The next item of business is a debate on motion S6M-07025, in the name of Maree Todd, on world AIDS day.
14:58
It is a privilege to open this debate. Today is a time of mixed emotions. First and foremost, it is a time to remember and pay tribute to more than 40 million people who have died of HIV and AIDS-related illnesses across the globe. We have become used to quoting fatality statistics and case numbers, especially during the past few years, and we have heard over and over again that those numbers are not just numbers—each represents a real person. Nonetheless, I will make that point again. More than 40 million people did not have the chance to reach their full potential, left behind friends and families and, all too often, had to battle stigma and prejudice on top of a deadly virus. They must never be forgotten. In paying tribute to them, I hope that we focus not on their deaths but on the lives that they led, and on the courage that so many of them showed in fighting for a better future, even if they knew that they would never see it.
As we remember, and as part of our tribute to them, we should also acknowledge that astounding progress has been made in diagnosing and treating HIV, and that that better future has, at least in part, become a reality. Forty years ago, an HIV diagnosis was, in effect, a death sentence. Today, it means daily medication or receiving an injection every two months. People with the virus can now live long, happy and healthy lives, without the fear even of passing on the virus, if they remain on effective treatment.
To be clear, that is not to downplay an HIV diagnosis, which can still have adverse physical and mental health impacts on an individual and which requires lifelong interventions to manage, but the illness is largely chronic now and not the killer that it once was. That is in stark contrast to the outlook when I was an undergraduate pharmacist in the early 1990s.
In Scotland, we have been working hard to prevent infection and ensure that those living with HIV receive the treatment that they need. The number of new diagnoses in Scotland has been falling since 2017. In 2018, we met the UNAIDS 90-90-90 goals, which are for 90 per cent of people living with HIV to know their HIV status; for 90 per cent of people with diagnosed HIV to receive sustained antiretroviral therapy; and for 90 per cent of people receiving antiretroviral therapy to have viral suppression.
All of that is hugely encouraging, but we cannot and must not think that the job of tackling the virus is done. We must instead set our sights on stopping HIV transmission. That goal might seem inconceivable to anyone who is old enough to remember the horror at the height of the HIV pandemic, but it is absolutely possible.
Of course, possible does not mean inevitable; it will require hard and dedicated work. We will need to test more people, work harder to find and connect with those who are at risk, and do all that in the most challenging circumstances that our health service has ever faced. None of that can happen without a clear plan. That is why, two years ago, the Scottish Government commissioned a proposal on how Scotland could become one of the first countries in the world to eliminate HIV transmission by 2030. In practice, that would mean zero people contracting HIV in Scotland.
Today, the Scottish Government welcomes that proposal, which was developed by the HIV transmission elimination oversight group—as an aside, I am told that other, longer names for the group were available. Before I go further, I extend my warmest thanks to Professor Rak Nandwani, who so ably chaired the group. I know that it was no small feat to assemble the clinical, third sector and academic expertise that was needed to develop the plan. I am also grateful to all those who made time to participate.
The proposal is wide ranging, and all those who worked on it should be proud of its ambition. The time today does not allow me to do justice to the care and consideration that have gone into it, and I urge everyone to read it for themselves.
Crucially, the proposal has three high-level goals. The first is to prevent people from acquiring HIV, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, deprivation or disability status. The second is to find people who are living with HIV, some of whom are still undiagnosed, and support them into HIV care and treatment. The third is to help to reduce the stigma that makes some people less likely to access HIV prevention, testing and treatment services.
I am whole-heartedly in favour of reaching those goals, as is everyone—I am sure—who is involved in HIV care or prevention. However, the plan acknowledges that the goals will be achievable only if organisations come together to make that happen—the plan calls that a whole-system and whole-society approach. That is often easier on paper than in practice. The scale of the effort that is required is demonstrated by the 22 recommendations that the plan sets out, which cover testing, education, prevention, contact tracing and HIV care. It would be unwise in the extreme for me to pretend that all of those goals can be achieved immediately. However, the plan recognises the complexity of the task and recommends an interim target on our journey towards transmission elimination.
The interim target is that Scotland achieves and maintains the UNAIDS 95-95-95 goals by 2025. I am pleased to announce the Government’s commitment to that target—for 95 per cent of individuals with HIV to have been diagnosed; for 95 per cent of people who have been diagnosed to be receiving treatment; and for 95 per cent of people who are receiving treatment to have a suppressed viral load.
I take this opportunity to accept another of the recommendations in the proposal: that an implementation group be established to carry on the work that is needed to ensure that we reach our targets. That group will provide dedicated focus and accountability, while ensuring that the proposal is taken forward in a careful, considered way that recognises the current challenges that our health services and third sector face.
That is vital work, and I am delighted to announce that Professor Nicola Steedman, the Scottish Government’s deputy chief medical officer, and Dr Dan Clutterbuck, clinical lead for HIV at the Chalmers centre, have agreed to chair the group. They are clinicians with huge experience in that field, and I am profoundly grateful that they will be taking on the task.
It will be for the group to develop a work programme, and I do not want to pre-empt that, but I will make two further announcements that, I hope, demonstrate the Scottish Government’s commitment to transmission elimination.
The first announcement is that we will fund a marketing campaign, in recognition that a key pillar of the proposal relates to increasing education and reducing stigma. The campaign will be developed by a range of partners, including the third sector, academia, public health experts and people with lived experience of HIV, and I expect to see its first outputs in the spring. I have often heard that the alarming and intentionally fear-driven campaigns of the 1980s have left a damaging legacy of stereotypes and misconceptions. A campaign to address them is overdue, and I am pleased to be able to commit to that today.
The second announcement is that we will provide funding for a pilot of ePrEP clinics. In 2017, Scotland was one of the first countries in the world to introduce an HIV pre-exposure prophylaxis service, which offered free preventative medication to people who were deemed to be at highest risk of acquiring HIV. To date, more than 6,500 people have had PrEP prescribed at least once and, in the four years since the service was launched, there has been a significant reduction in the number of new diagnoses of HIV among gay and bisexual men.
Has there been an improvement in the number of women coming forward to access PrEP?
An early action to support elimination efforts has been to widen eligibility guidance, so that anyone who is at risk can access PrEP. Work to develop and roll out that guidance is well under way. That is welcome news, but expanding eligibility also puts additional pressure on already stretched services. That is alluded to in the Conservative amendment.
We cannot address that overnight, but there is huge potential for people who are largely able to manage their care to request PrEP online and carry out necessary tests in their homes. Doing so could improve access to PrEP for people who live in remote or rural areas, while freeing up clinical capacity for people who might have more complex needs or require more support.
I must stress that it is only a pilot and, even if successful, it cannot be a panacea. However, it is an exciting development and, if we can make it work, in the long term, it has enormous potential to reduce inequalities—I think that that was what my colleague was alluding to—widen access and lessen the burden on NHS services.
I hope that what I have set out today conveys the Government’s genuine ambition to end HIV transmission in Scotland by 2030. I have tried to explain how challenging that will be, but in case I have failed to do so, I will say bluntly that the challenge is considerable. However, I know that the reward of success is greater—the prize is huge. As I said at the start of my speech, it is measurable in lives saved and in improved health, and in our overcoming the scourge of a stigma that has endured for too long. Today, I pledge the Government’s support for that; it is the greatest tribute that we can offer to all those people we have lost.
I move,
That the Parliament believes that, to mark World AIDS Day, everyone should commit to the goal of ending AIDS, and support the World Health Organization’s call to recognise and address the inequalities that are holding back progress; recognises that key to this is ensuring there is equalised access to essential HIV services for all; welcomes progress in recent years in the decline of HIV diagnoses in Scotland, and supports the ambition of ensuring there are zero transmissions in Scotland by 2030; notes the encouraging impact of HIV Pre-Exposure Prophylaxis (PrEP), and that HIV incidence rates fell by 43% in a large cohort of men attending sexual health clinics following its introduction in Scotland; further notes that over 6,500 people have accessed PrEP in Scotland already, and endorses the widening access to ensure that everyone at risk of acquiring HIV is eligible to be prescribed PrEP; appreciates that everyone in society has a role to play in the goal of eliminating HIV transmission in Scotland, and commends the HIV Transmission Elimination Oversight Group’s recommended population-based approach of testing, education and stigma reduction, combined with prevention, specialist care and contact tracing.
Thank you, minister. I remind members who seek to speak in the debate to ensure that they have pressed their request-to-speak buttons.
I call Jamie Greene to speak to and move amendment S6M-07025.2. You have around eight minutes, Mr Greene.
15:10
I thank the minister for her opening comments; I will reflect on some of them in my speech.
Members might recall that, last year, I brought a members’ business debate to the chamber to celebrate, commemorate and mark world AIDS day. I am pleased that we are having a Government business debate on the subject today, which gives us an opportunity to have a frank and fulsome debate on some of the issues.
My first debate on the subject took place as far back as 2016, after I was first elected, when Kezia Dugdale brought a very similar members’ business debate to the chamber, in which I was pleased to participate. I read back through some of my historical speeches on the subject—I spoke in 2016, 2018 and last year—with a glint of intrigue, a bit of sadness and a bit of hope, too, which I will come to in my comments as I speak again today.
In that first speech in 2016, a few short months into my new political life, I used phrases such as “chemsex” and “gym bunny steroid users”, which were perhaps a little risky—they certainly raised the eyebrows of the official report and broadcasting people in the booths. However, if we cannot be frank and honest in the chamber on a subject such as this one, what is the point of having a debate about it in the first place? We should never be afraid to challenge the wider world or ourselves.
In the 2018 debate, the phrase “undetectable equals untransmittable”—U=U—was introduced into political discourse. I remember recounting the horrors of the 1980s and some of the anecdotes that I had heard, which, to be quite frank, affected me personally. Last year, members might recall that I opened a can of worms with my take on the anniversary of the passing of Freddie Mercury. We also discussed the very topical TV show, “It’s A Sin”, which I still have not watched to the end.
I have struggled with how to go about my speech today. I want to say something different, because the subject is traditionally statistic heavy. Statistics are, of course, important, and we have heard many already, but behind stats are people, as the minister rightly pointed out.
The situation in Scotland and across the United Kingdom is markedly better than it was in 2016, or 10 or 20 years ago. Our collective ambition—and it is a collective ambition—to eliminate new HIV infections by 2030 is not just admirable but achievable. I am not one to praise the Scottish Government often when I stand in the chamber, but the introduction of the universal availability of PrEP is exactly the sort of game-changing policy that we needed. It has made such a difference because it has had a direct and immediate effect. In the first four years of the roll-out of the policy in Scotland, we saw a 43 per cent drop in the diagnosis of HIV among men attending sexual health clinics.
