World AIDS Day 2008

– in the Scottish Parliament at 5:00 pm on 27th November 2008.

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Photo of Alasdair Morgan Alasdair Morgan Scottish National Party 5:00 pm, 27th November 2008

The final item of business is a members' business debate on motion S3M-2817, in the name of Marlyn Glen, on world AIDS day 2008. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises the importance of World AIDS Day on 1 December 2008 and its aim of highlighting the challenges and consequences of the HIV epidemic around the world; acknowledges that there are 33 million people living with HIV/AIDS worldwide and that countries face a myriad challenges in halting the spread of the virus and improving the lives and experiences of people affected; recognises that HIV diagnoses in Scotland have been increasing in recent years with 2007 seeing the highest annual number on record; acknowledges that it is estimated that there are 5,500 people now living with HIV in Scotland; regrets that a recent poll found that people in Scotland had comparatively poorer rates of HIV knowledge than in other areas of the United Kingdom; considers that this lack of public understanding about the virus and how it is transmitted compounds and exacerbates the stigma and prejudice experienced by many people living with HIV in Scotland, and therefore supports this year's theme of Respect and Protect, which highlights the responsibility of everyone to transform attitudes to HIV and encourage actions that stop its spread.

Photo of Marlyn Glen Marlyn Glen Labour 5:07 pm, 27th November 2008

I am pleased to open the debate to celebrate the 20 th anniversary of world AIDS day. I thank all the members who have signed the motion, and members who have instigated similar debates in the past.

The red ribbon is a powerful symbol to challenge the stigma surrounding AIDS and HIV, so I encourage members to wear it with pride. I thank Catherine Murphy from the Terrence Higgins Trust, who sent out briefings and organised the stall in Parliament for today's debate.

The theme of this year's world AIDS day is "respect and protect". In addition to the essential protection messages, it highlights the responsibility that everyone has to transform attitudes to HIV. In particular, it aims to bring an end to HIV-related stigma and discrimination. A further aim is to highlight the promise of universal access to HIV prevention, treatment, care and support by 2010.

In June this year, the United Kingdom Government launched its strategy for halting and reversing the spread of HIV in the developing world. It is an unprecedented long-term strategy that will help us to meet the global target on halting and reversing the spread of HIV. A lack of public understanding of HIV and how it is transmitted means that people often believe the myths surrounding the illness, and misunderstand the ways in which the virus can be passed on. Sadly, a recent MORI poll found that people in Scotland are among the least knowledgeable about HIV in the UK.

World AIDS days can be a difficult and emotional time when people reflect on the damage that has been done by the epidemic and the lives that have been lost. However, it is also a valuable time to examine the progress that has been made and, more important, to focus on the work that is still to be done in halting the spread of the virus, improving the treatment and health of the people who are affected by it, and in eradicating the stigma and prejudice that are still too often associated with HIV.

Scotland has shown leadership on HIV and successes have been secured, such as the containment and reduction of HIV among injecting drug users. In Tayside, for example, the number of reported cases of HIV among drug users reduced from a high of 77 in 1986 to just one in 2007. We can be proud of the fact that everyone who lives with HIV in Scotland has access to life-saving antiretroviral treatment.

HIV featured in the earlier sexual health strategy document, "Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health". Now, there has been another surge in HIV, with 453 cases in 2007, which is the highest annual figure recorded and which compares with an average of about 160 throughout the 1990s. That confirms that HIV is still relevant today. I therefore urge the Scottish Government to renew the focus on HIV prevention at national level. I look forward to comments from the minister on the plans that are being developed.

Late diagnosis can have serious implications and can result in increased risk of conditions such as tuberculosis, pneumonia and some cancers. It also limits treatment options and affects the overall prognosis. Given that treatments can now mean that a person who is diagnosed early with HIV can reasonably expect to live a long and healthy life, it is hugely important that people who may be at risk test early. Crucial to that is the need for people who work in the national health service to be able to recognise the risk factors and the symptoms of early HIV infection. The chief medical officer has outlined concerns about that. I ask the minister what else is planned to provide HIV testing in settings such as primary care.

I am looking forward to the world AIDS day event in Dundee on Monday, which has been organised by Youth End Poverty Dundee and which I believe the minister will address. That kind of local initiative should be encouraged throughout Scotland. I wish YEP Dundee luck with its event and I hope that its message reaches a wide public.

