the infection continues. I have said that education is important. Of course it is. There is no known cure for AIDS and there appears to be no future or even medium term prospect of a cure although, mercifully, this is quite a fragile, vulnerable virus which is difficult to contract. It is also resistant to treatment and shows an unfortunate capacity to disguise itself and change its coating so it becomes extremely difficult to attack with anti-viral agents. Therefore, we have a real problem here with no cure and no prospect of a cure either in the immediate or long term but we know that even though there is no cure the old adage, “prevention is better than cure”, is particularly true in this circumstance.

We know also that prevention is possible through education. I feel I can speak with some authority on this because I became aware of this situation in 1982 from reports which started reaching us in the gay community of Ireland, particularly from San Francisco, of the occurrence of an unusual clustering of diseases which were contracted venereally. We were not quite sure at first what this meant but we were concerned, alerted, and we monitored these reports as they came to us from San Francisco.

As it became clear how serious the situation was, immediately we went into action with a massive programme, saturating the gay community with information. We published leaflets. New organisations began to develop. Groups like Gay Health Action, AIDS Action Alliance, Cáirde and, now, Front Liners, sprang directly out of the gay community and began the education process, and 250,000 leaflets were produced with no [1849] major subvention. I may say it is a disgraceful irresponsibility on the part of the Government that there simply has not been adequate funding for those education programmes that are realistic. I tell the Minister that I do not consider any of the material published under his imprint to be in the slightest way adequate. In no sense is it. We cannot tolerate this continual moralisation of what is clearly a health problem and there need be no doubt whatever that this is happening.

The material published from within the gay community was effective and the Minister himself clearly recognised that, as is evident, when he says in his speech that this — the pattern of infection through intravenous drug abuse — is a different pattern from that emerging in most northern European countries where the great majority of cases are among homosexuals. I presume he is aware why this is so. It is because we acted responsibly, because we broke the laws.

I was heartened to hear Senator O'Connell making the point that the situation is now so catastrophic that laws will either have to be broken or changed, because we are actually talking about people's lives. If any Members of this House have had the kind of contact with this infection — not, may I say, just in the gay community but outside it — that I have had, they will not worry too much about the technicalities of the law. This is a really serious situation in which morality has absolutely no part whatever. I should like to say in support of this that I recently read, amongst other important articles, in the New England Journal of Medicine published last week the author, June E. Osborne of the University of Michigan School of Public Health stating that the impressive scientific progress which has yielded such useful insights into the problems of transmission can be easily neutralised by a refusal to acknowledge any options except monagamy, or chastity, or to discuss risky behaviour. This is precisely what the Department of Health are doing, what doctors are now warning us [1850] against. They are refusing to acknowledge realistically any options except monogamy and chastity.

I would have to say that I would like to use this opportunity, this morning, to appeal to the Christian churches who appear to have such an influence with the politicians in this country to cease their campaign of disinformation on the subject of AIDS. Statements such as, for example, that the only defence against AIDS is faithfulness within marriage, which has been stated by the Roman Catholic Hierarchy and echoed by the Church of Ireland Prelates are dishonest. That is a lie. It is clear to anybody with a titter of wit that marriage is not an anti-viral agent, however worthy it may be in its social form. Let us stop the lying, because this programme of disinformation, in fact, discredits the real facts when they emerge. This is a health problem; it is not a moral problem.

Dr. Osborne continues by saying — and I think this is a most important point — that failure to warn adequately about the new virus and its consequences would be an extraordinary punishment for unapproved sexual activity. It is perfectly clear to me that there is a psychology at work here which suggests that the wages of sin is death and that it is an appropriate wage to be awarded to those who stray from what is perceived as the straight and narrow path.

My final quotation from this very useful article from a scientist says:

Knowledge brings with it the power to escape from the crippling stance of vast generations who were condemned to cower in ignorance before the Black Death or the invisible menace of Yellow Fever.

This is what we have the possibility to do. We can escape from this, but only if we behave responsibly.

I emphatically do not endorse the Government's public information and education programme. I describe it here in Seanad Éireann as a disgrace, an evasion of reality. Where do they give any useful information? They say that condoms cannot offer 100 per cent protection [1851] against AIDS, no more than they can offer 100 per cent protection against pregnancy. Why do they raise this doubt? They know perfectly well that, if used properly, they are a 99 per cent protection, and this is known. So why in their information campaign do they raise a doubt about it? There is no information on how to use them. Surely this would be the thing to do, to give people the right access to information about this, the most practical method of avoiding transmission. As Senator O'Connell said with regard to drug abuse, we must get rid of our moral preconceptions. Simply because people find the subject of condoms, the subject of human sexuality, distasteful and disturbing, are we going to abandon our young people to a horrible fate of disease? I believe that this would be utterly, grossly irresponsible. I believe that people are entitled to protection in their health. If we disturb people's sensibilities, that is unfortunate, but it is a risk which I would certainly be prepared to take.

There is no real information whatever about safer sex. I recommend the Minister and the Department of Health to consult the documentation which has been proved in this country to be accurate and effective, the information produced from it in the gay community which probably broke laws because it gave very specific information about the methods of transmission. I am not going to go into that because my colleague, Senator O'Toole, will be reading into the record very specific and factual information which I hope will be widely absorbed. We know about the method of transmission. We also know what sexual practices are safe, how certain sexual practices can be made safer and we publish this very explicitly. I tell the Minister today that what he must urgently do is to produce material which may cause some flutter of susceptibilities and sensibilities but I believe, from what I have heard here today, that Members of this House recognising the seriousness on an all-party basis, will support the Minister. There will be no division in the ranks if he [1852] develops some courage and produces material which is clear, specific, factual and explicit. This must be done.

I should like to continue along this line by saying that I am very disturbed at what I see as the Minister presiding over the growing sectarianisation of medicine in this country. I would link this also with the developments with regard to Barringtons hospital. I also believe very strongly that the Minister has not encouraged or funded — in fact, I know that he has not encouraged or funded — the most effective section of that campaign launched by the community which this morning I consider myself to be representing. I believe that this demonstrates a clear bias. I should like to refer to the Minister's speech where he says:

The most serious implication of this epidemiological finding is that the risk of spread into the heterosexual community is proportionately greater in Ireland. There is, in fact, evidence to show that the virus is already spreading into the heterosexual community, albeit slowly. As this epidemiological pattern has emerged, the Government's AIDS strategy has been developed to meet the situation.

I find that very interesting when I look into it, look underneath the surface. There is almost here an implication that, if it were some kind of myxomatosis which removed the gay community of 10 per cent from this island, we need not really worry too much, but once it starts getting out then we start worrying. Even that shows a relative lack of sophistication because, if the Minister for Health were aware of the sophisticated analysis produced by Alfred Kinsey, he would realise that 37 per cent of the adult male population of this country, as well as every other because this is a global statistic, engages over a three year period in more than incidental homosexual relationship leading to orgasm. So it is a very much wider problem than people are prepared to recognise.

What are the parameters of this problem? We learned yesterday — and some of the figures have been quoted — that [1853] there are about 700 cases, but testing is incomplete. Of course it is. We have detected a HIV-positive response in this number of people who have taken the test but there are not that many people taking the test, and why should they? Because they will be penalised. I urge the Government, on an inter-departmental basis, to address this problem which I brought to the attention of the House when the Insurance Bill was being discussed. It is now the policy of a number of major insurance companies to send out questionnaires to applicants for insurance including questions about whether or not they have taken the HIV test. Some of these people will be either heavily penalised or debarred from any insurance, even for just simply stating that they have taken the test whether it is positive or negative.

I brought this matter up in this House with the Minister of State, Deputy Séamus Brennan. He did look into the matter but the reply he received eventually from the insurance industry was totally inadequate and effectively confirmed that this is the situation. This is an attitude of the grossest irresponsibility on the part of the insurance company and calls urgently for Government action. I believe that, in saying this, I would have the support of all responsible members of the medical profession. I have no doubt of that, because this constitutes a disincentive to people to take the test, to take adequate precautionary measures subsequently and is a totally socially destructive phenomenon. It is something that must be attacked and I call upon the Minister to make this part of his ongoing representations.

It also represents a very unfair burden on people. The example I gave the Minister was that of a young man who was a haemophiliac and who was contemplating marriage. As a responsible citizen he took the test, found it was negative, wanted to proceed with his marriage arrangements, acquire a house — and the Constitution is supposed to support the family — and found that, as a result of the fact that he had taken the [1854] test, he could not get mortgage protection through life insurance and could not set up a home.

It seems to me that this is a situation that must very clearly be attacked. It is important that we know the statistics. That figure of 700 is undoubtedly an under estimation. It is at least three or four times that number. Also the situation is also changing quite rapidly. At the beginning of the onslaught of this disease we thought that, however tragic it was, only about 5 per cent to 10 per cent of the people tested as being HIV positive were going to go on to get the whole syndrome, but that pattern has been changing all the time. It is now up to 50 per cent and nobody really knows where it will stop. I do not want to engage in scare tactics but it is possible that it will go up 70 per cent, 80 per cent, 90 per cent or even 100 per cent; we simply do not know. The disease is so new that we do not have sufficient facts about the epidemiology of it. We do know — and this is a frightening statistic — that the conversion of sero-positives to the full AIDS syndrome is happening at such a rate that the numbers of those with the full acquired immune deficiency syndrome is doubling now once every eight months. There are 36 cases this year; there will be at least 70 or 80 cases next year. What are the Government doing to provide for this? It worries me because I know what the costs are. As Senator Fennell said, the cost is £7,500 for a year's treatment of AZT which will prolong life for about a year. Some people may wonder what is the point in these circumstances. The point is that — as Dr. Mulcahy so movingly said — for a young mother with a family of small children, even six months or a year to enable her to make provision for the rearing and education of those children is incalculably valuable. Yet, because of inadequate provisions of funding and an inappropriate method of allocation of funding, doctors are sometimes prevented from making allocations to enable this kind of treatment to be given. They have to fight within their own hospital, in an inter-departmental fashion, or they may [1855] simply have to tell the patient that he or she cannot have access to this treatment. That also worries me very considerably.

I believe there should be major support for the medical and caring professions. I know, for example, that to date one counsellor at St. James's hospital resigned recently in response to the work overload. There is no real attempt to address the economics of this. It costs £26,000 per annum for a five-weeks stay in hospital for somebody suffering from the terminal conditions such as pneumocystis carinii pneumonia. We now know statistically that most Irish AIDS patients need an eight weeks stay. Therefore we are talking about a great deal of money. Provision must be made in this area.

I would join other Senators in paying tribute to all those who have been involved in the front line of the campaign against this very unpleasant and distressing disease. There is a remarkable history of self-sacrifice and devotion. I may say — and I hope it will not be seen as being too sectional — there used to be a slogan in the late sixties and early seventies “Proud to be Gay”. When I consider the response of the gay community in this country, I can certainly say that with conviction. I urge the Minister to put himself in a position to contradict my assertion that those groups who sprang directly from the responsible action of the gay community have been deliberately starved of funding. This is a widely-perceived belief in the community. It is an inappropriate response, not only because it displays bigotry and prejudice, but because it cuts the public off from the most effective pool of information and expertise that this country possesses outside the direct involvement of the medical profession. Among other things it is an unwise practice. It is very widely believed that this is the case, despite the fact that these organisations have moved beyond the confines of the gay community and now involve a wide range of people. Therefore, it is a question of the Department cutting off their [1856] nose to spite their face but, alas, they are cutting off everybody else's nose as well.

