Acquired immunodeficiency syndrome with Kaposi's sarcoma in Ireland

Cultural constraints on the delivery of HIV/AIDS prevention in Ireland

HIV appeared in Ireland following an opiate epidemic in the early 1980s. Initially, however, the gay community mounted the only response to the spread of the virus while the implementation of early actions by the government was hampered by the constructions of the disease within Irish society. This paper considers the influence of the religious hierarchy in both the development of AIDS policy and in the shaping of public perceptions of the disease and those affected. A qualitative methodology is used to examine the role of such cultural constraints in an evaluation of the social context within which the prevention of HIV infection occurs. Three key issues pertinent to the policy context in Ireland are explored in depth. These are the role of the Catholic Church, the influences on health education programmes, particularly information giving, and the development of services and other interventions. These findings are discussed within the social and political contexts in which health policy is formulated.

Use of a Dublin inner city A & E department by patients with known HIV-1 infection

During the period January 1990 to January 1992 260 patients known to be infected with human immunodeficiency virus type 1 (HIV-1) attended the Accident & Emergency (A & E) Department of St James's Hospital, Dublin. There was a total of 709 visits with a mean annual attendance rate of 2.7, twice that for the general A & E population. Eighty-nine per cent of patients were intravenous drug users (IVDUs), 9% homosexual/bisexual and 2% heterosexual. Known HIV-1 seropositive patients accounted for 0.7% and 0.8% of the total number of patients who attended A & E in 1990 and 1991 respectively. The majority of patients disclosed their HIV status. Bacterial respiratory tract infection was the single most common reason for attending A & E and for admission to hospital. Seventy-two per cent of IVDUs fulfilled Centers of Disease Control (CDC) criteria for stage II and III disease; the majority of these used A & E for primary medical care, although listed with a general practitioner (GP) and attending during the daytime. Sixty-eight per cent of homosexuals/bisexuals were CDC stage IV with AIDS defining illnesses accounting for 52.6% of clinical presentations. Of this risk category, 79% required medical admission. Homosexuals/bisexuals represent more advanced disease, thus the full impact of HIV-1 infection in IVDUs in this A & E setting has yet to be realized.