High-quality and inclusive education on sex and relationships is essential for our young people. It is completely unacceptable for there to be stigma attached to them as pupils in schools or elsewhere. It is also important to have qualified nurses available in schools to provide sexual health advice. There are many issues that we have little time to discuss in the debate, so perhaps the minister will in the near future initiate a full debate on the Government's actions and plans to develop a successor sexual health strategy.

Gay and bisexual men carry a disproportionate burden of HIV infection. They accounted for 87 per cent of the cases in Scotland last year. The worrying levels of undiagnosed HIV—it is estimated to be as high as 40 per cent nationally and 50 per cent in Glasgow—combined with evidence that unprotected sex is increasing among that group, show that gay men in Scotland are now more at risk of HIV infection than ever. We need to reinvigorate prevention and safer-sex messages. Valuable targeted work is being done with gay and bisexual men, but it should be given added impetus with additional backing and leadership from the Scottish Government. For instance, in Tayside, diagnoses among gay men jumped from three in 2006 to 14 in 2007. Projects are well established in the large cities but, with rises occurring in Dumfries and Galloway, Fife, the Forth valley and Grampian, we must do more to ensure that prevention messages and support are reaching all gay men, regardless of where they live.

I urge the minister to consider ways in which the Scottish Government can work to ensure that people in Scotland, particularly those who work in public services, have a better understanding of HIV issues beyond just the health and safety approach. In particular, I urge the Government to take positive steps to reduce the stigma of HIV and to encourage and facilitate early testing. I look forward to hearing other members' speeches.

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party 5:14 pm, 27th November 2008

I congratulate Marlyn Glen on securing this important debate, particularly at this time. HIV is truly global in scale. About 25 million people have died of the appalling disease HIV/AIDS since it was first discovered about a quarter of a century ago. Despite the discovery of antiretroviral drugs, many people still die of it, throughout the world.

At the beginning of the epidemic, HIV was diagnosed in relatively few women and young girls. Today, more than a quarter of a century later, women account for more than half of all new HIV infections. Around the world, around 15.4 million women are living with HIV. The problem is even more dire in sub-Saharan Africa, where nearly 60 per cent of people living with HIV are women. In some sub-Saharan countries, young women aged between 15 and 24 are more than three times as likely to be infected as young men of the same age. In many such cultures, women have no power to insist that their male partners use condoms during sex or remain sexually faithful. Abstinence is not a viable option for women who are married, who are at risk of sexual violence or who hope to become pregnant. As a result, a crucial strategy is the development of microbicides, which can prevent HIV transmission, but the terrible truth is that in the less developed parts of the globe being female and marrying poor are often the most significant risk factors in acquiring HIV.

In India, a mostly Hindu society that for thousands of years considered one fifth of its members to be untouchable, discrimination and ignorance have a particularly unpleasant significance. Of the country's estimated 2.5 million cases, many are women who belong to several hereditary prostitute castes. Although some of those women are apparently not unhappy with their lot, many are wretched sex slaves who are pimped by their neighbours. AIDS haunts them all.

In Karnataka there still exists the now illegal tradition of temple prostitution. In ancient times, its practitioners included the daughters of royalty, who were dedicated in childhood to service the devotees of the goddess Yellamma. The modern lot almost all belong to a single caste of illiterate dalits who are distinguishable from run-of-the-mill village prostitutes only by an early entry into their career and therefore a high probability that they will contract HIV. Nearly half of these so-called slaves of God are believed to be infected with the virus.

India's regulations against sodomy and soliciting are another ugly local feature. By criminalising gay sex and prostitution, they have blocked many sincere efforts to quell the virus. In Bangalore, for example, one in five gay men has HIV and many are male prostitutes who are perpetually terrorised—and periodically raped—by the police.

Of course, as Marlyn Glen said, many diseases such as malaria and tuberculosis are concomitant with HIV/AIDS. As TB is the most common serious opportunistic disease in people who live with HIV and remains a leading cause of death, including among those who have received antiretroviral treatment, an increasing awareness of TB/HIV is vital. We must support more evidence-based policies and activities to address such issues and address and increase understanding of barriers to implementing evidence-based policies, particularly in India and sub-Saharan Africa where, as I have mentioned, prejudice is very strong.

Back in the developed world, approximately 1 million people in the United Status have HIV, the virus that causes AIDS, but 250,000 of them do not know that they are infected. In September, the Centres for Disease Control and Prevention recommended that all Americans between 13 and 64 be routinely tested for HIV. Such tests would not be compulsory, but those who visited clinics would be tested if they did not refuse to be tested.