If I look at the kind of groups that are involved there are: Gay Health Action, which produced a quarter of a million leaflets which helped with very little funding; they got, at one stage, less than £800, and there was a row about that. There is then the AIDS help line. There is a wonderful organisation called “Cáirde” which provides support group services for those with AIDS or those concerned about AIDS. There is “Front Liners”, which is very important, because, if we are talking about education, the single most effective thing you can do — and this has been shown in America — for children or any group is to get somebody who is actually infected to come in and talk because they are talking really from the edge of the grave. What they have got to say will be listened to. It is a traumatic psychological shock for people to realise that they are confronting somebody who has this disease. But it is one really effective method of getting the information across. I could list other organisations, all of whom had the impetus from the gay community, from the Hirschfeld centre; they have moved far wider than that. Every single one of them has been denied funds. I would like a response from the Minister on that aspect.

Senator O'Connell has stated that it is important that we do not allow the technicalities of the law to deprive us of the most effective way of controlling this disease. Why are the Government persisting, blindly and foolishly, in limiting the effectiveness of their own campaign? It is important that we get rid of the division of those suffering from AIDS into the innocent and the guilty. This is one of the most tragic and reprehensible attitudes I have witnessed. I would agree with some Senators that, by and large, reporting in Irish newspapers has been extremely well-balanced and non-provocative. I greatly welcome this, particularly when I contrast it with the attitudes adopted by both the British and American media. I hope this will be sustained because we are only moving into the most [1857] dramatic phase of the disease in this country and I am confident that journalists will continue to behave responsibly and to write in an informed fashion.

It is most important that clear and factual information is given with regard to this disease. I should like to reiterate my support for a most valuable suggestion by Senator Nuala Fennell, that the contacts between Members of both Houses of the Oireachtas and those who are involved in a frontline fight against disease must be continued. They must be put on an ongoing basis because, most regrettably, this will not be the last time we discuss this issue. We will come back to it as the financial and social implications of the tragedy become clearer to us. It was a most valuable suggestion and I will certainly be happy to co-operate with it.

I was involved with Senator O'Toole in establishing the briefing session. It was held on a very busy day when both Houses of the Oireachtas and a number of committees were sitting but it was attended by nearly 20 Members of both Houses representing all parties. I do not regret the bluntness of anything I said today. I stand over everything that I have said. I know it is incorrect to refer to the fact that the Minister is not present but I have already communicated to him my feeling of the inadequacy of the Government's programme and I hope that my word will sting the Minister for Health into the appropriate action which is not being given to the citizens of this country at the moment.

Mr. Lanigan: Information on Mick Lanigan  Zoom on Mick Lanigan  I do not intend to take very long in my contribution. I support the motion and in doing that I must apologise to the Labour group in that their names were not mentioned in the motion. This was due to an oversight and not because the Labour Party had not been consulted or were not in agreement with the motion.

Of course it can be said by anybody that whatever is done in this area does not go far enough, that the education regarding AIDS is not sufficient nor explicit but the Government have responded quite quickly to the very huge [1858] dangers involved in this killing disease. We want to get across to everybody that there is a very simplistic attitude by many people in this area but at the end of the day AIDS kills and that is the message that must go out from this House. We should not over-emphasise the fact that it has been referred to as the greatest killer of the century when one considers that there were 36 cases of AIDS reported in Ireland in the last few years of whom 16 have died. It should be emphasised in this House that over 17,000 people died in the last 12 months from tobacco-related diseases. If we do a parallel in terms of education, we have been saturated for many years by advertising which states that tobacco causes cancer and we have been hopelessly unsuccessful in spreading the message. No matter how explicit the message is it appears that the public will make up their own minds as to how they behave and, unfortunately, no matter what we do, lifestyles are not easily changed.

Senator Norris referred to the need for clear factual and explicit advertising or teaching in relation to the spread of AIDS. Clear, factual and explicit education methods have been tried in every country in the world since this dreadful disease emerged in 1981 but none has been successful in containing it.

The Minister's attitude, which was clearly acknowledged at the international conference he attended recently, is that the type of education campaign the Government have embarked on is one of the better ways of dealing with this dreadful disease. Information and advice on this disease has been increasing both from the Government and other people who, as Senator Norris said, have been dealing with the matter on a very human and face to face basis. Nevertheless, the information and advice given right throughout the world has not yet put the message across that AIDS does kill. Seven years ago it was an unknown disease and now about 10 million people may be infected with the causative virus. It is a huge number of people. Indeed it was suggested at first that this was a disease [1859] spread in the mainly homosexual community and there is evidence to show that homosexuals are very much in danger of contacting it. It is interesting to note the statistics given here this morning by the Minister in respect of sufferers from the disease in Ireland. These are: Seven haemophiliacs, one heterosexual, 13 homosexuals, 13 IV drug users and two babies born to infected mothers. These are the statistics available for this country and according to The Irish Times articles we may be exporting quite an amount of people who have contracted this disease into the English environment and possibly others.

There is no doubt that the only safe way of not contacting the disease is to have no sexual relationships, but that is not an option that anybody could go along with. Human sexuality is something that has not yet been sufficiently addressed but there is no doubt that sexual relations will continue and that there will be a growth and a spreading of this disease.

Senator Norris suggested that the proper use of condoms would eliminate the disease but statistics do not bear that out. It is reckoned that at least 25 per cent of people who use condoms do not use them properly or that the condoms do not do the job for which they were particularly made. It is unfortunate that condom salesmen and the manufacturers of condoms are much to the fore in suggesting that condoms will prevent the spread of AIDS, Condoms will not prevent the spread of AIDS but they can play a useful part in containing it. It should not go out from here or from any other forum that condoms alone will prevent the spread of AIDS. It is unfortunate that firms in the condom making business are getting so much publicity in their efforts to spread the use of condoms because they are not in business to prevent AIDS, but to make money.

The 49,132 cases of AIDS reported to the World Health Organisation from 104 countries by May of last year indicate that the tragedy of AIDS is throughout the world, in the Third World, the First [1860] World, the Middle World. The syndrome knows no boundaries and, unfortunately we cannot do, as was done in the past, confine people with AIDS to particular hospitals. In the past when fever hospitals were a well known phenomenon people with communicable diseases could be confined in them but unfortunately, there is no way this disease can be confined to a ward, to a country or a continent.

The Government, it was stated, have no long-term plans to halt the spread of AIDS. They have been working extremely hard and it must be said that the Minister has great concern for the people who have contracted this disease. I do not think there has been any suggestion, as Senator Norris said, of blaming the victims for the spread of the disease. They are victims and nobody has suggested otherwise. I do not think the Minister is insensitive to the needs of the victims but, of course, one of the problems with any disease which is not socially acceptable is that the victims will be the first to be blamed for the spread of it. There may be thousands of carriers of this disease throughout the world who do not know they are carriers. They can spread the disease unknowingly. Unfortunately, there has not yet been a reasonable method of tracing back the origins of the disease.

There is one area which can be addressed, the area of drug abuse, where people into drugs use dirty needles. It will be very hard to overcome that difficulty. There is no point in suggesting that these people will drop into social service centres or that they will go into coffee shops to get advice. The only way to get at these people is directly. We must have a more active drive — I am glad the Minister has said that this will happen — to get to the users and ensure they are aware of the dangers of using and reusing dirty needles. Sixty per cent of HIV positive individuals are drug abusers. It has to be said that the misuse of drugs in a causative factor. When people are hooked on drugs they are not going to take any precautions because they are not capable of making the decisions and that indicates that they should be more careful. A person who is [1861] drunk will not make a rational decisions, just as a person who is abusing drugs will not make rational decisions.

Like the cancer of tobacco, the cancer of AIDS is transferable from one generation to another. It is horrific to consider that babies born to infected mothers, intravenous drug abusers, have AIDS. I suggest that nobody in the House can come up with an adequate answer to this particular syndrome. Nevertheless, I agree, and I think most Members in this House will agree, that the Government are facing up to the problem and that we will see, over the next few years, an increasing use of well formulated advice, in particular for intravenous drug abusers and school leavers.

I suggest it is a little late in the day to start teaching the facts regarding AIDS to people as they leave school. There should be an ongoing teaching process from the very early teens at least into every aspect of human sexuality. I do not think that that educational process should necessarily show that there is anything wrong with human sexuality, that AIDS is the result of sexual contact. AIDS is the result of a syndrome which has not yet been identified in the sense that the cause has not been found and the cure has not been found. The teaching of facts regarding AIDS a little earlier than school leaving age is a necessity.

We should not overemphasise the fact that this is a disease which cannot be cured. There are many diseases in this world which have been addressed for much longer than this disease and for which a cure has not yet been found. Nevertheless, this one disease has been addressed a lot earlier than many of the other killers we have around. It is a long time since tobacco was first used but we still have not been able to persuade people to change their habits in regard to it although its use kills 17,000 people per year here and that number is increasing. I do not want to equate that with the 16 people who have died of AIDS — but that figure can multiply very fast, as Senator Norris said. The debate today has indicated a readiness by the Minister, and the Seanad, to discuss this very important [1862] aspect of life here and worldwide. I commend the motion to the House.

Mr. Ferris: Information on Michael Ferris  Zoom on Michael Ferris  I should like to thank the Leader of the House for putting the record straight in regard to a name from the Labour Party group being omitted from the list of movers of the motion. As the Leader of the House has said, we discussed the wording last week and, unfortunately, Senator O'Toole was unable to make contact about his signature. For that reason the motion went in as it appears on the Order Paper.

It is not to be taken that the Labour Party are unaware of the problem. Indeed, it is true to say that we were to the fore in ensuring that people were made aware of it and we have tried to address it in a way the ordinary people of Ireland wanted.

We have, as has been said by Senator Fennell, come a long way since the initiation of a family planning Bill, which was subject to quite a lot of criticism — political and religious — at the time. The record will show that during the debate on that minimal change in the family planning Act, AIDS was mentioned, albeit in a limited way, as one of the diseases that was becoming a world problem. The change in the legislation of the day arose from a declaration by the medical profession that they were no longer prepared to be the moral conscience of the nation. They represented the only source of advice and regarded their position as unacceptable. The changes made three years ago were regarded then as most revolutionary, although they are now seen as limited. Family planning methods were normally employed by people who had health problems and were receiving professional advice from doctors, pharmacists or gynaecologists attending maternity hospitals. The scope of the 1985 legislation was relatively minor. However, it is now the case that although morally some family planning methods are unacceptable, they are legally available and people have been advised that their use can be useful in curtailing the spread of one of the greatest scourges of the century. As Senator [1863] Norris has pointed out, such methods are not 100 per cent successful.

Senator Fennell referred to the stigma attached to those unfortunate enough to be stricken by diseases such as tuberculosis. I and many other people lost close relatives due to this disease. Progress was not made until the then Minister for Health, Dr. Noel Browne, addressed this problem and eventually the disease was wiped out. This success was due to the courage of politicians who realised that urgent action was necessary in isolating and treating tuberculosis sufferers, as well as the courage of the frontline nursing staff who cared for these patients.