A rise in demand has also meant a huge rise in pressure on health services. That was true in 2018—I said it then—it was true last year, and it is still true today. That is the whole point of my amendment, which I hope that members are willing to support.
I commend Jamie Greene for his excellent remarks; he always speaks so well on this subject, as he does on so many others. Does he agree that the delays that are caused by the pressures that he has described around access to PrEP are potentially causing illness to spread, and that we should consider expanding the areas in which PrEP can be accessed? Access is limited, particularly for people who live outside of major metropolitan areas.
Alex Cole-Hamilton has pre-empted the next page of my speech—I thank him, as that is exactly the point that I want to make. I support calls, which are being made by many organisations, including the Terrence Higgins Trust, Waverley Care, HIV Scotland and others, to expand access to treatment and services, especially in rural, remote and island communities.
I cannot imagine being in the unenviable position of someone having to approach their local general practitioner, who might be a family friend or neighbour, and trying to explain to them what on earth PrEP is, what it is for and why they think that they need it—which is probably because they think that they are a high-risk person. They also have to say all that without sounding promiscuous or foolish. I do not envy people who are in that position, but I am afraid that it is one that many Scots today are in. For example, if someone studies at the University of St Andrews, they have to travel to Glenrothes for sexual health services. How does that help to increase testing and access to treatment?
We do not all have the luxury or pleasure of popping along to the Chalmers or Sandyford centres, where the brilliant staff treat people with respect, kindness and, often, a bit of humour. I have absolutely no qualms about telling members that I saunter off to a centre for regular check-ups, even if I do get the odd annoying glance from the patrons sitting next to me in the waiting room.
Of course, if someone does not want to do that, much of this can be done at home: HIV and sexually transmitted disease kits are available, easy to use and free on demand. A couple of years ago, during Covid, I ordered a test, in the absence of being able to attend a clinic. I made a video of myself taking a home test and I chucked the video on Instagram. It warmed my heart when, a few days later, I got an email from somebody to thank me for the video because it had encouraged him to take a home test. I do not know the outcome of his test, but I can only imagine that it was an important one for him.
We have to destigmatise the issue. Knowing your status—we have spoken about this before—is the first and most vital way to defeat the virus. When in doubt, test: it is that simple. If you are afraid to go for one, whether you are afraid of the test or the outcome, talk to someone—talk to me or to any of us. I will happily come with you; drop me an email and we will go along together. Testing is vital. The U=U campaign lives on today, because we all know that undetectable means untransmittable.
In debates on this subject, we have spoken many times about stigma. I think that things are getting better. The fact that we talk so freely and openly in our national Parliament about the issue means that we are addressing stigma. Of course, Governments can make moves to address it—for example, there was the recent lifting of the ban on HIV-positive individuals on medication and people on PrEP serving in the military. There was also the landmark ruling on the blanket ban on gay and bisexual men donating blood; we did not go far enough on that, but we certainly made progress.
However, the 2030 goal will not be achievable unless we defeat the disease called stigma—and not just that disease but the other one that I have spoken about frankly in the chamber: the disease of bigotry, which often fuels stigma. It has been 30-odd years since the “Don’t die of ignorance” campaign. The question is, why has there not been a national campaign since then?
We have made progress, but we cannot defeat the virus at home unless we are defeating it abroad, so I want to raise a specific issue—if I have time, so with your permission, Presiding Officer. I am concerned that, although the worldwide trend is of a very welcome 32 per cent reduction in the number of new HIV transmissions between 2010 and 2021, there has been a rise of 33 per cent in the middle east and north Africa. For the past couple of weeks, we have spoken publicly about LGBT rights in Qatar, given the media attention on that country, but no one is really questioning the reality that there will be people there who are afraid to go for a test and to seek treatment, out of fear of retribution or prosecution, or even fear for their life. Political, religious and societal persecution remains, which is fuelling a rise in the number of HIV transmissions in that part of the world. Given that there is so much media attention on Qatar, perhaps we should use the opportunity to focus on the issue.
This is not just a job for Governments, for non-governmental organisations, for charities or for the third sector—they all have a role to play. I have countless examples that, if I had the time, I would share. It is all good stuff and welcome.
I will finish where I started, which is right back here at home. In Scotland, we will not meet our 2030 target if we do not properly fund and resource local sexual health services.
I welcome today’s announcement of a public awareness campaign, and I look forward to more details on what that might look like and how much it might cost.
Let us get back on track with reliable data. It is hard to source data about the subject at the moment, which is why I support the Labour call for annual reporting.
I know that times are tough and money is tight, but we have come a long way on this issue, and now is not the time to take the foot off the pedal. That progress should not and cannot be in vain.
I hope that, one day—maybe even before I leave the Parliament—we no longer need to have this debate on this day in this chamber, because we have met our target and eliminated new transmissions. I really think that we can do it; I certainly hope that we can.
I move amendment S6M-07025.2, to insert at end:
“; notes a rise in demand for access to appropriate sexual health services, and believes that timely access to such services is paramount in successful early detection, treatment and prevention strategies.”
15:20
I am pleased and proud to have the opportunity to open the debate on behalf of the Scottish Labour Party as we mark world AIDS day 2022. It is genuinely a pleasure to follow the minister, whom I know is very committed in this area, and Jamie Greene, who, as always, spoke with openness, frankness and integrity. It is always good to hear about his lived experience. As someone who is younger than he is, I find that it is always good to listen to him talk. [Laughter.] What he had to say about sexual health clinics, in particular, is important, and that is why Labour members will support the Conservative amendment today.
Today, we remember those people who have lost their lives to AIDS, we stand in solidarity with those who are living with HIV/AIDS and we commit to redoubling our efforts to eliminate HIV transmission, not only here in Scotland but across the world. We all stand on the shoulders of those who have gone before. As is so often said on world AIDS day, we remember the dead and we continue to fight for the living.
It is estimated that almost 7,000 people in Scotland are living with HIV. In recent years, we have made steady progress, with 92 per cent of people who are living with HIV being diagnosed, 90 per cent of people attending specialist services and 95 per cent of people who are accessing treatment reporting an undetectable viral load.
However, we cannot be satisfied with improvements because, although improvements are always welcome—every step that we take is welcome—it is not a case of job complete; it is very much still a work in progress. I think that we all recognise that and want to redouble our efforts to move forward.
As we have heard, not enough work has been done to widen access to PrEP to all areas of Scotland. That often results in a postcode lottery for treatment and access to things such as testing and drugs. I think that there is a particular issue in remote and rural communities, where people who may be eligible for PrEP are simply unable to access it because of their postcode. Jamie Greene spoke about some of the challenges that exist in that regard.
I am pleased to hear that the minister intends to proceed with a pilot to address some of those issues, and I hope that she will look at rurality as part of the pilot and seek to establish how we can quickly get more people to be able to access services online.
When it comes to education, it is clear that stigma is still associated with an HIV diagnosis. We must do more to tackle the outdated and often homophobic myths that continue to pollute the discourse in this space and have done over many decades. Although we are far on from those darkest of days, it is clear that such discrimination persists. I welcome the minister’s commitment to mounting a large campaign to address those issues in the public discourse. I look forward to receiving more information on that and, I hope, making a contribution to how we shape and progress that work.
In Scotland, there are certain groups of people who are more at risk. Those groups include gay and bisexual men, people who inject drugs and people who come from certain minority ethnic groups. It would be utterly wrong, though, if we continued to allow to persist the stereotype that HIV can affect only certain groups of people. We need to acknowledge that it can and does affect anyone.
I think that that is clearly borne out in the most recent statistics, which show that, in 2019, when there were 176 new diagnoses of HIV, the likelihood of men who have sex with men contracting HIV was only marginally higher than the transmission rate among heterosexuals: 37 per cent of new diagnoses were among men who have sex with men, while 32 per cent were among those in heterosexual relationships.
An important point that Jamie Greene made is that it is critical to remember that it was only last year that changes to blood donation rules allowed gay and bisexual men to give blood. That began to rectify an outdated and deeply homophobic practice, which was the product of the moral panic around homosexuality and the HIV/AIDS epidemic of the 1980s. Earlier this year, I was proud, as Scottish Labour’s first openly gay male MSP, to give blood for the first time since I was 17. It is undoubtedly the case that that historic change in the law has helped us to tackle the stigma relating to HIV/AIDS and it is clear that we must do more to continue that work.
I know that there is a consensus in the chamber that we must eradicate HIV transmission by 2030. To achieve that aim, we must have important interim markers that allow us to assess our progress on the journey to elimination by 2030. That is why our amendment calls on the Government to outline clear timescales for our work to eliminate HIV. In that regard, we can learn from other Governments and from plans elsewhere. For example, in Wales, the HIV action plan for 2023 to 2026 sets down clear actions regarding eliminating new HIV infections, improving quality of life and reducing stigma.
I welcome the commitments that the minister has made today, which will be helpful to us all in scrutinising the work, getting it right and moving it forward. We have an opportunity to look at how concrete actions will be followed through and at how much of the work can be mainstreamed into the HIV elimination plan.
We know that it is not enough to focus on the issues for just one day a year. We must do that day in and day out, week in and week out, and it should be a public health priority for the Government, Parliament, local authorities and us all.
The minister’s commitment to set up a group to look at implementation is very welcome. Parliament will want to take time to scrutinise that work. That is why our amendment calls for regular reporting to Parliament, so that we can all have a say on those issues.
On this world AIDS day, we must commit to moving the debate beyond good sentiment and warm words and must focus on having clarity to deliver tangible actions to eliminate HIV transmission in Scotland by the end of the decade, which we can and will do.
I move amendment S6M-07025.1, to insert at end:
“, and calls on the Scottish Government to outline a clear timescale for eliminating HIV transmission in Scotland by 2030 and commit to providing the Scottish Parliament with an annual progress report.”
15:27
I am proud to rise for my party in this great debate. I am grateful to Maree Todd for bringing it to the chamber so that I can hear amazing speeches from the likes of Jamie Greene, Paul O’Kane and the minister herself. People speak with real passion and from experience and we can learn a lot. More importantly, it brings us together as a chamber, as did our debate last night about the 16 days of activism on violence against women and girls.