As Marlyn Glen said, Scotland has its own problems. Although they are not on the vast scale of those that I have outlined in other countries, they are still very significant, particularly to the families who are affected. Given that as many as 40 per cent of gay and bisexual men who are HIV positive are unaware that they are infected, the Scottish Government has a role in ensuring that HIV awareness is raised and testing is increased.

I have received the Scottish Government's report card from HIV Scotland

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party

I will conclude very soon, Presiding Officer.

The report card shows that although the Government has done a lot of good public awareness work, a lot more needs to be done. It shines in its leadership—it gets an A-plus—but it gets a C-plus for education. We have much to do if we are to promote awareness in Scotland and do our bit in reducing HIV/AIDS across the globe.

Photo of Mary Scanlon Mary Scanlon Conservative 5:19 pm, 27th November 2008

I congratulate Marlyn Glen on securing this debate, which recognises the anniversary of world AIDS day. I also thank Kenny Gibson, particularly for raising the issue of infected women.

The aim of the day is to highlight the challenges posed by and the consequences of the HIV epidemic around the world. Although other countries are plagued by the disease and problems of treatment, we in Scotland have our own problems.

Figures released earlier this week show that, in 2007, 453 new cases of HIV were identified in Scotland. That is the highest number since recording began about 25 years ago. Since 2000, there has been a 194 per cent increase in new diagnoses. Between January and September this year, a further 298 people have been diagnosed with HIV. I am sorry about all the figures I am quoting. Of those who were diagnosed this year, 46 per cent are identified as heterosexual individuals and 75 per cent are known to have been infected outside Scotland. I welcome Marlyn Glen's point about gay and bisexual men, but we should also be looking at the heterosexual community.

The figures are worrying, but possibly of greater concern is the number of people with HIV who do not know that they have the virus—a point that Kenny Gibson and Marlyn Glen raised. It is estimated that about 40 per cent of gay and bisexual men who are HIV positive do not know that they have the virus, which has consequences for the risk of the disease being spread. It is estimated that people who are unaware of their own HIV infection could account for between 53 and 70 per cent of all new sexually transmitted HIV infection. Health economists have estimated that one onward transmission of HIV has a value of between £0.5 million and £1 million in individual health benefits and treatment costs.

As Marlyn Glen said, late diagnosis also has implications for the individual's health. It can lead to pneumonia, TB, heart and liver disease and some cancers. The Terence Higgins Trust states that nearly half of infected people who are diagnosed late show signs of an immune system that has already been compromised and around 7 per cent have an immune function that has been significantly damaged. Around a quarter of the HIV deaths that occur each year could be avoided through earlier access to diagnosis and treatment.

The stigma that world AIDS day seeks to remove is part of the problem of late diagnosis. People are unwilling to get tested because of the fear of others finding out or because of the stigma. The delay in diagnosis can have a devastating effect on their health and the health of others.

Today, I called some of the organisations that manufacture drugs that are used in the treatment of HIV. I can understand that people might not wish to get on to a regime of triple therapy, which can mean up to 30 or 40 tablets a day, but once the viral load is at a normal or acceptable level the drug intake can be as little as one tablet once a day. I also understand that there are now cases of people coming off treatment permanently. The message that I would like to get out today is to encourage people to come forward for testing; the fact that new drugs are being developed all the time will ensure that treatment is less complex.

Photo of Patrick Harvie Patrick Harvie Green 5:23 pm, 27th November 2008

I join others in congratulating Marlyn Glen on securing the debate and on raising this important issue in the Parliament at this time. One of the most important things she said in her opening speech was that it is sometimes so difficult to get across, particularly to many young people, the message that HIV is still relevant.

In developed, rich countries with sophisticated health-care systems, HIV has changed into what is commonly termed a chronic manageable condition. That does not undermine in any way its importance, its seriousness and the impact it can have on someone's life, but it does make it difficult sometimes to get across the message that it is as important to combat HIV now as it always has been.

The global and domestic dimensions of HIV have already been mentioned. Those dimensions are sometimes so different that it almost seems as if we are talking about two different viruses rather than a single phenomenon. The situations that Kenny Gibson mentioned are very different from the situations that people in Scotland face. However, with migration, we can acknowledge that the connections between the global and domestic dimensions are deepening and becoming more complex.