Cancer remains one of the great scourges and much work is being done in this area. The same applies in the case of heart disease, where it is recognised that most of the contributory factors are self-inflicted. This does not remove from the Government the responsibility of advising people about self-inflicted disease, caused by abusing ourselves and one another through drugs, drinking, smoking and all the other things which may lead to cancer-forming organisms and other disorders. We as legislators have a responsibility to chart a course, despite the fact that the accepted method of treatment may not necessarily meet with a full response from vested interests, be they moral or economic.

Senator Norris referred to the attitude of the Catholic Hierarchy, particularly in the case of AIDS. Unfortunately he described what they have said as untrue. He went as far as saying it was a lie. All of us must admit that what the hierarchy have said is true and legitimate, but only if ordinary people lived the ideal life. I am sure that the hierarchy and public representatives are aware that things are not as they should be, legally or morally, and that life is not ideal. We are not the conscience of the people. The hierarchy would hope to educate the conscience of the people and what they have said is true in an ideal situation. We must, however, come to grips with the reality of addressing this problem while being honest with ourselves, with our conscience and with [1864] our God, in the belief that He is the final arbiter and judge of our actions. The self-appointed pontificators in this area are not addressing the real problem of advising people who are in need.

Senator Norris also warned against falling into the trap of categorising sufferers from this dreadful disease. I agree whole heartedly in this regard. We must, however, take account of the fact that innocent people have contracted it. The result for them is no different and surely our hearts must go out to haemophiliacs and to babies who contracted this disease from their mothers. Through no fault of their own such people have been infected. This does not remove the obligation to feel compassion for those who are infected by the other known means, that is by intimate sexual contact with infected persons and the sharing of contaminated needles by intravenous drug users. The problem of haemophiliacs have been constructively addressed by the drug manufacturers and the preparations necessary for the treatment of haemophilia will no longer be a source of infection. This has allayed the fears of those of us who are involved with and advocate the donating of blood to the blood bank. We must compliment the people who run this service. I welcome the Minister's indication that we will soon be sufficient in blood products produced from a domestic blood supply. This is a most welcome development.

We must now turn our attention to the problem of intimate sexual contact between consenting adults and intravenous drug users. With regard to the former group, the Minister's programme of information appears to have been successful. Senator O'Connell has confirmed the results of the questionnaire which contained specific questions relating to knowledge of the disease and how it is transmitted. The positive replies they gave are an indication that people who are not drug users, but who are involved permissively or otherwise in sexual activities, are aware of the dangers and aware of precautions they can take. I hope the [1865] Minister's programme which is to be continued this year will address itself further to the people in that group.

My biggest concern is the area of intravenous drug users. Any programme we have initiated has been incapable of being either received or assimilated by that group of people simply because, when they were first hooked on drugs, AIDS was not a problem or was not generally recognised to be a problem or people were not aware of it. It has been said that it is only in the past number of years that people have become aware of the dread and the scourge of the disease that we have faced in this century.

Drug abusers since they are now considered to be addicts incapable of making decisions, unaware of health education bureaux, Ministers for Health, the consequences of AIDS or the spread of it to other people, are living in a hell of their own which is continually stimulated every day, not alone by abuse of drugs but by the repeated use of instruments and needles, and the borrowing and sharing of these used instruments. Those are the people I am extremely concerned about. Indeed the Minister's statistics prove that the highest number of confirmed cases we have are from that section and that it is likely to continue to increase. I am suggesting to the Minister that, if this one to one contact we talk about, which I know is difficult and expensive, is not addressed properly, all our efforts will be in vain. I compliment the front line workers in this area, the community care workers, public health nurses, doctors and people who have specialised in trying to address this major disease. Those people are to be highly commended by Members of this House. If we can introduce legislation to assist them to meet this challenge it should be done urgently.

I am concerned in particular about drug abusers in our prisons. We listen on a fairly regular basis to people professionally engaged in prisons, prison warders and other people, who are extremely concerned about drug abuse in prisons. There are now a number of drug abusers in prison who have been confirmed as carrying the AIDS virus. [1866] Within our own jurisdiction, within our own prisons, the Government have access to information and action can and should be taken. I am aware from talking to parents who have children who are committed to prison for long terms, with no hope of their sentences being commuted in any way, that they are now being subjected to the trauma of inducement to drug use as a way out of their hell and dilemma of being locked away in jail. They are asking for more money from their parents to meet the need that builds up with drug abuse in prison. Because there are already addicted drug abusers in prison who have been confirmed as carrying the AIDS virus obviously the risk of contamination to all prisoners serving long term sentences is very grave. This is an area which the Minister must address as a matter of urgency.

We have listened to the professional people working in prisons who are now faced with the dilemma of trying to handle and control drug abusers who are using contaminated needless and are possibly AIDS carriers. Ordinary people with family responsibilities who work every day in our prisons are faced with the tremendous dilemma of how to cope with this problem. A vast improvement will have to take place in the area of education on exactly how this disease can be contained and controlled. We need short term treatment for suffers. It is a major problem. It is one that none of us likes to have to address here in this House today.

I hope the suggestion made by Senator Fennell about an all-party committee of the Houses of the Oireachtas will be accepted and that they will address themselves specifically to all the areas we are worried about. Those areas would include the four different sections of our community who are at risk, the Department and the medical advisers to the Minister and other people who are continually addressing themselves to this problem by way of international seminars and the distribution of information to health care workers, people in the community care field, ordinary GPs and those [1867] of us who are concerned as legislators in an area which impinges on many people's moral standards but does not remove from us the legal responsibility of trying to address one of the scourges of this century.

I hope the Minister will be successful. I hope he will be more successful than other Ministers of Health in other countries who took action too late and, as a result, the incidence of the disease had doubled in some countries in the interim number of years. Until such time as a vaccine has been perfected which will stimulate the normal antibodies of the human body which are affected by this disease we all have a major responsibility in the areas of public health, public awareness and public advice in the institutions of the State, in prisons and particularly in schools where young people facing the world must be made aware of the dangers. We must overcome our inhibitions and be open and frank with children of a proper age.

This was done in the vocational schools where a proper way to teach sex education was perfected, in consultation with religious people. I believe that all other schools could develop such a programme if there was agreement on how it should be approached. I have no doubt that all of us now know the implications of being unaware of this disease. We lacked knowledge of it because society was not prepared to advise us on the implications. We must address all these matters in a responsible way.

Sitting suspended at 1.10 p.m. and resumed at 2 p.m.

Mr. Fallon: Information on Sean Fallon  Zoom on Sean Fallon  I welcome this opportunity to contribute to this very important debate. What strikes me about this disease is that the pattern of health problems is not peculiar to Ireland. In developing countries there is great awareness of the potential of preventive approaches to this disease and health promotion is now regarded as an integral part of health policy. The diseases which have caused [1868] most deaths in this country in recent years are cancer and heart disease along with accidents at work and on the road. I believe there is great potential for the prevention of diseases such as cancer and heart disease through lifestyles and diet. As we are all aware we have a health promotion unit within the Department of Health whose function it is to advise the Minister for Health.

As I have said, those are the diseases which cause the greatest number of deaths in this country and we have put a lot of work into their prevention, but unfortunately on top of these there is now the new problem of AIDS. Almost 700 people have been shown to be carrying AIDS antibodies and most of these came into contact with the virus five or six years ago. We do not know how many other people are infected and we hope there are not too many. The gay community and haemophiliacs are not the groups causing the greatest amount of concern and we have been informed that the gay community are not involved in the spreading of the virus.

The biggest source of concern, as has been spelled out loud and clear in this debate, are the IV drug abusers who are based mostly in Dublin. I understand that there are about 400 of these in the city. It is almost impossible to reach out to counsel and educate them because as we all know most of them are unfortunately in the low academic and social categories. I am of the opinion that television and newspaper advertisements and reports in the newspapers are of no use whatsoever to them.

There is no cure for AIDS even though it can be prevented through appropriate counselling and education. The Minister of State in his speech clearly demonstrated that the biggest source of concern in the future will be the IV drug abusers. He outlined in his speech that of the 36 cases in this country seven are haemophiliacs, one is heterosexual, 13 are homosexuals, 13 are IV drug abusers and two are babies born to infected mothers. The Minister of State in particular underlined the fact that the 13 IV drug abuse cases have arisen within the [1869] last 16 months. That is a problem we clearly have to get to.

We are all aware that this disease will spread and unless adequate preventive measures are taken it could become a huge problem. Health boards, obviously, have a responsibility in this area and while most of the discussion in this debate has centred around the Dublin scene it is no harm to refer to what health boards in other parts of the country have done because, as I understand it, most of them have adopted a strategy for controlling the spread of AIDS. While the Eastern Health Board in the Dublin region have a particularly important role to play other areas have, as I have said, adopted strategies to control the spread of AIDS.

I am a member of the Midland Health Board and we have adopted and outlined a strategy to control the spread of AIDS. It is no harm to examine what we have done, and our efforts are praiseworthy in view of the fact they were made within our budget for the year, which is to assign responsibility for the co-ordination and introduction of AIDS services to the director of community care and the medical officer of health in Longford and Westmeath. We set up a co-ordinating committee under the chairmanship of the programme manager of community care comprising representatives of the various hospitals and community care services to monitor, evaluate and review on an ongoing basis the measures which are being taken and which it is necessary to implement in order to control the spread of AIDS.

We held a seminar which was addressed by leading experts on AIDS for over 100 of our key personnel and heads of services. In conjunction with the Irish Council of General Practitioners we sponsored a symposium on AIDS in May of last year. We held a seminar for teachers in most of the post-primary schools within the board's area in May of last year which was very well attended. A selected number of our staff went to England to learn more about the problem of AIDS and came back to relay the information and expertise they gained to the board's staff. Most importantly, we [1870] set up a local telephone advice service which was manned for about three weeks by the community care doctors, and this was very successful.

We are probably the only health board in the country which offered a 24 hour confidential help line service. It received many inquiries not just from within the board's own area but from all over the country. People received advice regardless of whether they lived in the Midland Health Board area or not. We also made available copies of the various booklets which were issued by the Health Education Bureau through our hospitals and general practitioners. We took very practical and real steps in the Midland Health Board region to play our part in preventing, as much as possible, the spread of this disease. We showed films on this disease to our hospital staff, nurses and public health doctors and, if a case was brought to their attention they gave advice on a confidential basis. In our area we have adopted a very responsible role to the problem of AIDS and we have taken very practical steps to control the disease by education and so on.

As a nation we have had an advantage. There was a gap, a time lag, before this disease reached this country. As we know, it had been widespread in America, Britain and other countries before it even arrived here. It could be suggested that this was a compliment to our moral values, that we were less permissive than societies in other countries in the late sixties and early seventies. However, this could be the subject for another debate. As I said, this time lag has been to our advantage and we must learn from what happened in other countries.

We know from what the Minister said today that this is an ongoing problem, and the Department of Health have a responsibility to provide whatever funds they can to combat it. There is evidence to suggest that the Government strategy is succeeding at present, because we are far better off than most countries. In addition, the Department of Health are setting up a research fund for the education and counselling of people with AIDS. This could and should be financed [1871] by interested groups. It is a case of these groups putting their money where their mouth is. I have in mind the medical profession, medical companies, the Catholic Church and so on, as well as the special allocation from the national lottery — £450,000 for 1988 — to which the Minister referred.