Every year, thousands of people around the world still die of this terrible condition. It has not gone away. Last year alone, 650,000 people died from AIDS-related illnesses, particularly in areas of poverty around the world. There is massive global health inequality: although there are life-saving and life-enhancing therapies, those are not available to many sufferers and 1.5 million people became newly infected with HIV last year. We have heard the desperate and cruelly symmetrical statistic that 40 million lives have been lost in the past 40 years—that is 1 million lives for every year that the disease has been manifest in our population. We remember them today.
It is incumbent upon us to recognise the toll that HIV and AIDS still take on those living with the illness, both around the world and here in Scotland. There is an ever-present threat of complacency on the issue. Do not get me wrong: Scotland has made great progress in fighting the epidemic and we should rightly be proud of the role that we have played in acting as a global leader in ending transmission. We have heard several times—I salute the Government for it—that Scotland was one of the first countries in the world to make the life-saving HIV medicine PrEP widely accessible. It is absolutely vital in allowing people to protect themselves from transmission.
It is right that we acknowledge that, but we should not become complacent in doing so. Two years ago, the Scottish Government committed to ending all new HIV infection in Scotland by 2030. Although that was a welcome commitment, Scotland now risks being left behind other areas of the UK in driving the change needed to meet that target. In August this year, Scottish Liberal Democrat research revealed that patients in Lothian are forced to wait more than eight months for access to PrEP. That is just not good enough. We know that that medication is almost 100 per cent effective in preventing the passage of HIV. It plays a huge and important role in eliminating transmission in Scotland. Long waits for treatment risk an increase in transmission and the spread of the disease.
This year, patients have had to wait up to 260 days to receive medication, with all patients now waiting a minimum of 90 days in Lothian. In 2018, I asked the First Minister why Lothian had the longest wait in the country for PrEP and she promised to work with NHS Lothian to deliver the drug more quickly. However, four years later, not only is NHS Lothian still struggling to meet demand but delivery is even slower.
Jamie Greene rose—
I will take an intervention from Jamie Greene.
I am just returning the favour, Mr Cole-Hamilton.
I wonder whether—and hope that—we might hear in summing up from the Government more about the pilot scheme and that it might be not just in rural and island communities, but in suburban and urban communities, as well, where there is a very hefty waiting time to get appointments and seek treatment or to get renewed treatment and testing. I hope that the pilot will include people in cities, not just outside of them.
I can give you the time back, Mr Cole-Hamilton.
Just as my intervention showed the next page in Jamie Greene’s speech, so too does his intervention show members the next page in mine. We must compare notes before speaking in the future.
However, Jamie Greene’s point is well made. There is a postcode lottery in some cases, affected by where people are, particularly if they are in areas of rurality. Let us remember, too, that if someone lives in a small community, gaining access to intimate medical care of this kind can be very difficult. Everybody knows everybody else, but they may not know everything about your lifestyle and you may want to keep it that way. We need to find ways around that and ways of making that care far more accessible. The Scottish Government must ensure that every health authority has the right staff support and the necessary resources to eliminate HIV transmission through such preventative remedies from square 1.
It is also vital that we acknowledge that people who are living with HIV still face what Jamie Greene was right to call the disease of stigma. It is a disease—stigma blights so many aspects of our lives. It blights so many people who are vulnerable in so many ways, but in HIV I think that it is still one of the worst. It is discrimination. It is judgment based on people’s personal lives and personal choices.
A 2019 poll by the Terrence Higgins Trust found that public attitudes to HIV remain largely outdated and out of step with scientific progress—what we know about transmissibility and non-detectable viral load. Almost half of respondents said that they would feel uncomfortable kissing somebody who was HIV positive, despite there being no risk of transmission from that person. Prejudice leaves many people with HIV feeling marginalised and excluded from their communities, and can even have a negative impact on job opportunities.
Stigma also fuels the transmission of HIV, as we have heard several times today, by acting as a disincentive for people to seek testing and, by extension, treatment.
Does Alex Cole-Hamilton agree that there is great hope in the proposed advertising campaign from the Government to try to attack that stigma at its root and move us away from those horrible images of falling tombstones, which people still talk about? We have moved on and so must the thinking.
I am delighted that the Scottish Government intends to take this back to the public. In large part, the sum total of what people from younger generations know about HIV/AIDS may have been gleaned from that excellent Channel 4 drama “It’s A Sin”.
Martin Whitfield is right that things have moved on. HIV is not the death sentence that it was in the 1980s. There are therapies and treatments that we need to bring out into the light and we need to let people understand the risks, because people may not believe that they are actually in a susceptible or at-risk group and be all the more exposed because of that. I absolutely agree with Martin Whitfield that we cannot be complacent, because people who are living with HIV cannot afford for us to be complacent.
We must redouble our efforts and work towards a Scotland that is entirely free of HIV stigma, with zero new HIV transmissions and deaths from AIDS-related illness. The technology and medical care that we have available should make that a material possibility. To that end, there is more that the Government should be doing. It should establish a national HIV testing week for Scotland, something that is already in place in England and Wales. I wonder whether the minister might address that specifically in her summing up.
Work must also be done to significantly broaden access to PrEP, as Jamie Greene and I both discussed in our interventions. It should be far more accessible beyond specialist sexual health clinics, which can be difficult for some populations to access. It should be rolled out in GP clinics and community pharmacies, and in maternity and reproductive health services—let us not forget the increase among women.
I close with the words of HIV activist Alex Garner, who said:
“I ... choose to be open about who I am because I understand that affirmatively declaring who I am in a world where we continue to be marginalized and dehumanized is a powerful form of resistance.”
We move to the open debate.
15:35
I thank all the MSPs who turned up for the photo call that I was honoured to be able to sponsor, earlier today, to show support for the Terrence Higgins Trust, Waverley Care and the National AIDS Trust, and for Scotland’s goal of eliminating new HIV transmissions by 2030. I also thank everyone who is wearing a red ribbon.
Today, more than 40 years since the first cases were reported, is an important day in the journey towards eliminating HIV in Scotland. I will not be alone in noting the significance of the Scottish Government’s commitment to the interim 95:95:95 targets and to some other recommendations in the HIV transmission elimination proposal.
Being a member of the LGBTQI community, and working closely with others who campaign on issues that are important to us, I have heard some horrendous and heart-breaking stories from around the world in the 1980s. I have watched documentaries and dramas from that time with horror and a miserable fascination.
Often, pop culture plays an important role in raising awareness of social issues, particularly in cases such as this, as younger people may not have a good awareness of what happened during the AIDS epidemic. Russell T Davies’s “It’s A Sin”—a short TV series that was set during the epidemic and that was mentioned by my LGBTI+ cross-party group co-convener, Jamie Greene, who did a fantastic job in demonstrating how we can all play a part in destigmatising HIV—is a great example of a drama that is accessible and has clear messages but is also based on real experiences and true stories of what people went through and the stigma that they faced from friends, family and society.
Russell T Davies has said that he is very aware that younger generations are growing up without knowing anything about that period. We have to remember those stories and to be aware of the emergence of the same patterns. Young people who have HIV are still suffering the stigma that our whole community faces. We have to help them to understand where that comes from and arm them to challenge it, but we must also help them to know that they are not alone and that it is not they who are wrong.
Earlier this year, some of the incredibly stigmatising media commentary from the AIDS epidemic, and the kind of sentiments that were explored through characters in “It’s A Sin”, were echoed in stories about monkeypox. What were meant to be dramatised public reactions could be seen again, almost word for word, in tweets and Facebook comments under those stories. Yet again, people in the LGBTQI community were seen as disgusting, dangerous, risky, to be avoided and not to be touched. Too many people still believe the harmful misinformation that was spread before we understood what HIV and AIDS are, and too many do not know the difference not just between HIV and AIDS but between the HIV of reality and the HIV of scare stories.
Science has brought us a long way since the 1980s—to the point at which it is now completely possible for us, with existing therapies and preventative measures, not just to prevent AIDS but to stop new cases of HIV. PrEP alone is almost 100 per cent effective at preventing transmission, and, with the effective management of the virus, HIV-positive people are living into old age. Most people with HIV in Scotland are now over 50. It is not a death sentence. People can have a normal lifespan and can live healthily.
However, society still has work to do to catch up with that medical potential. In my contributions, I try not to make speeches that are too heavy on statistics or to read out facts and numbers as if they are going to go into people’s heads, but I will read out three, because they are incredibly important.
Almost half of the people who were surveyed in a Terrence Higgins Trust poll said that they would be afraid to kiss someone who was HIV positive—although there is no risk in doing so. That means that someone who is HIV positive might have only half as much chance of being kissed as someone else.
The figure goes up to 64 per cent—almost two thirds—when it comes to people not being willing to have sex with someone who is on effective treatment for their HIV, which prevents them from passing on the virus.
Most people with HIV will tell you that they face stigma because of their diagnosis. This morning, to mark world AIDS day, the Terrence Higgins Trust revealed data that showed that 74 per cent—nearly three quarters—of people with HIV say that they have experienced stigma or discrimination because of that.
The stigma and the lack of understanding of just how far we have come mean not only that people are suffering from that stigma and discrimination but that those at risk are missing out on the very thing that could prevent them from ever catching HIV. The high uptake of PrEP among gay and bisexual men has seen a significant drop in transmissions among that group but not so much among others, because 97 per cent of those accessing the drug through NHS Scotland are gay or bisexual men. We need to increase awareness of PrEP in other groups, so I was glad to hear the minister talk about expanding eligibility and access. I know that many cis women, trans people and non-binary people at risk of contracting HIV are completely unaware that PrEP is readily available to them and that, for those who are medically transitioning, it does not interact with their hormone therapies. We also know that black African women are more at risk and are not taking up PrEP. So, ladies and enbies, please look into PrEP if you are at high risk, and protect yourself.
There are many places where people can go to get advice about preventing HIV and to get tested quickly and easily. Waverley Care, which operates throughout Scotland, including in the Highlands and Islands, offers free testing at regular drop-in clinics. Highland Sexual Health also offers that testing service and advice in Skye, Wick, Aviemore and other locations, as does Nordhaven in Orkney, which is based at the Balfour.
I know that the minister, as a Highlands MSP who has previously represented the region, will be keen to ensure—as I am—that rural and island residents can and know how to access sexual health clinics. I hope that the marketing campaign that the minister mentioned in her speech will reach our constituents as well as those in urban areas.
15:41
I start with the apology that I need to leave before the closing speeches.
