We have an amazing opportunity. The end of AIDS is within our grasp. We even know how: by letting communities lead.

Around the world, communities have led every step of the AIDS response. In the 1990s and 2000s, communities led the fight to bring down the price of HIV treatment to make it accessible. Communities have fought to overturn laws that criminalise LGBTQI people.

Communities leading global HIV support

Communities have transformed global health, taking treatment services beyond hospitals and clinics right to the people who need them most. Communities are leading service delivery, especially to the most marginalised people.

Today, 30 million people living with HIV are on lifesaving treatment. New HIV infections have been reduced by 60% since the peak in 1995, and deaths have been reduced by 70% since the peak in 2004.

Today, 30 million people living with
HIV are on lifesaving treatment.

Supporting and empowering communities

However, the end of AIDS is being held back because communities are not getting the support they need. Community leadership is unacknowledged, under-resourced and, in some places, even under attack. All governments across the world need to recognise the critical role of community leadership and resource communities. They must empower communities by providing the necessary space for them to carry out their lifesaving work.

Globally, 9.2 million people living with HIV are still not on lifesaving treatment, but by supporting communities as leaders in the response, we can reach all those still left behind. Communities are not in the way — they light the way. With communities in the lead, we can end AIDS.

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Human immunodeficiency virus (HIV) transmission rates are now beginning to fall in Ireland compared to 2019 levels.

Access to treatment for people living with HIV in Ireland is increasing. This treatment enables people living with HIV to have long lives and prevents onward transmission. Around the world too, while the job is not yet done, the HIV response has secured remarkable gains.

Tackling stigma and facing HIV with pride

Crucial to progress has been tackling stigma. Stigma keeps people away from prevention, testing and treatment. Tackling stigma saves lives and transforms people’s qualityof life. I’m proud to be part of a growing movement highlighting that people living with HIV can not only survive, but we can also thrive.

This medical condition is no reason to be ashamed. As I have found, the experience of living with HIV doesn’t make you unlovable, it is just one extra thing that someone is going to love about you and you’re going to love about yourself. We are tackling the epidemic of silence. The momentum is palpable in Irish society and globally.

For the AIDS response to succeed,
let communities lead.

Supporting communities for HIV breakthroughs

Communities of people living with HIV, and those at risk of HIV, are powering progress. All these achievements take our time, our expertise and our energy. That is why it is so vital that communities are fully supported; we require more than just being granted a seat at the table; we need authorities to enable us to lead — and we need to be resourced for the work that we do. The most important lesson is this: for the AIDS response to succeed, let communities lead.

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Patient-physician communication is the foundation of erectile dysfunction treatment. Yet, the public is barely aware that there is a conversation to be had.

Erectile dysfunction (ED) is a condition that over half of men over the age of 40 experience, though only a minority can even define what it is. This alone should raise alarm bells, but the cause behind this lack of knowledge is not surprising.

Many find the topic of erectile dysfunction to be a taboo subject and avoid speaking about it when relevant. This lack of attention, and thus awareness, leads to worse symptoms and longer periods of suffering than if those experiencing EDs were empowered to speak to a doctor.

Awareness of ED found to be alarmingly low

In a 2020 pan-European study of over 1,000 individuals, only half of respondents could correctly identify the definition of erectile dysfunction. Research found that 52% of men aged 40–70 experience ED, making this lack of awareness a cause for concern.

Furthermore, respondents did not know how common the condition is, greatly underestimating its prevalence. This lack of knowledge and patient communication further contributes to the isolation people may feel when struggling with ED. The reality is: ED is treatable for most patients, and yet, one in four respondents had never heard of any of the listed treatments for ED.

Less than a third of patients spoke to their partners
about their struggles with ED, and a quarter never
spoke to anyone at all, including a doctor.

Erectile dysfunction and patient engagement

The lack of awareness around ED is a key example of the importance of patient engagement in the treatment process. ED has a tremendous quality-of-life impact on patients, leading to greater reported stress and anxiety, but the taboos and stigma around ED lead men to avoid seeking help. Less than a third of patients spoke to their partners about their struggles with ED, and a quarter never spoke to anyone at all, including a doctor.