We must strive to prevent the spread of this disease. We have been informed that of the 700 odd cases two-thirds of those identified as HIV positive are drug abusers. That is a fact. These people must be reached at all costs and the problem explained to them. This problem will grow unless we come to grips with it. I am heartened by the news that the Elan Corporation, based in my home town, are involved in human research. We must hope that a cure will be found for this disease. We have a duty to seek a permanent cure for this dreaded and very unpleasant disease. I know the Government will play their role in endeavouring to ensure that this is the case.

Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  I have listened with interest to the debate so far. It is high time a debate on AIDS took place in the Houses of the Oireachtas. It is not without significance that the debate has been initiated in this House, a House which is very often maligned and denigrated. The Senators who have contributed as well as the Minister, by their presence here today underline the seriousness of the subject about which we are talking and point to the fact that this area must be discussed openly and rationally and that very concrete plans for coping with this new medical condition must be forthcoming.

I should like to compliment Senators Norris, Robinson and Brendan Ryan who a long time ago put down a motion calling on the Government to implement a full, factual and explicit programme of education. I should particularly like to compliment the Leader of Fine Gael in the Seanad, Senator Manning who, on foot of distributing articles in The Irish Times, called for the coming together of parties to decide on an all-party motion on [1872] AIDS. I thank the Government party and all parties in the Seanad for coming together in a spirit of constructive political activity to frame this motion and to have it debated here.

AIDS, or Acquired Immune Deficiency Syndrome, is the most serious infectious illness worldwide today. It is serious not only in its epidemic magnitude and seemingly unstoppable onslaught, but also in its devastating effect on patients and their families. In this world hundreds of thousands of sero-positive patients live in a state of emotional torment. AIDS angst is certain to become a recognised psychiatric condition and it is something we will return to in the years to come in this House. I cannot help feeling that in a very few years when people look back at this debate many of the views expressed will be seen to have been prophetic while some will be seen to have been folksy and backward-looking and not particularly helpful.

Today when we look back, the debate on the liberalisation of contraceptives is seen to have been in many instances pathetic and irrelevant. It is not without irony that today the Minister for Health, who belongs to a party which during the debate on the contraception issue put forward antediluvian attitudes on the liberalisation of contraception, is the same Minister, who is faced with putting in place a campaign of preventive health measures, a component of which is the use of the condom in order to minimise the risk of infection. I find a certain irony in that. I found the Minister's speech somewhat bland and lacking in a sense of urgency. It was more in the realm of making reassuring noises off stage. This has been the hallmark of the Government's response to date. I know the motion requires me to endorse the Government's health programme, and I do but only to a point. The campaign began belatedly on foot of pressure from politicians, the media and outside pressure to get the show on the road and to initiate a campaign of preventive action. The concerned public reaction was to heave a collective sigh of relief when the [1873] campaign did appear and to say, “At long last, better late than never”, but on closer examination of the elements in that campaign it is possible to pinpoint certain flaws in the thrust of the campaign to date. I would be failing my duty as someone privileged to contribute to this debate if I did not point out where I see the flaws and where the area for collective action really is.

In this country, the pattern of the disease as explicitly outlined by the Minister in his speech clearly indicates that to date it has and is attacking certain identifiable groups of people who for different reasons have a high risk of infection. Yet, the campaign is aimed at the vast majority who are least at risk of contracting the disease or passing it on. The majority of Irish people are among the populations in the world least at risk of contracting AIDS and the question must be asked and answered — what other public health preventive campaign in this country has been targeted at groups least at risk of contracting the disease which the campaign is designed to prevent? Will the Minister and his officials contrast the preventive health campaigns in the area of AIDS with the recent anti-measles campaign which was specifically targeted on those it was attempted to assist. I would ask the Minister to contrast it with the TB campaign also.

Dr. David Nowlan in an article in the Irish Medical Times made some very pertinent comments in this area when he said that the Irish anti-AIDS programme seemed to be designed to be most persuasive to those who least need it and that while the use of condoms offers less than 100 per cent protection against HIV, those “in doubt” are advised to consults doctor rather than to simply use a condom in dubious sexual circumstances and that it is not as if the condom in such circumstances was being used as a contraceptive and that its use is or should be advised as a means of lessening the chances of contracting a fatal disease. That is prophylaxis in its best and original sense. I cannot but concur 100 per cent with that criticism of Dr. Nowlan of the campaign.

[1874] I noted that criticism coming across on this side of the House. Understandably, by and large, Senators who spoke from the Government side of the House loyally and manfully supported the Minister and his campaign, although it is not without significance that Dr. John O'Connell who more than any of us in this House by virtue of his training and background, knows what he is talking about, chose to differ with the Minister and to pinpoint the total absence of any possible suggestions in relation to how we deal with the drug abusers in our community.

I want this debate to be constructive about prevention and I want to make some constructive suggestions as to how we can better approach this problem. It is unlikely that a vaccine will be developed in the near future. The spread of the infection can be controlled only by structured preventive measures and health education. These should and most emphatically must be aimed at high risk groups, health care workers and the general public, in that order of priority.

Safe sex is the order of the day. The more sexual partners people have the more likely they are to have sex with an infected person, and that is axiomatic. It is the kind of information that should be clearly and unequivocally presented to people, not in a moralistic way but in a clear factual manner. People should restrict their contacts to established relationships. Of course, the ideal is constancy and fidelity in one's personal life. That is the position to which I subscribe, but I know that that is not the case in many instances, many more than we are prepared to admit. In the context of AIDS it would be the height of folly to blindly accept that this constancy and fidelity of which I speak, while desirable, is in fact, the prevalent norm in Ireland of the late eighties. It most assuredly is not so.

Those involved in programmes relating to prevention and health care should do themselves a favour and move around among young people, go to places where young people and not so young people consort and inform themselves of the realities on the ground in Irish life today. [1875] Those articles in The Irish Times certainly did us all a favour by spelling out unpalatable but nevertheless true facts about people's sexual activity. There is sexual promiscuity and infidelity in this country. Any decent realistic AIDS campaign must reflect this reality. It must be spelt out unequivocally to these groups how the risks of contracting AIDS can be reduced. Protected sex, that is the use of condoms, will reduce the risk as also will safe sexual practices.

Much has been said in today's debate which minimised the function of condoms in the matter. I know there is a certain embarassment in discussing safe sex, protected sex. I am a middle-aged, convent educated Irish woman. I do not find it easy to stand here in this House and to be as explicit as I am now going to be. I do so, conscious of the fact that I am privileged to be here and that I have a duty, and as such I am going to exercise that duty in the best interests of the health care of the Irish people.

Any sexual act that may traumatise the anus, the penis, the mouth, or vagina is risky. Anal sex involves the highest risk and should be avoided. During oral sex ejaculation in the mouth is best avoided. This type of clear explicit information should be part and parcel of a coherent structured health care programme designed to target those at risk. Earnest pleas to return to a more acceptable lifestyle do not address the problem as it pertains to the sexually adventurous or promiscuous or to those who lead what might be regarded by some or by many as sexually unconventional lives. If I can bring myself to be so explicit in this House, I do not see why the Minister and the Department in a health care programme cannot spell it out in that kind of detail, and why that kind of information cannot be given to the general public.

Those who abuse drugs intravenously are at high risk and in this country to date they are the epicentre of AIDS. Users of intravenous drugs make up the majority of AIDS cases in this country to date. The AIDS virus is carried in contaminated blood left in the needle, the syringe or [1876] drug-related implements and the virus is injected into the new victim by reusing dirty syringes and needles. Even the smallest amount of infected blood left in a used needle or syringe can contain live AIDS virus to be passed on to the next user of those dirty implements. No one, of course, should shoot up drugs because of addiction, poor health, family disruption or emotional disturbance. Death can follow. However, many drug users are addicted to drugs and for one reason or another cannot change their behaviour.

For these people the only way not to get AIDS is to use a clean previously unused needle, syringe or any other implement necessary for the injection of the drug. I agree with all the Senators who have spoken and called for consideration of the possibility of having a free needle exchange programme for certain controlled selected groups, where there is no other way of reaching them. If that means a certain seeming collusion with illegality, in the interests of a proper public health policy, that is the way we should set about minimising the statistical likelihood of the increase of AIDS.

The whole problem of AIDS in drug abusers is part of the difficulty and intractable problem of drug abuse. However, in view of the risks which intravenous drug abusers run and the implications for their sexual partners and offspring, a high priority should be given to health education for this group. The conflict of priorities which has been referred to in the debate between prevention of drug abuse and prevention of infection should be resolved urgently. Intravenous drug users should and must never share needles or syringes. It is unlikely any of them will hear my words and that is why I favour in addition to the possibility of free needles and syringe exchange programmes, a one-to-one counselling of these people many of whom are functionally illiterate and so addicted and hung up on their particular drug that they are very difficult indeed to reach. Yet, what they are at is absolute dynamite for the whole community and every effort possible and conceivable must be made [1877] to go after them and ensure that the risk of the spread of the infection for their sakes and for the sake of everybody else is minimised.

The Government campaign acknowledged this in the media advertisements with a sentence advising against the use of shared injection equipment. That is to my mind, as I have said, bland. So much more than this was and is required. If changes in behaviour among the drug abusers are required — and it must be in order to arrest the spread of AIDS — a fire brigade action is urgently needed and resources must be made available. I thought the Minister's speech was short on more information about the kinds of resources that will be needed in future down along the line to treat inpatient acute hospital bed occupying people who will contracted AIDS and for whom the costs are likely to be in the region, as already spelt out here today, of £26,000 per annum. That has huge political and health care implications.

Major decisions have to be made. I was one of the people lucky enough to have been at the small, short seminar arranged yesterday by Senators David Norris and Joe O'Toole. I have heard a consultant in genito-urinary medicine spell out the facts that at the moment a certain fighting for an allocation of funds has to take place within the in-hospital, in-house committee or however they run their affairs in that particular hospital, that no specific provision was being made. Of course, the amount of money eaten up by the AIDS patient is enormous compared to that of somebody who is in hospital for a relatively, indeed most relatively, minor situation. An outreach programme of one-to-one counselling by professionals or peer group should be put in place.

Fr. Paul Lavelle, who spoke to us most feelingly and poignantly, referred to a possible junkies' union where there would be peer group or self help kind of counselling, presumably from people who had cracked the habit, understood the implications and were behaving in a responsible fashion albeit within the ambit of their addiction. There is a case [1878] to be made for needle exchange programmes, for the distribution in controlled fashion of sterilised syringes to those most at risk. This, to my way of thinking — and the view is shared by many workers in the field — is the best way of lessening the spread of the virus in this group.

Information and education, also part of this motion, are the only weapons we have against AIDS. With proper information and education we can save lives, and I would like to hammer home that point. People must be prepared. They, indeed we, must learn as much about AIDS as possible and learn how to separate scientific information from rumour and myth. The public should be reassured and informed that they are unlikely to get AIDS from shaking hands, touching, hugging, toilet seats, taps, door knobs, swimming pools, coughs and sneezes, spitting, restaurants, food, cups, glasses and all the rest of the mythology that is floated when you discuss a subject like this.

Education concerning AIDS must start in the schools, at the lowest class possible, as part of any health and hygiene programme. Young people have a right to all the knowledge about sexuality they can comprehend. It must, of course, be in proportion to their age and degree of maturation. There should now be no doubt, reservation or hesitation about the fact that we need sex education in schools, preferably in the home backed up by the schools, but certainly we need it. It should include information on heterosexual and homosexual relationships. Children must be taught about human sexuality, its intrinsic beauty, its value, its loving, nurturing quality but they must be taught also about the down side of human sexuality and how its potential exercised unwisely and irresponsibly can harm, injure and infect. Parents, teachers and those involved in imparting knowledge and devising education policies, perhaps parents and teachers with opposing views on the inclusion of sex education in the curricula, should be able to come together to devise satisfactory [1879] programmes which will inform and consequently protect our children.