I declare an interest as a doctor—that will be quite obvious from what I say next. Human immunodeficiency virus—HIV—is a group of viruses called retroviruses that destroy a certain type of white cell in our bodies—the CD4 T-cell. Common symptoms include malaise; myalgia, which is a muscle ache; headache; diarrhoea; neuralgia, which is pain across the nerves; and rash. It is important that we test people at that stage, because finding out early means early treatment. After that phase, people become asymptomatic, which means that they have no symptoms. That phase can last for years. Eventually, that leads to AIDS—acquired immune deficiency syndrome. AIDS is a term that covers a range of infections and illnesses resulting from a weakened immune system, but we do not ever need to reach AIDS.
Those of us of a certain vintage will still remember one of the most petrifying health campaigns ever. In 1986, actor John Hurt voiced the menacing “Don’t die of ignorance” television adverts, featuring a huge granite tombstone warning the public of a deadly new virus that anyone can catch from having sex with an infected person. I remember that ad—I was six at the time, and it was terrifying. I still remember that black tombstone coming down. I suspect that the point of the ad was that it was terrifying. The hard-hitting ads did not exactly put people off having sex with new partners, but they had a significant impact through changing behaviour, particularly by encouraging people to use protection and get tested.
The campaign’s key message was clear and stark: if you ignore AIDS, it could be the death of you. Every household in Britain received a leaflet with the warning that anyone—gay or straight, male or female—could get AIDS and that 30,000 people were already infected. In the days when we posted letters—I am sure that most of us in the chamber remember that—the Royal Mail postmarked envelopes with “Don’t die of ignorance”. Back then, there was little knowledge of the disease and no drugs to treat it with. The predicted death toll was terrifying. The UK Government was told that it could be millions and millions. Hospital wards could be filling up with dying young men.
Dr Gulhane describes a terrifying time—I remember it, too. The stigma was legion around that time. There was a massive surge of infections in the 1980s, but there was also a surge in co-infections. People who had blood-borne viruses were contracting sometimes multiple lifelong viruses at the same time. Does Dr Gulhane agree that the work that we need to continue to do to tackle HIV and transmission in this country should be coupled with work on things like hep C, so that those communities that were co-infected are helped as well?
I very much agree with Mr Cole-Hamilton. We need to work hard at also eliminating hepatitis C, which we discussed in a previous debate.
Back in the 1980s, there was little sympathy for gay men with HIV and AIDS. A common view, which was so unjust, was that anyone with HIV had brought it upon themselves and should be left to their fate. There were stigma, prejudice and discrimination, and HIV and AIDS were known as the gay plague.
When I was at medical school in the 2000s, we were taught about the devastating impact of a diagnosis of HIV. It was drummed into us that, before testing, we students had to counsel our patients, talk about the implications of a positive diagnosis and get their explicit, informed consent, because such a result could affect their health insurance, life insurance and travel insurance, to name just a few of the financial aspects. In London in the early noughties, people were still dying of AIDS. Later, when I was an orthopaedic registrar in Birmingham, although infection control protocols were robust, there was still the perceived additional threat of occupational transmission from HIV-positive patients.
Just look at how far we have come. HIV is still a lifelong infection, but it can be managed successfully by antiretroviral therapy—ART. There is no vaccine or cure for HIV, but, if a patient takes tablets daily, the virus will not replicate and progress to AIDS. Now we even have drugs that reduce the likelihood of people becoming infected. For those who think that they have been exposed to the virus, we have post-exposure prophylaxis—PEP—and, for those who are HIV negative but at high risk of HIV infection, pre-exposure prophylaxis medicine reduces that risk significantly.
Thirty years ago, a diagnosis of HIV and AIDS was a death sentence. Now, the medical profession considers HIV a chronic disease. In fact, the prognosis and life expectancy for a person living with HIV are better than those for someone living with type 2 diabetes. Living well with HIV usually involves taking one tablet per day, and it does not result in any reduction in life expectancy. Regardless of how well it is controlled, type 2 diabetes is a progressive and life-limiting disease, with the need to increase pharmacological therapies over time.
It is estimated that 500 Scots are likely to be unaware that they are infected with HIV, and there is evidence that some people are still being diagnosed at a very late stage. On this world AIDS day, although there is so much to welcome regarding our knowledge of this disease and advancements in diagnosis, treatment and management, there is still so much to do. Our goals are to eliminate AIDS and have zero transmission of HIV by 2030. Testing will be key to achieving those aims, and well-functioning sexual health services are vital. However, too many people are still going undiagnosed, and that does not have to happen.
15:47
Like others, I begin my contribution by remembering all those who have lost their lives to HIV and AIDS. Too many lives have been lost too early.
There have never been more people living with HIV in Tayside than there are now. We see new diagnoses every year but, as we have heard from Dr Gulhane, thanks to modern treatments, HIV-related deaths are now rare. However, people who live with HIV continue to experience disproportionate stigma and discrimination that have an impact on their willingness to test for HIV or to engage with treatment and prevention interventions. Ultimately, stigma fuels the on-going HIV epidemic in Tayside, in Scotland and around the globe. Such stigma has been a major feature in many of the contributions in the debate, and I will return to it later in my speech.
I recently attended an event at Discovery Point in Dundee, to hear more about plans to make it a fast-track city. Fast-Track Cities is a global initiative that unites local leaders and organisations in the common goal of ending the HIV and AIDS epidemic by building on and strengthening HIV programmes to accelerate a locally co-ordinated response that reflects specific local needs. It seeks to unite local leaders in Dundee and Tayside and link them to a network of like-minded leaders across the globe. The initiative provides technical support, including data and systems, opportunities to share best practice via connections with other such cities, capacity-building support and solutions for funding and resource mobilisation.
With the support of Fast-Track Cities, Scotland is on track to meet the UNAIDS target of elimination of AIDS by 2030.
In 2019, Tayside was the first region in the world to effectively eliminate hepatitis B, 11 years before the World Health Organization’s 2030 target date. There is a determination in Tayside to also be the first to eliminate HIV transmission. I want to highlight the work of the Tayside sexual and reproductive health service, including Dr Sarah Allstaff, consultant genitourinary physician and clinical lead for HIV. Dr Allstaff and her team worked tirelessly during the Covid-19 pandemic to support people living with HIV. The Covid-19 pandemic had a unique effect on people living with HIV, often bringing back memories of stigma, contagion and contamination. The work of Fast-Track Cities stalled during the pandemic, so I am really pleased that, certainly in Dundee, that work is progressing once more at pace
I also commend the work of Waverley Care and the Terrence Higgins Trust. Waverley Care is leading on reducing new HIV and hepatitis C infections, getting people diagnosed, tackling health inequalities, promoting good sexual health and, crucially, challenging stigma.
The Terrence Higgins Trust, as members will know, has been supporting people living with HIV since the early 1980s—since those horrible ads that others have talked about. The trust provides testing services for HIV and other sexually transmitted infections and helps service users achieve good sexual health. It also highlights issues with the stigma surrounding HIV. The trust advises that stigma is often born out of fear and that it can take many forms, including hostility, physical and verbal abuse, and the avoidance of or exclusion of a person from activities that they used to take part in. My colleagues have noted some of the other impacts of stigma on people living with HIV.
Although we all hope that some day there will be a cure for HIV, the actions that we are taking right now mean that Scotland is on course to be one of the first countries in the world to eliminate transmission of HIV. In the meantime, it is crucial that we do everything that we can to tackle that stigma, which is a remaining barrier. Stigma is the recurring theme of my speech and other speeches today. HIV does not discriminate, as we have already heard, and neither should we or anyone else.
Members across Parliament supported the Terrence Higgins Trust “can’t pass it on” campaign. I want to take this opportunity to again highlight the key message that people who are on effective HIV treatment cannot pass on the virus. Twenty years’ worth of evidence proves definitively that people living with HIV with an undetectable viral load cannot transmit HIV sexually. As Jamie Greene and others have said in their contributions, undetectable equals untransmittable. The message behind that phrase is worth repeating: people who are on effective HIV treatment cannot pass on the virus.
I am delighted that Dundee is to become a fast-track city. I am confident that we can learn from the fantastic works on-going in other cities across Scotland and around the world. On world AIDS day 2020, I stated that
“the goal of eliminating HIV transmission is now in sight”.
Two years on, I believe that that remains the case. Let me be clear, though: irrespective of the progress that we have made in recent years, as the minister said in her opening remarks, elimination is not inevitable—but it is achievable. By working together, Scotland can—and I believe it will—eliminate HIV transmission by 2030. The minister’s three significant announcements today will support that ambition.
I call Claire Baker, to be followed by Evelyn Tweed. Ms Baker, you have a generous six minutes.
15:54
It is four decades since the first cases of HIV were diagnosed, and world AIDS day provides an important opportunity to stand with those living with HIV and those affected by it today, and to remember the millions of lives that have been lost to HIV and AIDS.
As we have heard, Scotland has made huge advances in that time, including being one of the first countries to make PrEP widely accessible. However, we know that more concerted and continued action is needed if the goal of zero new transmissions by 2030 is to be met.
Although we welcome the progress that has been made in the fight against HIV, there remain challenges that must be addressed holistically and specifically if we are to succeed. With cross-party backing for plans to end new HIV cases within a decade, the challenge for the Scottish Government is determining the route to get there.
Our amendment calls for a commitment to annual reporting to Parliament on progress, but we also need to see action such as a more proactive approach to HIV testing, wider access to PrEP, public education and work to address HIV stigma and HIV health inequalities, particularly among people who are intravenous drug users.
It is vital that the Scottish Government’s drug strategy takes into account the risk of HIV transmission among populations in Scotland who inject drugs. Data on routes of transmission for first diagnosis of HIV recorded in 2020 shows that 17 per cent were linked to people who inject drugs; and data on routes of transmission for those living with HIV, up to December 2019, shows that 9 per cent were linked to people who inject drugs. When we think about the risks of drug use, transmission of HIV and other blood-borne viruses must be a part of that discussion, so we can address that issue within the broader action that is being taken.
Claire Baker makes a compelling argument about the link between intravenous drug use and HIV transmission. Does she agree that we saw an outbreak of HIV in Glasgow when funding was cut to alcohol and drug partnerships, and that that underscores why we need to adequately fund on-the-ground drug services in our country?
That is an excellent point, and it is one that I made in last week’s debate on the national drugs mission and the action on stigma. The centralisation of our drug and addiction services leads to good medical outcomes, but there must be more locally delivered provision, because that is where people look to access assistance, and, last week, I argued for more provision in GP practices.
