**2. Literature review**

The relationship between HIV and sex work is well documented. In 2009 the UNAIDS Advisory Group[7] was established to provide guidance and advice on issues to do with HIV and sex work, while at the same time emphasizing the human rights of female, male,

and transgender sex workers and the importance of universal access to HIV prevention, treatment, care and support.

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Irish Drug Using Sex Workers Accounts of How They Contracted HIV and Hepatitis C 277

statutory and non-statutory sectors and people living with HIV and AIDs. In 2000 it published an AIDS Strategy 2000 [8] which promoted prevention, treatment and care. In 2008 NASC [9] published a 4-year plan for HIV and AIDS Education and Prevention in Ireland with the aim of reducing infection through education, awareness raising and prevention measures. The action suggests that best practice measures targeting sex workers and those buying sex should be integrated into sexual health campaigns. It recommends that there should be appropriate and innovative approaches to HIV screening and treatment including mobile services and new technology. In 2010 a mobile health clinic entitled Safetynet Network for Homeless Health Services was established in Dublin targeting homeless people and sex workers [10]. It provides primary health care and harm reduction

Figures published by the Health Protection Surveillance Centre [11] on newly diagnosed HIV infections in Ireland in 2011 showed that there were 152 new HIV diagnoses in the first six months of 2011 (less than the 166 cases reported in Q1&2 2010 and the 164 in Q3&4 2010). This brought the cumulative total number of HIV infections reported in Ireland to more

• Of these newly identified cases, 9.2% were diagnosed with an AIDS defining illness at

• Of the heterosexual cases, 35.7% were individuals originating from countries with generalised epidemics, and a further 19% were individuals with a partner originating from a country with a generalised epidemic, or with a partner known to be HIV

The 'risk environment' is a simple model or explanatory framework developed by Tim Rhodes [12] to examine the multiple environmental factors that produce health and other types of risk. There are four types of environmental influences: physical, social, economic and policy in the context of three levels of environmental influence – micro, meso and macro. The risk environment is made up of the risk factors that are external to the individual; these risks can mediate the individual's capacity to reduce the risk of harm. For example, if a country provides free needle exchange programs or opiate substitution programs they help the individual user to reduce the harms associated with intravenous

• The highest proportion (39.5%) was among men who have sex with men.

the time of their HIV diagnosis, and 41.4% were asymptomatic.

services.

**4. Prevalence of HIV in Ireland** 

than 6,120. The HPSC notes that, as regards new cases:

• People in the 15-24 year old age band comprised 9.2%.

positive or a partner who is an injecting drug user.

• Heterosexual contact accounted for 27.6%.

• Intravenous drug users accounted for 7.9%.

• Females accounted for 25.0%.

**5. Risk environment** 

opiate use.

The overall growth of the HIV global AIDS epidemic seems to have stabilized. There has been a steady decline in the number of new HIV infections since the late 1990s; and due to antiretroviral therapy fewer AIDS-related deaths have occurred. The UNAIDS vision is zero new HIV infections, zero discrimination and zero AIDS-related deaths. That said, new HIV infections are still high and worldwide there has been an increase in the number of people living with HIV. The population under discussion in this paper remain at particularly high risk [7].

The UNAIDS report (2010) states that there are three high risk behaviours associated with the spread of HIV are injecting drug use, practising unprotected paid sex, and men having sex with men [7]. There are also risks in discordant heterosexual relationships where one partner is HIV positive and risks transmitting the virus to the other partner in a long term relationship. It emphasizes the importance of couples testing for HIV. Becoming sexually active at a young age is also a risk factor; the report states that young people still lack the information and the necessary tools to practice HIV risk-reduction strategies. There is a lack of provision of harm reduction materials such as condoms and lubrication, and sterile needles. It argues that in order to protect women and girls from HIV they need to be protected against gender-based violence.

The UNAIDS Advisory Group Report [7] noted that sex workers often face widespread and interconnected human rights violations which impede both their effective participation in HIV responses and their right to access HIV and other health and social services. It stated that societal stigma and discrimination against sex workers results in repressive laws, policies and practices, and the economic disempowerment of sex workers. The Report warns countries against the persecution of sex workers and the conflation of trafficking with sex work.

#### **3. Irish government policy response to HIV**

In Ireland, in response to the HIV epidemic in the 1980s the then Eastern Health Board [1] (now the Eastern Region Health Service Executive) established two specialised drugs intervention clinics (one for female sex workers and one for gay men and male sex workers) in the capital city, Dublin. These clinics provide free HIV screening and other harm reduction services such as needle exchanges and methadone maintenance for intra-venous drug users. In 1987 the Dublin Aids Alliance (DAA), a voluntary non-governmental organisation with charitable status, was set up to improve conditions for people living with or affected by HIV and AIDS. DAA is; provides front line services, such as counselling, outreach and condom distribution. It is the representative for the eastern region of Ireland on the Department of Health and Children's National AIDS Strategy Committee (NASC) and its Education and Prevention Subcommittee. NASC was established in 1991 and published its first Strategic Report in 1992. It took a multi-disciplinary approach involving statutory and non-statutory sectors and people living with HIV and AIDs. In 2000 it published an AIDS Strategy 2000 [8] which promoted prevention, treatment and care. In 2008 NASC [9] published a 4-year plan for HIV and AIDS Education and Prevention in Ireland with the aim of reducing infection through education, awareness raising and prevention measures. The action suggests that best practice measures targeting sex workers and those buying sex should be integrated into sexual health campaigns. It recommends that there should be appropriate and innovative approaches to HIV screening and treatment including mobile services and new technology. In 2010 a mobile health clinic entitled Safetynet Network for Homeless Health Services was established in Dublin targeting homeless people and sex workers [10]. It provides primary health care and harm reduction services.