The motion before us today refers to education for school leavers. The Minister indicated that together with the Minister for Education certain steps were being taken to put this in place. He said no child should leave school without being aware of the facts of AIDS. That is fine, but there are children leaving school in Ireland today who are unaware of the facts of life. The finger can be pointed for that at the lack of a policy in this area and of a slowneses of approach from Government who have shown a certain unwillingness to confront the moralistic pressure groups which exist, who would prefer to think that human sexuality would somehow or other go away — well, not quite go away because that would mean that the human race would not exactly continue — who would prefer not to have to deal head on with this topic which presents them with certain problems and difficulties, all related to a lack of proper sex education in the first instance for themselves.

We must talk about what not to do in relation to this. Panic, fear and ignorance have led to some extraordinary and worrying suggestions as to how to combat the spread of the disease. I have cited people who have floated notions of compulsory blood testing. That is not necessary, is unmanageable anyway as a procedure and is cost prohibitive. Many people who test negatively might be positive to recent exposure to the AIDS virus, and a false sense of security would be given both to them and their possible partners and there could be ensuring carelessness in the use of proper protection. Quarantine is sometimes talked about, when people really become panicky. That is absolutely absurd. There is no room for quarantine because AIDS is not spread by casual contact. Only if there is an individual who knowingly and deliberately in a paranoid, crazy fashion sets about infecting people could the notion of quarantine even surface. Then we get the really off the wall stuff from people who talk about AIDS carriers being [1880] marked with some visible sign. That is absolutely daft, because the whole population would have to be tested then and you would have problems of discriminating against certain groups of people.

The Minister referred to my own constituency of Waterford, saying there was the establishment of a new clinic in Waterford. A telephone call to the community care office in Waterford has revealed the interesting information that the clinic is not fully set up yet and is going to be set up at the casualty centre in Ardkeen Hospital. Again I would fault somebody — the Department — for unnecessary delay because I know training was given to a specific health person some months ago in this area, and I fail to see the reason for the delay. I would also like to know why notices are not going to be put up in specific places indicating where the STD clinic is. Not so very long ago at a meeting of the SouthEastern Health Board, of whom I was a member, I raised the fact that in public lavatories and certain suitable public places there were no signs, directions or telephone numbers for STD clinics. I was told clearly that under the Censorship of Publications Act it was not possible at that time to have such notices in place.

I would like the Minister, in his reply, to indicate if there has been an amendment of the Censorship of Publications Act or if, in view of the AIDS crisis, there has been a statutory instrument or some way of displaying notices in suitable places in order to direct people to the source of information, prevention, treatment and, not in the case of AIDS but in the case of other sexually transmitted diseases, cure. People must be reminded that there is the possibility of cure.

Many people think that the statistics which the Minister read to us are not alarming — 36 cases of AIDS, seven haemophiliacs and so on. Many people have referred to them in their contributions. The growth of AIDS is dramatic. The figure will be doubled by next year and we will be faced with horrendous choices down the line. We will have to consider the social impact of AIDS on [1881] our community, the financial implications and the political implications. There will be people who will be very fearful of grasping all those sorts of nettles, but grasped they must be in the interests of all.

I would like to pay tribute to the people working in this field. They are, in short, heroic and, by and large, unsung. In the context of this debate on AIDS people should have the opportunity of paying the fullest possible tribute to the doctors, nurses, health care workers, pastoral care teams and people who have courageously stepped forward and shared their views with all of us in the community.

I would like to comment on the fate of haemophiliacs. What has happened prior to the heat testing of blood has been, for them, nothing short of a tragedy, a most appalling tragedy. It is bad enough to be a haemophiliac or to belong to a family who, because of the nature of the disease, will always have to live with it, without having to endure what has happened in recent years in this country because we did not know the facts. I am pleased that we now have our act together in that area and that haemophiliacs or indeed anybody requiring a blood transfusion can have that blood transfusion in the sure and certain knowledge that there is no risk or danger involved.

Some of the Senators who spoke seemed to think that those who donated blood at any stage are at risk but of course that never was the case. That is part of the myth that might discourage people from coming forward and giving donations of blood. Donating blood is such a public-spirited, worthwhile thing to do that I would hate to think that the mythology and the general ignorance attached to AIDS would in some way affect that public-spirited action.

I am pleased this House has had this debate. I hope that some good will come of it and that the Minister will feel encouraged and emboldened and will decide to be more explicit, more up front and more dynamic about this matter and not be hesitant and bland and fail to confront people with the facts, unpalatable as they are, which has been the [1882] hallmark of the campaign to date and which I find disturbing and worrying. I am not alone in that view. Medical correspondents, many political commentators and socially aware and concerned people have reacted to the campaign to date with those kinds of criticisms. If the debate is to mean anything other than the statements of positions, going through the motions and speaking for the record, it should mean that something will flow from it and that we will bring into the future programmes of preventive health care in the area of AIDS some of the thinking of this House of the Oireachtas.

Mr. Fitzsimons: Information on Jack Fitzsimons  Zoom on Jack Fitzsimons  I have often prefaced my remarks by saying that I welcome the opportunity of making a contribution but on this occasion I will not do so because I am in no way anxious to get deeply involved. I simply want to play what I feel is the part of every Senator in this House in saying what I have to say in a simple and straightforward way. I, unlike all other speakers, would question the value of this debate. Like Senator Bulbulia, I hope something positive will come from it but I have grave doubts about that. This is an area which could involve many professionals. There are involved a moral aspect, a religious aspect, a philosophical aspect, the area of jurisprudence, sociology and many other areas. Experts from all religions and other areas could make a meaningful contribution. Perhaps in that sense the ordinary individual will not have anything of great value to add. If something positive is to come from a debate of this kind it must have some influence on legislation. A longer period of time should have been given for consideration of the matter before it appeared on the Order Paper. However, I realise it has been there for some time.

I would like to refer to the briefing session which was held yesterday. Unlike most of the other speakers, I have reservations about this briefing. I realise that certain Senators went to great pains to provide worthwhile information at that session and perhaps they could impart it [1883] to me. I was attending the Joint Committee on Women's Rights at that time and therefore I could not attend the briefing. I would like to put on record my reservations about this briefing. The letter which we received included a paragraph as follows:

To allow public representatives bring themselves up to date on the issue and in an attempt to raise public awareness, a short briefing session on the subject of AIDS has been arranged by Senator David Norris and myself for Wednesday afternoon in Buswells Hotel. The session will begin at 3.15 p.m. and conclude by 4.15 p.m. There will be short inputs by Senator David Norris, Fr. Paul Lavelle, Fr. Bernard Lynch and other expert speakers.

I realise that those who attended that session have acknowledged that they found it helpful. My exception to it is with regard to holding it immediately before this debate. I would prefer to come in here and say exactly what I think without any influence from Senator David Norris, Fr. Paul Lavelle or Fr. Bernard Lynch. I am quite willing and happy to meet with any other Senators after the debate and to listen with an open, clear mind to what they have to say.

As a Roman Catholic, I would not agree with having two priests present at the briefing yesterday. Other religions should have been represented and might very well have been represented. But, by and large, I feel that religion should be kept out of this entirely. In my young days we had a situation of religious diarrhoea. Now we have turned full circle so that we have religious constipation. I realise that religion has made a very positive contribution in people's lives. I know also that many would blame religion for what they might regard as a waste of time in their lives. When I was young almost everything that anybody did was regarded as a sin. At present the very opposite applies; clearly, nothing is regarded as a sin.

In this regard it is unfortunate that two [1884] priests should have been there because we have the name, rightly or wrongly, of being a priest ridden society. I have always in my simple way, campaigned for a pluralist state. In the input to the forum, I recall, the episcopal contribution at that time stated that a Catholic Government or country should not feel it necessary to have to apologise in a situation where there is a Catholic consensus and ethos that the laws reflect the Catholic values. They asked if minority rights were more important than majority rights. But it seems to me that in a truly pluralist society minority rights are of equal importance. From that point of view I would leave religion out of the question totally.

I would like to refer briefly to last Sunday's Sunday World where Micheline McCormack referred to this problem of AIDS. She said:

Monica Barnes gets up my nose.

Her latest statement on AIDS, in my opinion shows her to be a person not at all understanding of the torture that a person with AIDS goes through.

As Chairperson of the Dáil Committee on Women's Rights she has said:

People who deliberately wreck lives, for example husbands who infect their wives, are committing a serious crime.

Because of the deadly threat of AIDS in society today we feel consideration should be given to amending existing laws in this area.

Miss McCormack went on to criticise Deputy Monica Barnes in this regard. As a member of the Joint Committee on Women's Rights who has a very high regard for the Chairperson, Deputy Monica Barnes, I would like to put the record straight and to say that in my view Deputy Barnes was not responsible for the initiation of this matter. It came up recently at a seminar on 30 January with regard to the Law Reform Commission on their consultation paper on rape. I would like to quote a paragraph from a [1885] draft submission which came before us yesterday. It is as follows:

While not falling directly within the law on rape, the joint committee feel that consideration should be given to the amendment of existing law, not necessarily in the present context, to deal with people who deliberately or recklessly infect others with a sexually transmissible disease for example, AIDS, in circumstances where they know they are carriers of the disease or are infected with it.

A simple telephone call to Deputy Barnes would have elicited the information that it arose in that fashion. At yesterday's meeting — and Senator Nuala Fennell has already referred to this — it was decided to include that paragraph. Also it was felt that this, more properly, should come within the ambit of offences against the person rather than within the ambit of rape legislation, so that it would be taken into consideration in sentencing in situations where this arose. It was also mentioned yesterday that there had been cases, not in this country but abroad, where people with AIDS had deliberately set out to infect others with AIDS through sexual intercourse. I hope that explains that particular problem.

With regard to statistics, I think that the recent articles in The Irish Times have been very helpful, particularly to people who are not knowledgeable about the subject. It was stated on February 9:

Latest studies show that 60 to 70 per cent of HIV-positives will develop AIDS. That could mean 1,725 to 2,450 AIDS cases in the next five to seven years.

That is an extraordinary number. Let me quote a short paragraph also from The Irish Times in the same series:

There's an Irish solution to an Irish problem and now — after all that fuss about the first Irish AIDS cases being imported via foreign flings — Ireland, it seems has made AIDS her latest export, along with the young people.

[1886]“Dublin is unwittingly exporting its AIDS problem to London” says Dr. Graham Hart, of London's Middlesex Hospital, a researcher at one of the cities three main drug dependency units. One in ten of the young drug users seen at the Middlesex is Irish. The first casualties of the AIDS, generation bring the AIDS virus with them wherever they go.

It is unfortunate and intolerable that, with regard to our unemployment problem, that is, in effect, what is happening. Our AIDS problem is, to some extent, being exported. In this regard perhaps there is a vicious circle. I do not think anybody would disagree when I say that sexual abuse of children, reports of which have been published in the papers, seems to be a problem. Whether it is related to unemployment or to television or the media or whatever, there is a serious problem here. But, in general, it would be felt that many of the problems of crime and other areas are related, to a large extent, to unemployment.