When we look at our record on drug-related deaths, we must also think about the number of deaths that are related to HIV and hepatitis C. The National Records of Scotland’s drug-related deaths publication for 2021 shows that, between 2010 and 2021, there were 413 deaths resulting from hepatitis C or HIV, which are not included within the definition of drug-misuse deaths but might be associated with present or past drug use.
Harm reduction measures have a key role to play in reducing HIV and other blood-borne viruses, and the effective delivery of the medication assisted treatment standards is important in ensuring that those measures are successful. MAT standard 4 includes provision for access to harm reduction services at the point of MAT delivery, injecting risk assessments and blood-borne virus testing. Service providers will be required to have a procedure in place to offer testing for HIV and other blood-borne viruses. However, as we know, implementation of MAT standards has slipped, with full implementations of standard 4 in place in only eight ADP areas where a progress report was carried out. Full development of MAT standard 4 will happen only if the services are properly developed and funded, and we must meet the target of delivery by next April.
We talk about safer drug consumption facilities primarily in terms of preventing overdoses, but they also reduce the risk of people contracting HIV and hepatitis C by providing people with a safe space to inject and reduce needle sharing. Of course, we are still waiting for those kinds of facilities to be in operation in Scotland. I understand that a submission has been made to the Crown Office for the facility in Glasgow, but it is disappointing that, three years after the declaration of a public health emergency, we still do not have a pilot facility up and running in Scotland.
The joining up of policy and service delivery is vital in our fight to eradicate HIV transmission. We have seen the benefits of the collaborative working that has been engaged in by Public Health Scotland to prevent blood-borne viruses among people who inject drugs. In recognition of the fact that people who inject drugs are disproportionately affected by blood-borne viruses and of the challenges of tailoring interventions to reduce the health inequalities that are faced by that group, Public Health Scotland worked with NHS boards, third sector organisations and other key partners to design and implement monitoring and evaluation initiatives, and the needle exchange surveillance initiative that is supported by the Scottish Government is an example of data gathering to support better intervention, and is the kind of action that we need to see more of.
As I have said, last week, I spoke in the debate on stigma and the importance of addressing stigma in drugs policy. That, too, is vital to this debate. Knowledge and understanding of HIV among the public is still too low, and much more needs to be done to end the stigma and discrimination around it. There has not been a major public information campaign about HIV since the 1980s “Don’t die of ignorance” messages. Data that was released this summer by the Terrence Higgins Trust showed that the public attitudes of many are still tied to that campaign, particularly among older people.
I welcome the minister’s announcement this afternoon about an upcoming campaign. Like others, I would like to see more detail on that, but it is positive that a campaign is forthcoming, because just 38 per cent of people who were surveyed knew that people who are living with HIV on effective treatment cannot pass it on to partners. The same survey found that just 30 per cent of respondents would be comfortable dating someone who was living with HIV and on effective treatment.
A disconnect remains between knowledge about HIV transmission and the impact on how people who are living with HIV are perceived and treated. The Government has a role to play in addressing that. A new campaign should help to address stigma by informing the public about the realities of HIV, encouraging more people to get tested, and providing better support for those who are living with HIV.
If we are to successfully end HIV transmission in Scotland, we cannot do so by thinking about it in isolation. For individuals who inject drugs, the risks of harm are interlinked, and they need to be addressed by looking at them holistically. The implementation of the MAT standards can help to play a key role in ensuring that several providers are able to engage with at-risk groups. However, we have waited too long for that to take effect.
Improving public information is essential to reduce stigma, and collaborative work across agencies will help to reduce the inequality in the provision of support and to reach groups that can be too often missed.
16:01
I apologise to members for my lateness today.
“It felt like a death sentence.”
Those were the words of a constituent of mine who supported his partner through an HIV diagnosis in the 1990s. The diagnosis was kept under wraps amidst a great deal of discrimination. Thankfully, my constituent was keen to highlight the enormous progress that has been made since his partner’s diagnosis, with many public figures now openly sharing their status as HIV positive.
Today, on world AIDS day, we remember the millions of lives lost globally to HIV and AIDS. It is also an opportunity to stand in solidarity with those who are living with HIV and to reflect on the progress that has been made.
In 2018, Scotland met the UNAIDS 90-90-90 target, with 91 per cent of people living with HIV diagnosed, 98 per cent of them accessing treatment, and 94 per cent of them with an undetectable viral load. I am sorry to give some statistics, as we have already talked about that, but they are important.
Once again, the Scottish Government is showing an ambitious approach to tackling health issues. I welcome its announcements today.
Treatments for HIV are now very effective, and free HIV testing is available to anyone on the NHS. As we have already heard, pre-exposure prophylaxis, or PrEP, is a medication for people who do not have HIV, and it is almost 100 per cent effective in preventing transmission. I commend the Scottish Government for making PrEP available on the NHS. Scotland is the first nation in the UK to do so and one of the first in the world to take that approach.
However, as we have heard, social attitudes lag behind medical advances. Misconceptions of HIV risk still abound. In 2020, HIV Scotland found that 31 per cent of Scots believed that they were not the type of person who could get infected with HIV, and only 17 per cent believed that medication could prevent HIV infection. If Scotland is to reach zero transmission by 2030, outdated myths need to be overcome, so I welcome the minister’s comments on a new awareness campaign.
Since PrEP has become more widely available, the demographics of new diagnoses have shifted. Those who are being diagnosed are more likely to be women or black African, and to have acquired HIV outside Scotland.
However, from July 2017 to June 2019, less than 1 per cent of those prescribed PrEP were women, and only 0.4 per cent identified as African or African Scottish, despite that being an at-risk group. Black African and Caribbean women living in the UK report low levels of knowledge about the benefits and effectiveness of PrEP. That results in low take-up and little change in rates of diagnosis. Studies have also highlighted the importance of peer networks for information on sexual health for that group.
In a 2021 study, HIV-positive asylum seekers and migrants in Scotland reported feeling stigmatised by public health services. However, they described overwhelmingly positive experiences with dedicated services such as the African health project at Waverley Care. I look forward to hearing how the Government will support people of colour, migrants and asylum seekers through diagnosis, treatment and prevention.
Scotland has been able to show that PrEP has, and can continue to have, a powerful, population-level effectiveness. On world AIDS day, I am so happy to hear the positive progress that we are making and to hear my fellow parliamentarians speak about their own experiences.
We have moved on so much from the dark days of the 1980s—from the adverts showing tombstones, with foreboding music, that I remember as a teenager, and from the fear that everyone felt. Scotland is already well on the way to zero transmissions by 2030, and I welcome the Scottish Government’s announcements today.
I call Gillian Mackay, who has a generous six minutes.
16:06
I begin by expressing my condolences to everyone who has lost someone they love to AIDS. I also give my thanks to all the activists who have led, and who continue to lead, the fight for better treatment, diagnosis and understanding of HIV and AIDS. We would not be where we are today without their efforts, which have often been made at great personal cost.
Huge medical advancements have been made in the decades since HIV was first discovered, and it is now a very treatable disease. However, access to diagnosis and treatment is still not equitable, both globally and in Scotland. Inequality drives risk and creates barriers to diagnosis and treatment across the world—70 per cent of new HIV infections are among people who are marginalised and often criminalised. According to the World Health Organization, division, disparity and disregard for human rights are among the failures that have allowed HIV to become, and remain, a global health crisis. We cannot make those same mistakes.
We can end HIV transmission only by scaling up HIV services, removing structural barriers and tackling stigma and discrimination worldwide. Those structural barriers are evident in Scotland. For example, the current HIV outbreak in Glasgow is closely linked to widening health and social inequalities—including those relating to poverty and deprivation—faced by people who inject drugs. Analysis by Public Health Scotland found that none of the deaths associated with the outbreak was from an AIDS-related illness. However, people who inject drugs face a range of inequalities that increase their risk of HIV infection and their rate of mortality, such as homelessness and poor access to healthcare. Those factors interact in complex ways, presenting significant barriers that prevent people from staying well.
The Scottish Greens believe that action to address underlying health inequalities will help to reduce the number of drug-related deaths as well as related harms such as HIV infection. Alongside tackling underlying inequalities, we need to ensure that it is as easy as possible to test for HIV. Vulnerable people who might be at increased risk can be labelled as difficult to reach, but, in reality, testing is not always accessible.
Early diagnosis is crucial to ensuring that people with HIV can live the healthiest lives possible. However, according to the most recent statistics from Waverley Care, three out of every 10 HIV cases are being diagnosed late. Waverley Care’s analysis states that access to HIV testing can be impacted by structural barriers such as lack of capacity, time constraints, lack of knowledge about how to obtain a test, low perceived risk of HIV infection, fear of a positive test result and issues relating to disclosure.
Does the member think that there might be some merit or benefit to the proposal for a national HIV testing week, when there could be a huge country-wide roll-out of mobile, home and in-clinic testing in one specific identified week? That could help to find some of the 500 undiagnosed people, which would go a long way towards reducing case numbers in Scotland.
I will give Gillian Mackay the time back.
Thank you, Presiding Officer.
I agree with the member. If a national HIV testing week becomes a reality, I would challenge every member in the chamber to get tested, too, so that we can help to break down the stigma.
I am aware that, although not directly related, the current protests outside abortion clinics, which are often on the same sites as sexual health clinics, are putting people off getting tested, because they fear being recognised. However, I echo Jamie Greene’s calls to get tested, and I join him in offering to go with anyone who is frightened to do so or who has concerns.
In addition, people who live in rural or remote areas of Scotland might be discouraged from getting tested, as it can be difficult to maintain anonymity in rural communities, where simply accessing HIV testing services might expose someone’s HIV status. It can also be costly to travel to get tested if facilities are located far away.
If we are to improve care for people with HIV and achieve zero transmissions by 2030, we need to ensure that everyone who has contracted HIV is tested and diagnosed. Initiatives such as those involving HIV self-sampling tests will play an important part, but we must explore other options to widen access. The Terrence Higgins Trust is advocating expanded opt-out HIV testing in healthcare settings, and the HIV Commission’s flagship recommendation is:
“Opt-out rather than opt-in HIV testing must become routine across healthcare settings, starting with areas of high prevalence.”
I am pleased to see the Government’s commitment to that in its report “Ending HIV Transmission in Scotland by 2030”.
Around the world, we have already seen the difference that opt-out testing can make. Around the year 2000, opt-out HIV testing was implemented in maternity services. With take-up of more than 99 per cent, that innovation has become mainstream and has eliminated HIV transmissions from mother to baby.