We face a serious problem in Scotland. As other members have mentioned, we have rising infection rates while resources are dwindling and being less specifically allocated to HIV. We also have poor knowledge levels in comparison with the rest of the UK. There is a great deal more that we can do in that respect, but even that should not satisfy us. An increased level of knowledge and understanding is, in itself, no guarantee of prevention. Earlier this year, I spent some time in hospital with a close friend who had recently received his diagnosis. For many years he had been in contact with services, with youth work when he came out and with the available information. He was aware and had a high level of knowledge of HIV. In itself, such knowledge is no guarantee of prevention; it is necessary, but not sufficient.

It is important that we are bold and radical in our approach to school education and to out-of-school education for young people as well as for older people. That means that resources will be needed. It means that support and training will be required for teachers, youth workers and community workers. It also means that there must be political courage and a willingness on the part of Government—at national and local level—to challenge entrenched attitudes and not allow resistance to the taking forward of certain radical work on sexual and reproductive health. It certainly means taking on some of THT Scotland's proposals, for example for a national campaign on stigma and prejudice against those who have HIV, for work to increase testing uptake, and a proper look at its proposals on home testing. Finally, it requires a strategic vision for the future, beyond the respect and responsibility strategy.

In closing, I will say something about the global picture. This is an important moment and we have a great opportunity. President-elect Obama—even before he has taken up office—has thrown out the irrational approach of abstinence-based programmes and the Bush Administration's refusal to fund condom provision and sexual health awareness-raising around the world. The Scottish Government has a long-standing commitment to international development. We must ensure that we, too, challenge those irrational approaches. There are still people in the world who would go through a country that has an HIV prevalence of 30 per cent or higher telling people that it is wrong to use condoms. Such an approach is not morally defensible and we should be willing to challenge it.

I join Marlyn Glen's call for a full debate on HIV in Scotland, not just in relation to public health, but in relation to education and international development. Ministers and those who are involved in those areas would be welcome to contribute to that debate as well.

Photo of Richard Simpson Richard Simpson Labour 5:27 pm, 27th November 2008

I join other members in congratulating Marlyn Glen on securing a members' business debate on this important topic at this time. Others have referred to the fact that the number of new cases of HIV recorded for the past full year—more than 450—is the highest number since recording began in 1984. It behoves us all to take a fresh look at the situation and at HIV.

HIV is almost becoming a forgotten condition, which is unacceptable. The rises in the number of cases of HIV throughout Scotland, including in Forth Valley, which is one of the health board areas in my region, require every health board to look anew at addressing training for staff in awareness of the condition.

It is sad that, just this week, a potential vaccine that showed so much promise in animal testing has failed in tests on human subjects. That is regrettable. We must hope that the vaccine will continue to hold out promise. However, that should not prevent us from ensuring that the present situation is managed effectively.

Other members have referred to the worldwide nature of the problem, particularly in regard to the African continent. The rise in the number of cases globally from around 10 million in 1990 to 33 million now indicates that the problem is still significant. Furthermore, 2.7 million new cases have been reported worldwide in the past year. That has happened in areas where the health services are under enormous pressure and the systems are extremely weak. For example, the British Medical Journal this week describes the health service in Zimbabwe as being in total collapse, with those who have HIV in absolute despair about the management and treatment of their condition.

In other countries, too, corruption has led to drugs not being dealt with in an appropriate way, even when they are available. As Patrick Harvie said, there are still people in the world who will speak out against the use of condoms. That is totally and utterly unacceptable. We need to send out a loud message, in the international field, that we will not support that sort of nonsense.

What about the situation in Scotland? As others have said, as many as a third of those with HIV might not know that they have HIV. We have opt-out testing systems in place, but we need to do more in terms of testing. Patrick Harvie referred to home testing kits, and that issue needs to be considered carefully.

I am concerned about the question of school nurses. They are under enormous pressure to deliver the human papilloma virus vaccination programme. That programme is extremely welcome but, unless they receive additional resources, it is difficult to see how they will be able to continue to provide vital sex educational input and support to young people—particularly young gay men coming out. I ask the minister to consider the issue carefully. I am also concerned about the HPV vaccine in relation to general practitioners as well, but this is not the time for that.

We need a new campaign—not the old tombstone campaign—that will raise awareness and increase the level of information that people can access. Scotland is extremely poor in that respect.

We need to readdress and reinvest in the mental health aspects of the management of HIV. It is now a chronic condition with which people live, and the Government has given particular attention to that. However, we need to examine the mental health aspects of the situation, because it is difficult for people with HIV, who are still subject to discrimination, to live comfortably with the condition.