On Wednesday 10 February The Irish Times continued the series stating:

The young victims of the AIDS generation are the babies born with the virus. Prevention is the cure for AIDS, but these babies are the surest sign that sexual behaviour is difficult to change.

The British newspaper, The Independent, of 23 February published an article by William Rees-Mogg on the same subject in which he questioned the wisdom of the condoms campaign and stated in the heading that the only defence against AIDS was a change of sexual habits. Of course, having regard to human frailty and problems, many people feel that changing sexual habits would be difficult and would be like getting water to flow up a hill.

I understand there is a changing pattern in America and that it has been brought about by fear. It is no harm to say that religion is an inhibiting factor and it is this fear which has brought about this [1887] change. I recall Catechism lessons at school long ago in which the Graces were a fear of hell, a fear of losing heaven, the horror and filthiness of sin, gratitude to God and the thought of having offended a God so good in Himself. I always felt that the fear of hell was the biggest factor and I think it always will be. If the situation has changed in America I believe it is fear that has changed it. The idea of self-preservation will extend worldwide because it is a very important factor.

The article in The Irish Times on 10 February 1988 dealt with sex education and stated that school leavers said the young need sex education, including AIDS awareness, from age 12. A former convent school girl said she disagreed because there was no point in giving 12 year olds a bad view of the world. The article in the British newspaper, The Independent of 23 February dealt with this matter also. It gave some arithmetic with regard to permutations and combinations related to AIDS and stated:

Of course, this arithmetic is an oversimplified model. Someone who has sex with an infected prostitute may have only one sexual contact, but that could be sufficient to catch the disease. He would have linked himself to a very large infectious network. But what the model shows is the explosive increase in the risk of catching AIDS matching the increase in the number of sexual partners. For obvious reasons, these risks are greatest in large cities, which are travel centres. This makes me doubt the wisdom of the condoms campaign.

The implied suggestion of that campaign is that condoms make promiscuity safe. In so far as the campaign encourages promiscuity it offsets the reduction in the risk of infection that the use of condoms would offer. The campaign has the same message as the jocular farewell of the Second World War: “Be good, and if you can't be good be careful”. It is the implication which is remembered.

In that regard, I think there are many [1888] people who would be very much in favour of legalising prostitution, who would favour bringing in laws in relation to homosexuals and who would be in agreement with providing clean needles and syringes for drug addicts. I believe that a majority of people would be in favour of introducing those measures but the one reservation which would be at the back of their minds would be that perhaps by doing those things they would encourage those activities. Many people are anxious to move forward in those areas but that reservation is the one restricting factor. For example, they feel that if prostitution was legalised young people might conclude that, because the State had legalised this activity, it would be morally right. As I have said, my approach is a pluralist one and for that reason my views on this issue are the same as my views on divorce. Divorce is a right and it should be provided but the fact that it is available should not mean it is easily undertaken. It should be a last resort and be difficult to obtain and I believe the same should apply in relation to the other areas I have mentioned.

Senator Fennell referred to condoms and to Fianna Fáil members who had reservations when that legislation was introduced. I am sure the Senator would make allowances for the fact that the party in Opposition have to take a certain stand.

Mrs. Fennell: Information on Nuala Fennell  Zoom on Nuala Fennell  Why is that?

Mr. Fitzsimons: Information on Jack Fitzsimons  Zoom on Jack Fitzsimons  If legislation is going through the House it should be questioned.

Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  Indeed, but not necessarily absolutely opposed for opposition's sake.

Acting Chairman (Mr. Farrell): Information on Willie Farrell  Zoom on Willie Farrell  One speaker, please.

Mr. Fitzsimons: Information on Jack Fitzsimons  Zoom on Jack Fitzsimons  I agree with Senator Bulbulia and I have made that point before.

Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  Yes, the Senator has.

[1889]Mr. Fitzsimons: Information on Jack Fitzsimons  Zoom on Jack Fitzsimons  I believe many people feel that the provision of condoms, apart from the religious aspect, makes a sex object of women. From that point of view many people who might not necessarily feel any inhibitions in relation to the religious or moral aspect might be opposed to it. I want to quote from the British newspaper, The Independent, of 23 February, 1988 which states:

I doubt whether morality can be taught conditionally. All successful moral codes are absolute, and have been taught absolutely. The world, and human nature, will whittle away all too much of even the clearest commandments; they will obliterate altogether merely relative advice. In this the conservative theologians are right, and one has to side with the Pope, the Chief Rabbi and the Bishop of London against the moral relatives.

Having criticised religion, and taking the honest view of it, we could also think that religion has played an important part as well. That is brought out in the final paragraph of the same article. It refers to the problem of syphilis, a contagious disease which was controlled but never eliminated. It was controlled to the extent that it did not reach epidemic level. The final paragraph states:

This was largely achieved in Western society by the spread of Puritanism both among Protestant churches and in the Catholic counter-reformation. Puritanism undoubtedly increased the proportion of the population who practised strict monogamy, and it probably reduced the number of sexual partners in the non-monogamus population. Pencillin and the Pill seemed by the 1960s to have killed Puritanism by removing the fears of disease and pregnancy.

We have moved away from that. There is nothing further that I really want to say except to read a final short paragraph from the New Society, 19 February 1988:

The National Federation of Funeral Directors rules that a person dying of [1890] AIDS shall be zipped up in a body bag which must remain sealed until burial. It is only one indignity among many, but it hopelessly disrupts the ritual of mourning. There can be no chapel of rest, no viewing of the body, no last respects. Family and friends who wish to bid farewell must do so at the bedside where the patient dies. I think that paints a very sorry picture.

I agree with Senator Bulbulia's contribution. I wish to pay tribute to all those individuals in dealing with this major problem for which I hope more finance will be made available. I hope also that more research will be carried out in this area and as a result of the briefing yesterday, the debate today and some of the matters related by Senator Bulbulia, people will be less afraid of those suffering from AIDS.

Perhaps the Government will be able to provide help, not necessarily on a one-to-one basis but as near as possible to that. I hope that sex education will be brought into the schools. I know, like all parents with a young family that it is a difficult area and there is always the question of moving ahead of the children. There are many problems in this area but I would have to agree that education is necessary, it is better to be educated than to come up against this problem without preparation.

Finally, I hope this problem will be looked at with sympathy, consideration and concern and that ample resources will be provided to bring it under control.

Mr. W. Ryan: Information on William Ryan  Zoom on William Ryan  It now appears there are quite a number of Senators anxious to take part in this debate. As you know it was decided this morning that the debate would conclude at 4.30 p.m. By agreement of the Whips, we have now decided we will not conclude the debate today but that we will adjourn it. Accordingly, I propose; Notwithstanding the Order of the House this morning, the debate on Item No. 2 will be adjourned at 4.30 p.m.

Mr. J. O'Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I second that proposal.

Acting Chairman:  Is that agreed?

[1891] Agreed.

Professor Murphy: Information on John A Murphy  Zoom on John A Murphy  I am very glad also to be participating in this debate. I welcome the sincerity and frankness with which my colleagues have spoken. Indeed, leaving aside for a moment the gravity of the subject matter, I think one is glad we have come a long way since the early forties when our predecessors in this Chamber were reluctant even to quote from the mildly Rabelaisian, The Tailor and Ansty in case, its being stitched into the record would put the parliamentary debates Official Report on sale to a salacious public.

Mr. J. O'Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  The Joint Services Committee would be pleased to make a profit out of a publication of the House.

Professor Murphy: Information on John A Murphy  Zoom on John A Murphy  I hesitate to think what their reaction would have been to some of the speeches here today but I seriously think we have come a long way in our attitude to matters like these. Unfortunately, the seriousness of the subject compels us to be frank.

I support the motion to the extent that, obviously I support the information and education programme of the Government but, like other Senators I have reservations about its effectiveness. I think the literature is bland and inadequate. Mind you, I do not fully go along with Senator Norris's interpretation of events and his interpretation of the Minister's speech. To be fair I do not think that the opening paragraph of the speech bears the homophobic gloss that Senator Norris put on it because what he suggested was that the Minister said, “we do not really worry as long as the homosexuals have it but when we, ordinary guys are at risk, it is time to get worried”. I really do not think that is the implication of that paragraph, to be fair to the Minister. I think the Minister was saying that the spread into the heterosexual community puts so many more people at risk. It is a question of the whole community being at risk. I would like to dissent from [1892] Senator Norris's interpretation. Otherwise I applaud his contribution, a contribution which, I thought, could only have been made by him.

I think Senator Fitzsimons does not fully understand the nature of this briefing in Buswells Hotel yesterday. I think Senator J. O'Toole and Senator Norris performed a public service in laying on this information session. After all this is a deadly serious subject. As public representatives we have to talk about it, but few of us are experts in the way that Senator O'Connell, for example, is an expert. This information session was very welcome and in the event it turned out to be extremely informative and moving. There were two people there, one of them a priest — Fr. Lavelle — and Dr. Fiona Mulcahy, who perhaps is the expert on the ground in Dublin on this matter. What they had to say informed and enlightened us all. I think that Senators O'Toole and Norris deserve our thanks for that.

Among the points they made, and which were repeated here today, was the need for explicit information. I admire Senator Bulbulia's contribution, which she made against, shall we say, a certain protected upbringing and background, which indeed we all share. It is not easy to talk in these forthright terms but it is necessary.

May I say that television is the medium which has most hope of reaching the public in this matter but not enough use is being made of it. The Health Education Bureau campaign seems to have fallen away with the disappearance of that body. The effectiveness of television for this purpose about which we are talking here was graphically demonstrated in every sense of that word by Gay Byrne on the “Late Late Show” some months ago when, as only he with his particular brand of professionalism and insouciance can do it, he very frankly and explicitly gave an optic lesson on the use of the condom. That is the kind of information we need. We do not need squeamishness at this serious stage of the development of this plague.

Senator Fennell, I think it was, [1893] referred to the fact that the term “school leavers” in the motion does not altogether adequately cater for what has to be done now. Doctor Fiona Mulcahy, who speaks as an expert, yesterday talked about the sexual precocity of the children in this whole area with which she has to deal. She talked about sexual activity at the age of ten or 11 years — a prospect which all us brought up conventionally would find distasteful and shudder away from, but the facts are there. If the facts are there, then the problem must be dealt with. It is no time for squeamishness.

Something came across very clearly also from this briefing and indeed from other people to whom I have talked — and I have the benefit of consultation with a family doctor in Cork, a man who is not simply a family doctor but who specialises in general practice — in fact, he lectures in general practice. He, in his own personal philosophy, is extremely conservative but he has no trouble whatsoever in distinguishing between the morality of the topic and the overwhelming problem of social health which it presents. He is convinced, as other people are, that sexual behaviour and other deviant behaviour involving, for example, drug abuse and so on, if it cannot be stopped at least can at least be modified and the ravages of the disease limited.

There is, of course, as Senator Fitzsimons said, a moral grey area here concerning our moral disapproval of many of these actions, indeed the doubtful legality of what Senator O'Connell was suggesting in regard to the distribution of safe needles, and our attitude towards condoms which is as much an aesthetic as a moral distastefulness. But, again, we must distinguish that while we may retain our moral attitude and our moral philosophy towards all these areas of behaviour, we must recognise that we are talking about a plague, a disease which threatens the whole population, innocent as well as guilty.