Subsequently, the National Institute for Health and Care Excellence published guidance in 2016 that stated:
“In areas of high and extremely high prevalence”,
HIV testing is recommended
“on admission to hospital, including emergency departments, to everyone who has not previously been diagnosed with HIV and who is undergoing blood tests for another reason.”
According to the Terrence Higgins Trust, the initial findings from the first three months of opt-out testing in England found that 102 people had been newly diagnosed with HIV and that 60 people had been reconnected to an HIV clinic. There have also been 328 new hepatitis B diagnoses as well as 137 new hepatitis C diagnoses. Piloting a similar approach in Scotland could be a vital way of ensuring that no one is left behind in Scotland’s response to HIV.
Along with improving access to testing, we must continue to tackle stigma, as we have heard from members across the chamber, because it still presents a real barrier to diagnosis and treatment. People who receive antiretroviral medication can reach an undetectable viral load, which means that they cannot pass on HIV to anyone else within six months of beginning treatment. That is incredible progress.
However, knowledge of HIV has not kept up with medical advancements. At the risk of being booed by colleagues, I point out that I do not remember the “Don’t die of ignorance” campaign.
Members: Boo!
Thank you. I was not born until the early 1990s. However, I grew up during a time when there were many myths about HIV, several of which persist today. That is why it is so important that we raise awareness of improved treatments and what having an undetectable viral load means. The Terrence Higgins Trust’s “Can’t pass it on” campaign aims to spread the simple message that someone living with HIV and receiving effective treatment cannot pass it on. Raising awareness of that reduces the stigma around HIV, and it is a positive message that encourages people with HIV to stay on treatment in order to keep both themselves and their sexual partners healthy. The more people who test and start effective treatment, the fewer HIV transmissions will happen.
I welcome all the interventions that the minister has announced today, and I look forward to seeing the impact that they will have. World AIDS day is an important reminder that HIV has not gone away. An estimated 38.4 million people live with HIV, and more than 4,139 people are diagnosed with the disease each year in the UK. Access to diagnosis and treatment is not equitable, and stigma is still a reality in many people’s lives. We must continue to widen access to diagnosis and treatment, increase awareness, fight prejudice and improve education.
Thank you, Ms Mackay. I will check what standing orders say about gratuitously flaunting youth—there you go.
I call Brian Whittle, who has a generous six minutes.
16:14
I promise that I will not fall into the category that you mentioned, Presiding Officer.
I am delighted to speak in the debate and to follow some excellent contributions. I am struck by how far we have come. I will show my age in remembering those who changed the conversation about AIDS and HIV and who helped to reduce stigma. Freddie Mercury was one of the first people of note who we found out had AIDS. The great American basketball player Magic Johnson remained in elite sports condition and went to the Olympics as part of the American dream team. I will always get in a mention of sport and rock music whenever I can, but those people were heroes to many and were in the public eye; they really brought to us the reality of AIDS.
In 2019, the Welsh rugby player Gareth Thomas announced that he was HIV positive, and the BBC documentary “Gareth Thomas: HIV and Me” aired shortly afterwards. He timed that announcement to coincide with his participation in an Ironman triathlon. A carefully orchestrated media campaign drove home the simple message that HIV did not weaken him—he was in control and his life was not over.
I do not know whether we all remember Princess Diana visiting the Terrence Higgins Trust and—shock, horror—shaking hands with people who were HIV positive.
All those people began to change the way in which we view HIV and to tackle the stigma.
In 2020, Nicoletta Policek, who served as chair of HIV Scotland, told of her experience as a woman living with HIV for most of her adult life. She reminded us that anyone can acquire an HIV infection—it is not limited to a subsection of people, as we used to believe and used to be told.
World AIDS day was the first-ever global health day. As at 31 December 2021, 6,415 people were living with HIV in Scotland. My colleague Jamie Greene spoke eloquently, and I agree with his assertion that access to better sexual health services is vital in the fight against HIV, but so too are education and access to public health services such as drug and alcohol treatments.
Many people who are living with HIV are not acknowledged in the public eye, such as those who are battling addiction or who are homeless. Those populations are often difficult to reach, which results in substantial health inequalities. I am proud to rock the ribbon for the world AIDS day 2022 campaign and be an HIV ally of those who are often overlooked.
We need to look at public health programmes, such as needle exchange programmes. More generally, drug and alcohol partnerships are underfunded. Between June 2014 and December 2020, 188 new diagnoses of HIV infection were detected among people who injected drugs in NHS Greater Glasgow and Clyde’s area, as part of an on-going outbreak. That was the largest HIV outbreak among people who inject drugs in the UK in more than 30 years.
I think that it is no coincidence that the needle exchange programme had been reduced at that point. Levels of reported needle and syringe sharing in the past six months have increased from a low of 7 per cent in 2015-16 to 11 per cent in 2019-20. We must be cognisant of that and understand the part that needle exchange programmes play.
I welcome the fact that the number of new diagnoses in Scotland is declining. In 2021, 218 reports of HIV diagnosis were recorded, in comparison with 326 reports in 2019. However, late diagnosis persists, so it is vital to continue to educate people and provide outreach. The proportion of first diagnoses that are recorded as being late has decreased in the past two years, during the Covid-19 pandemic, but there is evidence that some people are still being diagnosed at a very late stage of HIV infection.
It is concerning that individuals who are diagnosed at a late or very late stage of infection have an eightfold risk of dying within one year of their diagnosis. Often, their response to treatment and therapy is poor, which increases concerns about quality of life during their last months. Testing remains a key public health priority for all risk groups in order to reduce the number of undiagnosed infections. If we identify individuals early in their HIV infection, they can benefit from the most effective antiretroviral therapy and we can reduce the potential for onward transmission.
Public Health Scotland notes that the challenge during Covid-19 recovery is to re-establish and improve opportunities for testing in primary care settings and across all medical specialties, in addition to home and self-testing options. I argue that raising public awareness is also important—as Jamie Greene said in his intervention—so that the public know the risk factors and what help is available.
In East Ayrshire, there are an estimated 52 cases and, in South Lanarkshire, there are 577 cases. In Lanarkshire, North Lanarkshire Council, South Lanarkshire Council, NHS Lanarkshire and the Lanarkshire blood-borne viruses network have created a partnership to address HIV and hepatitis, both of which we recognise that we could eliminate. That joined-up approach ensures that those services are accessible to the young and old alike, as well as to patients and medical providers.
Research into pharmaceuticals and treatments will obviously be extraordinarily important. PrEP is a drug that is taken by HIV-negative people before sex, and it reduces the risk of getting HIV. It continues to be a particularly effective preventative intervention, and the monthly average number of individuals accessing the service for their first prescription between July and December 2021 was the third largest observed since the first year of the programme. However, underrepresentation of some groups who might benefit from PrEP, such as women, must be tackled in order to ensure equality of access to the PrEP service.
Once again, I am thankful for the opportunity to speak in the debate. Of course, there is an awful lot of work to do but, if we have the will, we can eliminate this virus by the target of 2030.
16:22
We have heard a lot in recent weeks in this Parliament about the founding principles of the NHS. We need to apply those founding principles of our national health service to the global community’s fight against international and intergenerational pandemics. That means that we need to get medicines to people according to need, not according to wealth. That is what we need to do for those who are ill, not just for those who can afford to pay. That must be fully funded and paid out of general taxation. It should be done not to enhance the profit margin and the shareholder dividend but to enhance universal life expectancy and the humanitarian dividend, because people must be the assets on our balance sheet. Those are the principles of Aneurin Bevan, and those are the principles that we should stick to today.
There is another principle and article of faith that guides me and many others—although I recognise that it might be a minority view in this Parliament—which was best set out by Tom Mann, who, a century ago, wrote:
“No narrow nationalism can satisfy our people. Nothing short of Cosmopolitanism can really satisfy a world citizen. ‘The world is my country!’ is the declaration of every Socialist.”
So, I view the world crisis in AIDS as my crisis. I view it as all of our crisis, which is why we must all work to harness science and get the most advanced and effective medicines without frontiers to those who need them, because the prevention and treatment of HIV/AIDS is a human rights issue. When private companies take over public health, profit becomes dominant over need, and we have a two-tier system.
The corollary of the corruption of power, which we see with the superprofits and racketeering of big pharma, is the corruption of powerlessness. So, we need more democracy in this global approach and an organised people’s counterweight to the power of organised big business. I am talking about big businesses such as Gilead Sciences, which last year generated $27 billion in turnover; settled a $1.25 billion patent infringement case with one of its main rivals, ViiV Healthcare, which is majority-owned by GlaxoSmithKline; and still managed to pay Daniel O’Day, its chief executive officer and chairman, more than $19 million.
Last year, the theme of world AIDS day was “End inequalities. End AIDS. End pandemics”. This year, there is a warning to end “Dangerous inequalities”. However, we know that inequality is the root cause of a still-rising number of cases in certain parts of the world. New infections are going up among women, and among young women and adolescent girls especially. In sub-Saharan Africa, girls are three times more likely to acquire HIV than boys of the same age.
I have to say to Conservative MSPs that this debate is, in the end, about inequalities of wealth, but it is also about inequalities of power, because what is happening out there globally is that, while people with wealth survive, people in poverty are dying. According to the UN, last year,
“children accounted for only 4 per cent of all people living with HIV but 15 per cent of all AIDS-related deaths.”
The cuts to overseas aid, the cuts to organisations that tackle AIDS globally and the cuts to the Global Fund to Fight AIDS, Tuberculosis and Malaria beg these questions on world AIDS day 2022: where is our sense of injustice; where is our moral outrage; where is our adherence to a civilised code of human rights, let alone of children’s rights, in this?
Winnie Byanyima, the executive director of UNAIDS, was absolutely right to say this week that
“What world leaders need to do is crystal clear”.
She went on:
“In one word: Equalize. Equalize access to rights, equalize access to services, equalize access to the best science and medicine. Equalizing will not only help the marginalised. It will help everyone.”
If all right-minded people challenge prejudice and stigma head on, take action so that there is no place for the profit motive and the shareholder dividend in this humanitarian quest, recognise that silence is a vice, and show real international leadership, then there is hope for a better future.
We can break the link between corporate power and global poverty; we can end not only the “Dangerous inequalities” but the very pandemic itself. That is the task facing us in this generation. We can begin by setting a clear timetable in Scotland, with a route map and annual reporting. We can make sure that resources are guided not by profit but by need, and we can truly be, in the Tom Mann sense, citizens of the world.