Awareness and communication are key to treating ED

Engaging patients with educational tools and direct communication are key to breaking through the taboos surrounding men’s sexual health. If patients don’t know that they aren’t alone, don’t know that their symptoms are the result of a medical condition and don’t know that treatments are available to them, why would they communicate their struggles?

Physicians need to proactively communicate with their patients about ED. We, as a society, need to break down the taboos around ED; and men need easy access to educational tools to inform them about such conditions and treatments.

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Sexual health has a long history of stigma and shame, in part because of how we do — and don’t — talk about it.

I believe in advocating for loud, unapologetic and candid use of language to empower men and women. The normalisation of sexual health can reduce the stigma associated with it and encourage individuals to embrace it as an integral aspect of overall health and wellness.

Impact of sexual health language and words

When it comes to discussing our sexual health, the silence is deafening. A lack of education about our vulvas, vaginas and penises has led to a generation that is confused, embarrassed and unsure of their bodies. The impact of this ‘hush hush’ culture is having devastating health consequences; for instance, 35% of women report not attending routine cervical screenings, asserting embarrassment as their main reason.

Barriers to breaking the silence

This silence is catalysed by advertisement laws, which have made it nearly impossible to discuss sexual health online. The word ‘vulva’ sits among 40 others that lead to shadow-banned content across social media, which means the content — including the word — is likely to reach fewer people. This doubles the chances that those looking for answers may resort to pornography for information, which is often unreal, unfair or misleading.

The word ‘vulva’ sits among 40 others that lead to shadow-banned content across social media.

There has been positive progress with the likes of the Centre for Intimacy Justice and others campaigning for change to social media policies. Following such activity, last year, Meta announced changes to its sexual health policies. However, several brands are still reporting shadow banning for content specifically surrounding women’s sexual health.

Influencing change in sexual health stigma

There is clearly a way to go in undoing the stigma around sexual health. For healthcare providers, the priority should be to ensure patients feel safe, confident and empowered to discuss any sexual health issues they may face.

For governments, it is to ensure all young people have access to accurate, comprehensive and informative sexual health education. For you and me, it might be as simple as starting to talk about our experience with our sexual health. Let’s call them what they are: penis, vagina, vulva.

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Late-onset testosterone deficiency (TD) is a deficiency of testosterone in men as they age. It is a hormone disorder in men, like others such as type 2 diabetes.

Testosterone deficiency can lead to a range of signs and symptoms that can significantly affect quality of life. TD is also a risk factor (meaning, it can put you at a higher risk) for type 2 diabetes and osteoporosis, among other conditions.

Testosterone deficiency risk factors and characteristics

It is important to note that if you have some pre-existing conditions or risk factors for disease, your risk for low testosterone is higher. Some of the most common conditions associated with low testosterone are obesity and type 2 diabetes. Certain medications and illicit drug use can also lower testosterone. As a result, it is important to make sensible lifestyle choices to reduce your exposure to these risk factors.

The testosterone molecule acts on receptors called androgen receptors that are all over the body. These receptors are responsible for developing and maintaining male characteristics as well as regulating mood, and they also play a role in metabolism and sexual function.

The three most common signs or symptoms
relating to low testosterone are low libido
or sex drive; loss of early morning
erections; and erectile dysfunction.

Signs and symptoms of testosterone deficiency

The three most common signs or symptoms relating to low testosterone are low libido or sex drive; loss of early morning erections; and erectile dysfunction. These symptoms rarely travel alone, and below are the other common associated symptoms with testosterone deficiency.

Physical: Fatigue; loss of muscle tissue; increased weight around the midsection.

Psychological: Increased anxiety; lower mood; loss of concentration.

Typically, a middle-aged man may present with low mood or increased anxiety. On further questioning, he may reveal a history of reduced libido or the inability to maintain erections. Sometimes, we accept these things as ‘I’m just getting on,’ and as a result — without prompting — it may never have crossed his mind to mention such symptoms or ask for help.

If you have any of these signs and symptoms which are suggestive of low testosterone, please speak to your GP who may be able to help you, and visit testosteronedeficiency.ie for more information on the condition.

Sponsored by Besins Healthcare. BHUK/2023/798- ROI. November 2023

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