Incidentally, one of the interesting points raised yesterday by Doctor Mulcahy was when she referred to the fact that the problem in Ireland is largely a [1894] Dublin problem. I had not thought of it in that way. It is a Dublin problem presumably because of the widespread incidence of drug abuse in this city. It has not as yet really affected other urban areas of the country in any perceptible way. What I am inferring from this is the need not to be complacent. We may well feel, those of us who live outside Dublin, that Dublin has particular problems, as indeed it does, but it will be our problem the day after tomorrow and I think that we should remember that as well.

I put to the Minister a point which my friend, the specialist in general practice, made to me yesterday. He felt that there is not enough professional epidemiological knowledge of the problem, that we do not really know the state of the problem, that the Department of Health have not the statistics on their fingertips, as it were. I do not know whether this is true or not, whether there is a lack of professionalism in this area. It would apply, of course, obviously not only to AIDS but to other diseases which might plague us in the future, the need to be aware of the extent of the problem in as exact a way as possible.

It was Senator O'Connell who referred to what he called the extraordinarily well informed attitude of the public towards AIDS. He quoted very high percentages of people who were aware of all the areas of risk, the sources of contamination and so on. Many people here talked about the admirable articles in The Irish Times for illuminating our views on this, but I should like to make a couple of points here. The Irish Times is, indeed, a grand newspaper but it is doubtful if the information it presented reached a very wide audience, or reached the kind of audience who need it most. Again, I come back to my point that what we need is media information at its most popular and its most graphic.

The other point is that if people are informed and if the polls reveal them as knowing much about AIDS, then I suggest that public attention flags very quickly. What we need is a sustained campaign. We cannot afford to assume that people continue to be well informed [1895] and to be interested. In fact, I think that one of the great dangers is that people are very bored by AIDS. It has become the opposite of a buzz word. Someone has suggested that the leading candidates for boredom in 1988 are AIDS and Australia. I could think of a few more candidates for the category. I make the point seriously that the public need to be informed at a sustained level and need to discuss the problem. As Senator Bulbulia said, we need to distinguish, and have the public distinguish, between the real dangers and the mythology. She listed and disposed of some of the myths associated with the ways in which one can pick up AIDS but, again, I think that there is an area there where people need clear information. Is there not an in-between area where people are not quite sure whether, for example, the methods of disposal of syringes, needles and blood present hazards to those who are handling them? How great is this risk? What is the risk to dental surgeons, for example? I would like to see mythology separated from fact in that area and that kind of thing to be conveyed in the information programmes.

I mentioned my friend, the specialist in family practice, once or twice. One of the points that he makes is how important the family doctor is when you come to the level of information, advice and counselling. In Ireland particularly, perhaps because of the family nature of our lives, I think the family doctor plays a particularly important role, if only his role in allaying people's fears about their lives and about what is happening. It is extremely important that the family doctor be informed, be sensitive, be sympathetic, that he does not have a judgmental attitude. The family doctor can play a vital role in combating the ignorance which prevails in this area.

Finally, I came back to the moral medical ambivalence, if you like, of this problem. People do live in fear of moral condemnation. To add to their other unnamed fears about disease and death, there is this fear of being made moral reprobates, moral lapers. An important [1896] educational orientation in our whole campaign against AIDS is the need for us to distinguish between people's individual rights to inculcate a moral philosophy in matters of sexual behaviour and, on the other hand, the responsibility they have to see this as a social disease, a public health problem, indeed, a plague threatening the whole community, guilty and innocent.

The notion that somehow God is not mocked, that the wages of sin is death and that AIDS is a plague sent to us because of our bad ways and our moral degeneracy must be resolutely combated by all the people involved and by Church and State. It does not add anything to our understanding of this problem to think of God as some kind of sadistic monster who first of all equips us with a sexual nature and then destroys us because we behave in a way which is supposedly not in conformity with the way He intended us to use our sexual nature. That attitude is most unhelpful and illogical because one of the great tragedies of AIDS is the fact that the innocent have been afflicted with the disease. It also affects haemophiliacs, who are totally innocent. An innocent partner in a marriage can also die from AIDS, without any moral guilt whatsoever——

Mr. Doyle: Information on Joseph Doyle  Zoom on Joseph Doyle  It also affects unborn babies.

Professor Murphy: Information on John A Murphy  Zoom on John A Murphy  Yes, of course. It makes nonsense of this sinister, Old Testament notion that we are somehow at the receiving end of God's anger and churchmen have an obligation to scotch this notion. These superstitions are an obstacle to the campaign of public education and information and churchmen and professional moralists have a duty to make the distinction between advocating — of course — a particular moral line of conduct and discouraging the superstition. They should point out that the matter is one of public health and a major social scourge.

The Department of Health also have the duty to disregard the quasi-religious, quasi-moral overtones which, up to now, [1897] have informed some of their information literature. The business of the Department of Health has nothing to do with the moral implications of sexuality. Their duty is to give information in a totally non-judgmental way. I hope that if Government Departments have, up to now, been influenced by these misguided and irrelevant considerations, it will not be so in the future.

Mr. Farrell: Information on Willie Farrell  Zoom on Willie Farrell  I welcome this debate which gives us much food for thought. The Minister for Health is doing a very good job and is receptive to other views to help him to reinforce his efforts to alleviate this great problem or, if possible, to eradicate it.

In studying this problem, we should cast our minds back 20 years. In the late sixties and early seventies “permissiveness” was a very fashionable word. It was the start of the permissive society, the in thing. We were supposed to abandon our sheltered way of life. I do not agree that AIDS is a scourge sent by the Almighty, because men and women are free agents. However, God gave us guidelines and if we violate them we suffer the consequences. Are AIDS, sexual and drug problems and, indeed, marital problems the seeds of the permissive society which have grown and flourished to their present level? I am not good at remembering quotations but somebody said a long time ago that we think our fathers are fools, so wise we grow. No doubt our sons someday will think us so. I am sure today's youth think we are fools.

We have lost our moral fibre. If we obeyed the Ten Commandments there would be far fewer problems in society. We hear an awful lot about getting back to basics and we are constantly being told that there is an acceptable level of noise, violence and drink. We are conditioned to acceptable levels of all kinds of malpractices. There should be no such thing as acceptable levels of violence and so on. We should always strive for the greatest good of society.

Senator Murphy said the innocent [1898] suffer as well as the guilty. Unfortunately, that is not true, apart from the odd, innocent victim being affected. By and large, the guilty suffer most but they will cause an awful lot of suffering and problems to innocent people who have to treat them and care for them. They are the innocent people who suffer.

We have heard an awful lot recently about sex education. One would imagine it was a cure all remedy. Did it ever occur to us that birds, bees and wild animals do not have the addictions which apply to the human race? Who are the wise people? Who are the fools? It is up to us all to do the best we can for those suffering from any affliction but we should make it clear that we do not approve of their lifestyle. It is like telling a criminal to wear rubber gloves to rob a bank and that, if he gets away with it, no harm is done. The word “wrong” seems to have gone from our vocabulary; nothing now is wrong. Indeed, the word “sin” has also gone from our vocabulary. Despite all the experts trying to interpret the Gospels, we still know as little about this world as the infant in its mother's womb. We should return to the old guidelines that were handed down to us. More than 20 years ago when I used to visit Dublin I stayed with my cousin who lived in Ballymun flats. I could park my car at those flats for a night or a week and not have it damaged. I was very safe going through those flats when the population was as great as it is now. At that time there were no drugs, no sex——

Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  No sex?

Mr. Farrell: Information on Willie Farrell  Zoom on Willie Farrell  There was, but it was controlled and within families. It was nothing like it is today. It was safe to park a car in that area. At that time there were many animals kept as pets but we never heard of them being savaged. What has gone wrong in the last 20 years during which time we spent a fortune on education and health promotion? We did everything possible to improve the health of our citizens but I wonder if we have a better life now. Financially, our people [1899] are better off but I wonder if they are better off in other ways. Like alcohol, drugs are an addiction.

Some years ago the North Western Health Board considered what to do about alcohol addiction and a former Member of the House, Senator McGlinchey, remarked that we should not be worrying about alcohol but about the danger of drug abuse. He warned that it would become a problem if we did not take action. We did not take action and drug abuse is a problem. I can recall hearing people saying at that time that only a few people around Dublin abused drugs and that it would never extend outside that city, but the problem is widespread today. Unless we take positive action our society will destroy itself. We will have to get back to our good moral values. I am not referring to Catholic values because members of the Church of Ireland, and other Churches, believe in the same moral standards. They are proud to be able to say that they can trace their heritage back eight and nine generations but if we continue as we are going today I wonder if anybody in 30 or 40 years time will be able to trace two generations of their family. It is difficult to trace a family tree where disruptions do not exist and I wonder what the position will be a few years time with all that is taking place, marriage breakdowns, remarriage and so on.

Mr. J. O'Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  On a point of order, I should like to ask the Leas-Chathoirleach to identify the motion under discussion.

Mr. Farrell: Information on Willie Farrell  Zoom on Willie Farrell  I may be debating it in a different context from the Senator. I had the pleasure of meeting the Senator's wife and family and I know that he is a family man. For that reason I am sure he agrees with my point of view.

Mrs. Bulbulia: Information on Katherine Bulbulia  Zoom on Katherine Bulbulia  This is good revivalist stuff; let us have more of it.

An Leas-Chathaoirleach:  Senator O'Toole did not raise a point of order. We must proceed with Item No. 2.

[1900]Mr. Farrell: Information on Willie Farrell  Zoom on Willie Farrell  I accept that there is a lot of pressure on young people today and that most people want them to be an instant success at everything. If one goes to a feis one will see mothers drilling children and telling them that they must get first place. We have ceased to realise that it is in the race all honour lies, in the striving, not the prize. We do not say as we all compete in a race that one person is as good as another and that there can be only one winner. We are putting too much pressure on our young people. When one listens to the radio, watches television or reads the newspapers, one gets the views of experts on instant cures for this, that and the other. We have reached the stage where many people are addicted to tranquilisers. Our fathers and mothers never heard of tranquilisers. Is it not time that we carried out some research in regard to their use? We like to retain our old buildings, to keep our environment clean and free but I wonder why we do not consider preserving ourselves in a healthy and moral state.

The fear of sin was mentioned by a speaker. Fear keeps us on the right road but there is no longer any fear of committing a sin. When in a hurry home, one is inclined to go fast but because of fear one will not travel at 100 mph but confine the speed to 60 mph reducing to 30 to 40 mph on bad bends. Most drivers do not have the courage to keep the boot down because they know that if they do they will cross the ditch.

An Leas-Chathaoirleach:  I am slow to interrupt the Senator but while a passing reference to these matters is in order I cannot allow him to depart from the terms of the motion which deals with the Government's public information and education programme. The Chair would be obliged if the Senator concentrated on the terms of the motion.

Mr. Farrell: Information on Willie Farrell  Zoom on Willie Farrell  We can deal with this problem if we get back to living a proper life and forget about the free and easy way of living we have developed over the years. I accept that we must do something about this problem and in that regard I [1901] should like to compliment the Government on the work they have done to prevent the spread of AIDS. I have no doubt they will continue with that work. We should be considering how we can contain the spread of the disease. What are we doing to prevent more young people getting hooked on drugs? We can decide to give clean needles to drug abusers and distribute condoms, but where will it stop? I understand that £480,000 has been allocated to the AIDS programme this year but I am afraid it will be £4 million in a couple of years unless we take action to stop the spread of this terrible disease. AIDS is not like the many diseases that baffles us. We do not know the answer to cancer or many heart problems but we know that if we lead a good life and keep away from what is called loose sex, and the abuse of sex, that we will stop the spread of AIDS. We should not be content to live with the disease or to try to keep it under control as we would a cross dog by confining it in a yard tied up. We must work to eradicate the disease before it gets out of hand and leaves many people with heart aches.