I call Gillian Martin, who is the final speaker in the open debate, for around six minutes.
16:28
I, too, am glad that the Government has made time to hold a Government debate on world AIDS day. It allows us that bit more time to amplify the key aims of the National AIDS Trust, which works tirelessly to promote the information that people need to prevent new cases of HIV; to secure the rights of the people living with HIV; and, crucially, to fight against HIV stigma and discrimination. It also gives us a chance to let our constituents know what services are out there and to highlight the importance of testing.
HIV Scotland makes it easy for anyone who is worried that they might have the virus to get tested quickly. It can send self-testing kits, delivered in discreet packaging, to their home and signpost people to other forms of support. I was pleased to hear the minister’s determination to get more people tested.
We have certainly come a long way in the decades since HIV and AIDS entered the public consciousness, and the strides that have been made in clinical treatment are a huge part of that. HIV is now a treatable and manageable condition. People who receive a diagnosis can expect long and healthy lives with managed care.
The extraordinary headway that has been made in how the virus is seen by society is due, in large part, to the bravery of the people who have come before us in speaking out, and to organisations such as HIV Scotland and Waverley Care that make massive contributions to tackling stigma.
However, stigma remains. Yesterday, it was concerning to read a piece in The Herald by Grant Sugden, the chief executive of Waverley Care, who said that, in a recent survey by the National AIDS Trust,
“only a third of people agreed that they have sympathy for all people living with HIV”.
I found that really staggering and depressing. From that survey response, it seems that HIV is still associated with promiscuity or other behaviours that lead people to think that contracting it is the fault of the person with the disease or that it points to some kind of moral failure. Those damaging and hurtful stereotypes persist.
I think that the dreadful “Don’t die of ignorance” campaign in the 1980s, with its sinister voice-over, images of terrifying icebergs and tombstones and ridiculous scaremongering messaging, was at the root of many of the problems around stigma that we still see today, so it is great to hear the minister commit to a new public messaging campaign. Apart from the 1980s campaign being completely and utterly useless at giving any public health information, it was hugely stigmatising and set the public discourse, which quickly became deeply homophobic and anti-public health. From the survey that Mr Sugden cited, it seems that the legacy of the campaign remains, preventing people from coming forward for testing and blaming them for how the virus is spread.
I echo Emma Roddick’s points about the HIV prevention drug, PrEP, which is currently almost exclusively accessed by men who are at risk of HIV. In the first eight months during which PrEP was available in Scotland, only 10 out of the 1,299 people who accessed the drug were women, which begs the question: are women not coming forward, and if not, why not? That is why I intervened on the minister’s speech in the way that I did.
One of the aims of the National AIDS Trust is to completely eradicate HIV. The decline in the number of cases in Scotland and the UK more widely is hugely welcome, but despite the progress that we have made here in preventing, treating and managing HIV, the illness is still a critical public health issue in other parts of the world and, in particular, in the global south. I have massive sympathy for everything that Richard Leonard said in his speech in that regard.
One in 21 heterosexual African women live with HIV, and UNICEF has reported that, globally, a child is infected with HIV every two minutes. Of the estimated 2.7 million children in the world who live with HIV, just half receive antiretroviral treatment, meaning that the rest of them have a very short life expectancy. The figures for how many children in sub-Saharan Africa are orphaned due to AIDS are similarly frightening and point to poverty and inequality being the main driver for this on-going public health crisis. We are managing it here in the UK—things are an awful lot better than they were—but, as Richard Leonard said, there are other countries that are not managing it, and they need assistance from big pharma and from Governments that are managing it successfully.
That just goes to show that we can never rest in the fight against HIV, and that we should never make outdated assumptions about who can be infected. Nearly 40 years on from the discovery of HIV, we know so much more about the virus. We know that people who have access to healthcare can live with it. However, we also know that it is a diagnosis that is still rife with stigma, and that some demographics in Scotland might still be hard to reach when it comes to testing and treatment.
As long as HIV infection remains a problem anywhere in the world, we must talk about it and act to eradicate it in countries that do not have access to the healthcare and public health messaging that we have.
We move to the winding-up speeches.
16:34
I join all my parliamentary colleagues in marking this year’s world AIDS day.
In closing for Scottish Labour, I also want to take the opportunity to remember those people at home and abroad who are no longer with us, having lost their lives to this terrible disease. The work that we must continue should always be done with them in mind. I refer to Jamie Greene’s reminder that, behind the statistics, there are always people and their families.
The on-going battle against AIDS is a remarkable success story for co-operation on research and development that has had a positive effect, at least here in Scotland, if not all over the world. I will return to Gillian Martin and Richard Leonard’s points.
The Government motion correctly commends the work of those who have ensured that we have vastly reduced the number of HIV diagnoses across Scotland—I have no doubt that that feat will continue for years to come—but the intended goals cannot stop there.
As my colleague Paul O’Kane said, we will support the Tory amendment, which highlights the need for timely access to sexual health services and the importance of ensuring that treatment and prevention strategies are at the forefront of all our policy making.
A number of colleagues talked about the need to look at rural inequality. The minister nodded vigorously when that point was made, and I am sure that she will address it in her closing remarks. My colleague Gillian Mackay made an important point about the cost aspect for people who live in rural Scotland. She also spoke about the sensitivity of a situation in which a person in a very rural community might be worried about exposure before they are ready for it if they need to access services. Those are important points.
I thank Joe FitzPatrick for offering hope from his constituency in relation to where we might go with our work in this area. It is important that we all seek to talk about examples of success.
Many members spoke about stigma, which is such an important issue. This morning on the radio, I heard someone from Waverley Care speak about the need to reduce stigma. Although it is incumbent on the Scottish Government to do something about stigma, all members have a responsibility to act. Along with Waverley Care, we have called for an anti-stigma campaign, and it is great that the minister has said that the Government will run such a campaign.
Emma Roddick painted a historical picture and Brian Whittle mentioned a number of people who, in my lifetime, stood up and were counted. Given the petrifying advertising that went on in the 1980s, which Dr Gulhane and others mentioned, it is so important that we get the campaign right, and I hope that the minister will mention that again.
Scottish Labour shares the Government’s target of reducing transmission to zero by 2030. As my colleague Paul O’Kane discussed, that is why our amendment calls on the Government
“to outline a clear timescale for eliminating HIV transmission in Scotland by 2030 and commit to providing the Scottish Parliament with an annual progress report.”
I hope that the minister will support our amendment, which is about how we get there and make the biggest difference.
I thank my colleague Claire Baker for talking about the various transmission routes that exist and about other action plans that may need to come together to help us get to where we need to get to.
Given the havoc that HIV wrought for so long, it is incredible to think that we could reach the stage where it is under control and, potentially, is no longer transmitted at all. That was unthinkable not so long ago. I cannot begin to imagine the extent of the work and dedication that went into achieving that, whether that took the form of research or people making us aware of the issue so that we pushed and pushed on the facts.
Gillian Martin and Richard Leonard spoke about other parts of the world, where the reality is stark. Scotland and the wider UK have a responsibility to alleviate the suffering that many experience every day. To do that, we must continue playing a lead role in the fight against AIDS for generations to come, passing on to the rest of the world the hard-won knowledge that we have gathered. That begins with pushing against the damaging rhetoric from some quarters saying that foreign aid funding should be reduced. Foreign aid has vast benefits: millions have been able to survive with HIV and to live a prosperous existence in their communities. We have a role across the globe and must not cut our efforts. We heard from Gillian Martin and Richard Leonard about how people in other countries live.
Innovation and research must remain key. The introduction of PrEP has been remarkably positive, as have the focus on prevention and specialist care and the use of contact tracing have. Together, those form a modern and considered approach to tackling the problem. It is important to mention Alex Cole-Hamilton’s request for the minister to speak about some areas—such as Lothian—where there are very long waits for PrEP and about how those will be tackled.
If we can maintain the current trajectory and ensure accountability, we will be going a long way towards improving the lives of thousands of people at home and many more abroad. That can only be good. We can do this. I hope that all parties can work together to make an essential, global difference to HIV and AIDS.
16:41
It is a privilege to close the debate for the Scottish Conservatives. I remember the early 1980s, when the first cases of AIDS were discovered. I was a teenager at the time and around 16 years old. Looking back, I do not think I fully grasped the gravity of what was happening. I could not possibly have imagined in 1981 that an estimated 40 million people would lose their lives to AIDS-related illnesses in the decades following the first diagnosis.
Paul O’Kane said that we stand in solidarity with those who are living with AIDS, but, as Claire Baker pointed out, we cannot be satisfied with our progress.
Brian Whittle highlighted some heroes: Magic Johnson, Freddie Mercury and Gareth Thomas.
To have lost so many lives is heartbreaking, but so, too, is the awful truth that many were stigmatised and shamed before they died because of their illness and—all too often—because of whom they chose to love. Sadly, as my colleague Jamie Greene pointed out, there are still parts of the world where the number of infections is rising because people are afraid to go for a test or seek treatment, for fear of retribution.
Whether Richard Leonard likes it or not, Gilead developed 11 antiretrovirals that treated more than 16 million people. I say to him that, without Gilead funding, many HIV charities would not now exist and many lives would have been lost.
For many years, HIV and AIDS were vectors of social prejudice and lightning rods for bigotry, homophobia and discrimination. Although attitudes have changed over time, they have not changed enough. Shaming and fear-inducing tactics are often used to change behaviour, and the HIV stigma of the 1980s and 1990s still looms large. Data released earlier this year by the Terrence Higgins Trust shows that public attitudes to HIV are still stuck in the 1980s. That terrible stigma was the main theme of Joe FitzPatrick’s speech.
As we know, stigma can prevent people from getting tested. According to the National Aids Trust, roughly one in 16 people living with HIV in the UK do not know that they have the virus. Gillian Martin quoted alarming statistics showing that there is still huge stigma and hurtful stereotyping. As we have heard today, testing is pivotal, as is addressing the barriers that prevent people from getting tested.
My colleague Jamie Greene stressed the message, “When in doubt, test,” and I commend him for his courage in posting the testing video. Gillian Mackay highlighted underlying issues of division, disparity and disregard. It is a huge issue when it comes to eradicating barriers to progress, as she said.
As the Scottish Conservatives’ amendment emphasises, “timely access” to sexual health services is so important. Dr Sandesh Gulhane stressed the importance of a well-functioning sexual health service, Paul O’Kane cautioned about a postcode lottery and Alex Cole-Hamilton, Jamie Greene and Emma Roddick made calls to improve access to treatment services in rural areas, including in the Highlands.