As an interim measure the provision of clean needles and condoms will help to slow down the spread of the disease but such action will not solve the problem. This reminds me of the man who has a number of apple trees that are not bearing fruit and it is suggested to him by an expert that she should spray them. Another expert may say they need to be pruned. However, the person who really knows his job will advise that they should be dug up and new trees planted in their place. Are we trying to dig out the roots and get back to sowing new seed? This is what we must do. Unless and until we do that we will not come to grips with any of the addictive diseases, of which AIDS is no doubt one of the worst. Drug addiction is also a killer. We are trying to eradicate a disease in animals. Are we trying to eradicate disease among human beings? Tough measures may have to be taken. Tinkering with the symptoms and talking about acceptable levels will not provide the answer. We must dig deeper [1902] to get at the roots and eradicate the problem.

Mr. Doyle: Information on Joseph Doyle  Zoom on Joseph Doyle  This is a very serious and sensitive issue and I hope this debate will be effective. The Acquired Immune Deficiency Syndrome known as AIDS was first described clinically in California and in New York in 1981. Cases were soon described in Great Britain and in Europe and the World Health Organisation set up their own surveillance system. Cases of AIDS were identified in Africa. AIDS and HIV were reported from 100 countries, although the most affected regions so far have been North and South America, Central and East Africa, Europe and Australasia. Thus it has been possible to carry out research on this disease in the past six years only. While scientists are very eager to stress how far they have come in acquiring knowledge and understanding of the syndrome and the virus, they are equally aware of gaps in their knowledge and they are continually learning.

The AIDS virus is essentially a very fragile organism which cannot survive long outside the body. The virus can be transmitted in three ways. I note that the Minister mentioned four ways, but I am taking two of them together. The first means of transmission is from male to male in a homosexual relationship. It can also be transmitted from male to female or from female to male in a heterosexual relationship. The principal factor affecting the risk of HIV infection of individuals is the number of sexual contacts, which determine the probability of meeting an infected person. The rate of spread within a community once the virus has been induced is dependent upon the proportion who may have sexual partners. This varies in different communities but it is high among homosexuals in North America and in Europe and among heterosexuals in Africa and parts of the Caribbean.

The second way it can be transmitted is through the blood system. Blood transfusions in the past have given rise to this problem and the infection has also been detected in blood and blood products [1903] which have been donated by infected persons. The virus is able to survive longer outside the body in such materials. Blood transfusion as a means of spreading the disease has not been almost totally eliminated because high risk donors are not coming forward due to the screening of donors for HIV antibodies.

One of the main means of transmission is the sharing of equipment by intravenous drug users. Extensive contamination of equipment is usual in such cases and provides an easy means of transmission. Many people who abuse drugs also engage in prostitution to finance their addiction. This forms a potential bridge to the heterosexual community. Infection can also be passed from an infected mother to her unborn child. When a person is exposed to HIV by one of these three means, he or she has roughly a 50 per cent chance of becoming infected.

We hear and read much about HIV antibodies. Some four months after infection, virtually all persons with HIV infection will develop antibodies of HIV. Antibodies are produced by the immune system to any foreign substance, particularly micro-organisms. It takes some time for the antibodies to respond but, unfortunately, in the case of AIDS it appears that the antibodies do not have a role in preventing the disease. A person who is found to have HIV antibodies cannot determine whether he will develop the disease. The presence of HIV antibodies is, however, a means of showing whether a person has been infected by HIV in the past. Overall the incubation period of AIDS may be one to five years from infection but could be much longer. Most studies to date indicate that 10 to 20 per cent develop AIDS after three years and perhaps 10 per cent after five years. I note from the excellent articles published recently in The Irish Times that the figure can be anything up to 70 per cent in some cases.

A person with AIDS is susceptible to a particular range of infections and tumours which are termed “opportunist”. The organisms concerned take [1904] advantage of the opportunity provided by the defect in the host defence system to cause a disease that would not normally be caused. The pattern of opportunist disease depends primarily on the nature of the immune defects. A person with AIDS is not ill all the time since being susceptible will not make him ill. He or she is only ill when opportunist disease, usually infection, occurs. After prompt diagnosis and treatment the person is well again, although remaining susceptible to a recurrence of the disease. The susceptibility increases with time and ultimately the infection becomes harder to treat. At this stage the person becomes progressively ill and deteriorates rapidly in health.

I now turn to the methods of treatment which are available. Unfortunately, the only drug currently available for the specific treatment of AIDS is ATZ which is produced by the Wellcome Foundation. This drug acts as a retarder, prolonging the patient's life and it is hoped that it also prevents the virus from attacking the central nervous system. The Wellcome Foundation are also carrying out trials on other drugs in the hope that they will find one to combat the virus.

Few, if any, would dissent from the view that AIDS represents the greatest public health crisis society has faced in recent years. While more people die from cancer, heart disease and road accidents than from AIDS, there is reason to believe that, should the virus continue to spread unchecked, we will have a very serious problem on our hands. It is now estimated that AIDS is the biggest killer of single men in New York and San Francisco. That is a frightening comment to make when we think of all the other problems that cause death. A cure may not be found for ten to 30 years, if at all. In the meantime the best way to avoid getting AIDS is to stop having sex, or better still not to start until you find your own partner in life.

The House of Commons in the third or fourth of the social services committee, volume 1 in paragraph 74 states:

[1905] We conclude from this that the wisest approach is to advocate celibacy before marriage and fidelity within it as the ideal, but to accept that some people may find this hard to achieve.

I too would support that as an ideal but also as a legislator I have to accept that some people would find this very hard to achieve. In the last administration of which I was a member, we passed the family planning amended legislation which provided for the use of contraceptives freely for people over the age of 18. I am glad to hear Senator O'Connell, who voted against that legislation in the other House on that occasion, change his view on that in the statement he made here today.

These are not political issues. The health interests and the interests of the community generally should come first. Where sex education is undertaken, it must be done in the context of a moral framework, emphasising also the importance of a caring and loving relationship. Dr. James Walsh, the deputy chief medical officer with the Department of Health, is of the view that sex education should start at the age of 12. He stated, and I quote from The Irish Times of 10 February 1988:

You've got to get the fundamental message across before they develop into the sexual phase of their lives. By then they should have the information they need to make wise decisions. If you start too late at the end of secondary school, you're competing with the already developed sexuality which is a strong force.

I would fully subscribe to that. In Ireland we are very poor in the area of relationships. We do not have these loving and caring relationships for each other that we should have. That gives rise to serious problems. People should bear that in mind. The emphasis has not been put on the role of parents. Parents have a very important role to play in the education of their children, especially in sexual matters. Irish parents should not see AIDS as a dirty word, which often happens in [1906] our society. They should not turn off the television programme when the subject comes up. Parents should educate and communicate with their children in a friendly and loving way. The other day I was watching a programme which dealt with homosexuality and I turned to my little son of 12 who was watching the programme with me and I said: “Do you understand what is meant by homosexuality? I felt that I might have had the difficult problem of explaining it to him. “Oh yes,” he says “Daddy, it is when one person is attracted to his own sex”. I felt that school was doing a good job in that instance. That was information that was imparted at school. It is good that children have the information and have it in the best form from their parents or from their teachers.

Ireland has officially 35 AIDS victims but many of Irish origin probably also exist in London. This would substantially change the statistics that we are quoting here. Many Irish people who suffer from other social problems sometimes go to London to have them dealt with.

According to Dr. Fiona Mulcahy Ireland's main problem is that it has no long term plan to deal with this epidemic. She is quoted as saying: we know what is going to happen; it is inevitable; it is just a matter of working out what needs to be done. Here, the Minister and the Department must play a very important role. Up to now that role has not been fulfilled. That is why I welcome the debate on this motion before the House.

Instilling a sense of urgency is difficult according to Dr. James Walsh, the chief medical officer with the Department, who is in charge of the Department's efforts to plan in this area. He is quoted as saying that if 15,000 people per year were going to die before the next election, then we would have action. But how do you communicate a sense of urgency to something that is going to happen in five years' time? That is the problem that we find ourselves with. It is a hidden problem out there but in five years' time it might not be as dormant as it is today. We should accept and understand that. We should not be quoting the figures we [1907] are quoting because in fact they might not be the actual figures at the end of the day.

Counselling has a very important part to play in the prevention of AIDS. Many Irish gays go to London for treatment, acceptance and counselling that they cannot get at home. I read recently in The Irish Times that a social worker at St. James's Hospital, working in the STD clinic has just resigned because she could not take it any more. She was expected to counsel all the 17 AIDS patients whom she was looking after and the hundreds of HIV positive and their families as well as counselling syphilis cases. There is work in that department for at least three social workers. If the Minister and his Department are serious about a programme to prevent AIDS, then money would be well spent in the counselling area. It is very important to have a one-to-one counselling service for people who have or who think they have the virus. I also feel that a permanent confidential telephone line should be available to allow — especially young people — to communicate and discuss their problem. I know from another organisation in which I worked that this can give great relief and can remove certain anxieties that people have. It would also encourage people to receive the necessary treatment.

If the Government is to take an active role in the prevention of AIDS then they will have to spend money. The counselling area is one area that they should think seriously about.

Finally, like Senator Bulbulia, in her excellent speech today, I would like to pay tribute to all those in the medical profession, doctors, nurses and everyone else who care for those who suffer from AIDS. This is a problem that we will have to face up to in society. It is a very serious problem. If we take the figures from England in proportion to our own population, then we will have a very serious problem [1908] as I outlined earlier, in the next ten to 15 years if no cure is found for the problem.

At the moment in California, San Francisco and also in London they are thinking of the idea of a hospice for those suffering from AIDS. That is long term planning that is necessary in this country as well. We must treat those suffering from AIDS with the dignity and respect they deserve.

I would like to conclude by referring to the attitude of the Irish people to those who suffer from AIDS. Senator Murphy in his contribution used the term “moral leprosy”. That brought my mind back to the time of Christ's mission on earth when the social stigma of His time and for many years afterwards was leprosy. He was not slow in His Ministry in stretching out His hands to touch and cure those suffering from leprosy. I hope that we who proclaim to be Christians in this society will not be slow in stretching out our hands to help and assist those who are suffering from AIDS.

Mr. J. O'Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  In agreeing with that may I get myself on the record as the closing speaker in the current debate so that on the resumption of the debate I will continue it?

An Leas-Chathaoirleach:  Will the Senator move the Adjournment?

Mr. J. O'Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I will.

Debate adjourned.

Mr. W. Ryan: Information on William Ryan  Zoom on William Ryan  As the next speaker will have to conclude by 4.30 p.m., I propose that the House now adjourn, pursuant to a resolution of 18 February, until 3 p.m. on Friday, 26 February and that, at the conclusion of that sitting, we adjourn until 2.30 p.m. on Wednesday, 2 March 1988.

The Seanad adjourned at 4.15 p.m. until the Joint Session at 3 p.m. on Friday, 26 February 1988.


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