If someone does get tested and receives a positive diagnosis, HIV stigma means that they can feel isolated and alone when they are most vulnerable. I was struck by a comment made by Nathaniel J Hall, who starred in the television series that has been highlighted today—“It’s A Sin”—and who was diagnosed with AIDS at just 16. He said:
“There was a lot of working through all that shame of being gay and trying to unpick all that homophobia”.
He had internalised that, and then came the other thing:
“I’d contracted this virus. I didn’t tell anyone, I didn’t tell my family and my friends—I told very few friends—until about 2017.”
Imagine being 16 years old, being given a life-shortening diagnosis, which is what it was at the time, and trying to cope with it alone. Imagine trying to do that while dealing with decades of bigotry that makes you believe that, because you are gay, there is something wrong with you.
We need to keep working towards the goal of zero transmission by 2030. We also need to aim for zero stigma, which was so rightly pointed out by Emma Roddick. We need to provide mental health support to people with a diagnosis of HIV and AIDS, if they need it. With early diagnosis and treatment, people with HIV can lead a normal life, so I welcome the announcement by the minister of a public awareness campaign. No one should feel that they must go through it alone. It is about emotional health as well as physical health.
Many of us in the chamber are wearing our red AIDS ribbons. They were first introduced 30 years ago, at the height of the AIDS crisis, by the Visual AIDS artists’ caucus in the United States. In 1992, actress Elizabeth Taylor wore a red ribbon to the Oscars and it became an internationally renowned symbol of compassion, support, awareness and hope. She dedicated so much of her life to AIDS activism, even though she was warned that it was one of her lame-duck causes that could hurt her professionally. She stuck her head above the parapet over and over again as Governments the world over scrambled to come up with a coherent public health response.
As Maree Todd and Dr Sandesh Gulhane emphasised, with advancements in medical treatment, a diagnosis is no longer a death sentence. Antiretroviral medicines can effectively reduce the viral load to undetectable levels, and PrEP can prevent HIV if taken properly. We have come so far since the red ribbon first became embedded in our collective consciousness as a symbol of solidarity and hope. The UK has met and surpassed the UN’s 1990 target. There has been a huge reduction in HIV transmission in the UK and in Scotland, but the fight to end AIDS is not over yet.
I call Maree Todd to wind up. You have until 5 pm, minister.
16:48
Oh my goodness! I thank members for their participation in this incredibly important debate. I am very glad of the consensus and support that I am feeling around the chamber, and I am pleased to confirm that the Government is very happy to support both the Opposition amendments.
Today is a stark reminder that although there have been huge advances in treatment and diagnostic tools in recent years, the virus has not gone away. The stigma surrounding HIV diagnosis persists, and far too many people have died and will continue to die.
In Scotland, we have made tremendous progress, as I set out in my opening speech, but we cannot and must not become complacent. I am determined that we will build upon our successes, and I am grateful that the work that has gone into the elimination proposal will help us to do that. I have every faith that the HIV transmission elimination strategy implementation group will continue to drive momentum and to deliver real and tangible results.
I will not repeat the detail of my opening remarks, but I hope that the announcements that have been made today demonstrate the Government’s commitment to eliminating HIV transmission in Scotland by 2030 and to ensuring that people who live with HIV are able to live long and healthy lives, free from stigma and discrimination.
I will try to respond to many of the issues that have been raised. Jamie Greene opened by reflecting on the sadness of the day, but also on its hopefulness. I know that members of all parties share that sense of being on the cusp of something momentous, and I am absolutely delighted to be the minister for public health in Scotland at this moment. I commend Jamie Greene for his work in the area—in particular, for publicly testing and for using his position of power to tackle stigma.
I announced the commitment to widening access to the ePrEP pilot, which I hope will improve access to PrEP for people who live in remote and rural areas. However, I hope that it will also have an impact in urban areas.
I draw an analogy between the development of that service and advances that we have made in telemedicine access—for example, to early medical abortion at home. That is one of the few positive things that have come from the pandemic. With that advance, our sexual health teams have demonstrated their ability to be agile, to change how they deliver care, and to enhance their person-centred focus. We must be grateful for the many clinicians and teams around the country who have worked in the area for so long.
I am intrigued to hear the detail, and I hope that the minister will share it with members when she can do so. However, face-to-face contact provides two important things that remote e-pilots do not provide. First, when a person receives a positive diagnosis, they will need one-to-one personal interaction with somebody who knows what they are talking about.
Secondly, people who are taking PrEP are often tested for many other things, due to their sexual behaviour. Will that issue also be addressed? There is no replacement for physically going to sexual health services—which, too often and for too many people, are simply not available when they are needed.
I am more than happy to provide detail as we develop it, as the Labour amendment asks for, and I am more than happy to keep members updated.
As an MSP for a remote and rural area, I have heard directly from constituents who have been given very difficult news after having to travel, alone, for a very long distance—often involving a flight—to a hospital. They have told me that they would prefer to have had that news by telemedicine, in the comfort of their own home, with support and with their family around them. That illustrates the need to work in a person-centred way and that one size does not fit all. I trust the sexual health people who work in the clinics. They are phenomenal at working in that person-centred way, without judgment—certainly without pre-judgment—and without assumption. Day in and day out, alongside the people whom they care for, they get the decisions right.
Paul O’Kane talked eloquently about the homophobia and moral panic that have been front and centre of the AIDS debate since the HIV virus first burst on to the scene and into our lives. As the minister who has responsibility for the blood donor system, I am absolutely delighted that he gives blood. Every donation saves up to three lives, so I thank him. I also thank him for using his position of power to tackle stigma and to lead the way.
A number of people asked for more details about the pilot project. Because we will be trying to gain results from it, it will probably be necessarily limited to a specific geographical area. We are still developing it. However, the service that we will develop on the back of that pilot will be targeted at people who are able to self-manage, rather than being geographically targeted. Therefore, the final service, when it is developed, will potentially help in rural and urban areas.
Gillian Martin and others asked about women. I absolutely acknowledge that there is much more to be done on the issue. The educational resources that will be available to clinicians as part of the widening of access to PrEP will highlight that it is not only gay and bisexual men who are at risk of acquiring HIV. It is about risk profile, not gender.
Evelyn Tweed gave some incredible statistics that highlight the worrying and persistent idea that some people have that they are not the type of person who might catch HIV. That is another very powerful argument for a marketing campaign, if ever we needed one.
Emma Roddick, as ever, gave a beautiful and powerful speech. She should definitely use statistics more often. To state that people with HIV have half the chance that others have of being kissed is a powerful way of describing the lingering ignorance and the impact of stigma.
Dr Gulhane talked eloquently about medical advances over time. Nowadays, HIV is significantly less fatal than smoking, for example, which is still quite a common pastime that will kill two thirds of the people who do it. HIV is no longer the fatal disease that it once was.
Joe FitzPatrick took the opportunity, as ever, to highlight the fabulous work that is going on in Tayside to tackle HIV, and to highlight Tayside’s world-leading work on tackling hep C. I commend him for his work while he was in this role. I know that he shares with me the absolute thrill of having been part of this exciting moment in history. The goal of elimination is in sight. As I would expect from a past public health minister, he took the opportunity to reiterate the vital message that people who are on effective treatment cannot pass on the virus. If that is the one message that comes out of this debate, it would be a powerful one to see being replicated throughout the media tonight and tomorrow.
Claire Baker was absolutely right to highlight the effort that is required to reduce risk for people who inject drugs. The Scottish Government has funded numerous projects that were designed to identify and enlist in treatment people in that population who have acquired HIV. For example, last year, we funded the cocoon project, which provides a person-centred approach for people who inject drugs and are at risk of poor sexual health, blood-borne viruses and increased mortality. The project provides point-of-care BBV testing and treatment, as well as testing for other diseases, including sexually transmitted infections and Covid-19. The main aim of the project is to provide an holistic service that combines all care at a single point, while integrating wound care, naloxone provision and other harm-reducing measures.
In my speech, I mentioned MAT standard 4, which is the one that is about BBV testing. Can the minister assure me that she is speaking to the Minister for Drugs Policy, Angela Constance, and that they are speaking regularly to alcohol and drug partnerships about delivering on that, which has to be done by April?
Absolutely. I have regular catch-ups with Angela Constance. That is a very high priority for both of us.
I was shocked to learn that my esteemed colleague Gillian Mackay was born when I was at university. What wisdom in one so young: it is just astonishing. I am very pleased to confirm that we are considering an HIV testing week as part of the marketing campaign. I, as a mum of three, have been tested three times. I would have absolutely no qualms about being tested again, and I am sure that many members around the chamber would join the campaign, should we decide that it is the best way forward.
Brian Whittle and I share an absolute passion for sport, and a belief in the power of sport to change the world. It will be no surprise, therefore, that I—as he does—commend sporting heroes such as Gareth Thomas, who are using their public position to counter stigma.
I also share much of the concern that was expressed by Richard Leonard. Although we are focusing today on eliminating HIV from Scotland, we must not forget that HIV is manageable only with access to the right treatment at the right time. Unequal access to HIV antivirals costs lives. We know that the disruption to health services that has been caused by Covid is likely to have made inequality worse. It is estimated that, in 2021, more than 38 million people around the world had HIV. Of those, 16 per cent had not been tested and did not even know their status. That is more than 6 million people, while more than 9 million people are waiting to start antiviral treatments.
We can—and we must—end that. First and foremost, that is because we can never accept any life being lost needlessly. Secondly, we are a connected global community, so nowhere is safe until everywhere is safe. We would continue to forget that at great cost to ourselves.
To answer the point that was made by Carol Mochan and Alex Cole-Hamilton, I point out that in August this year NHS Lothian recruited additional staff to enable it to increase the number of clinics and to reduce waiting times for patients to start PrEP.
I am extremely grateful that we have had the debate, and I thank all members who have been in the chamber to hear it. I also thank and commend the key stakeholders; representatives of many of them are in the public gallery, including HIV Scotland, Waverley Care and the Terrence Higgins Trust. Those organisations have been working in the field for decades, having begun doing so in an era when it was much tougher to stand up and speak out on the issue than it is now. I am so grateful to be working with them all.
I know that members will be unified in supporting our aim of ending HIV transmission in Scotland by 2030. Having such a unified collaborative approach will ensure that we reach that target and can better the lives of people in Scotland who are living with HIV.
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