Photo of Robin Harper Robin Harper Green 5:32 pm, 27th November 2008

I congratulate everyone who has spoken, and I particularly congratulate Marlyn Glen on securing the debate.

I want to deal with education, the importance of which has been mentioned by several speakers. In the 1980s and early 1990s, full-time and part-time guidance teachers were a common feature of Scottish secondary schools, and I was one. We were professionally trained, especially in sex education and relationships education. In the school at which I taught, we had a large box with every contraceptive device that you could possibly think of. It was passed around for demonstration lessons in order to familiarise pupils with the devices. We did not just talk about condoms; using a model, we showed pupils—boys and girls—how to put on a condom. We did that so that condoms would not become something that would cause the pupils to blush or make them giggle, and would instead become something that could be openly discussed in class.

However, because of the pressures of the curriculum, many schools have moved away from that approach and are returning to placing those responsibilities on the shoulders of the classroom teachers, who do not have the training that is required if teachers—especially young teachers—are to address the subjects without embarrassment and with absolute confidence.

I appeal to the minister to work closely with the Cabinet Secretary for Education and Lifelong Learning to see what can be done, as a matter of urgency, to address the drift away from having a small cadre of full-time, professionally trained guidance teachers in every secondary school and towards the cheaper option of giving a small amount of training to the classroom teachers and expecting them to be able adequately to do the extremely responsible job of imparting sexual health and relationships education to the young children in their care.

Photo of Shona Robison Shona Robison Scottish National Party 5:35 pm, 27th November 2008

The motion highlights vividly the enormity of the worldwide HIV/AIDS epidemic and of the issues that we face here in Scotland. As the Minister for Public Health, I welcome the opportunity to close the debate on behalf of the Scottish Government.

I thank Marlyn Glen for bringing forward an important debate. It is clear from the many and varied speeches that her motion has struck a chord with a great many members. It is important that, in addition to our work throughout the year, we take time on world AIDS day to recognise its importance and to highlight the challenges that we face.

As has been stated, more than 33 million people worldwide are living with HIV. In 2007, there were 453 new diagnoses of HIV in Scotland, which is the largest annual figure since records began in 1981. Although some of the increase reflects an increase in testing, and recent figures show a reduction in the number of undiagnosed cases, there is evidence of transmission occurring among certain at-risk populations in Scotland. Specifically, in Scotland, men who have sex with men and people from sub-Saharan Africa are more likely than anyone else to be affected by HIV. These stark figures not only set us a global challenge to work together internationally to reduce the spread of HIV, but also set the Scottish Government, health boards, local authorities and voluntary organisations a challenge to reduce transmission of HIV in Scotland.

One of the overarching aims of respect and responsibility, our national strategy, is to tackle the rising incidence of sexually transmitted infections, including HIV. As members may know, the strategy is supported by additional funding of £5.18 million per annum until 2010-11. We are also investing £9.5 million each year to prevent the spread of blood-borne viruses in Scotland. The majority of that funding goes directly to NHS boards and is used to improve and support access to clinical service and for local targeted prevention work. That support is, of course, vital for health boards to continue their work. However, following a stocktaking review of the strategy, we are refocusing our efforts in order also to address the culture and attitudes that are associated with sexual health and HIV in Scotland. I have directly reflected that change in focus in the membership and work of the national sexual health and HIV advisory committee, which I chair, and in the new outcomes for sexual health, which were issued widely in September.

I accept that changing some of the long-standing attitudes and values of the Scottish population is a real challenge and that it will not happen overnight, but it is a challenge from which we must not shy away. Change cannot be achieved by any one body or organisation alone. It is important for each of us to recognise our own role in providing leadership, delivering change and working together to achieve change in an often sensitive area.

I will now discuss the work that is taking place on the wider social and cultural factors. I am pleased to be supporting the work of the lesbian, gay, bisexual and transgender hearts and minds agenda group. The group is made up of representatives of the Scottish LGBT community and has been working over the past two years to examine in more depth negative attitudes towards that community. In February, the group published its report, which contains recommendations for the Government and others on how we can make progress in tackling some of the negative attitudes and prejudice to which Patrick Harvie referred. The report is aptly called "Challenging Prejudice" and it has the potential to be a significant step in changing attitudes and reducing discrimination. Although the Government has not yet responded to the recommendations in the report, we will do so shortly. I believe that the report can act as a catalyst for change and as a tool for making policies and services more inclusive and more relevant to the LGBT community.

I have already spoken of my concern about the rising incidence of HIV infection in Scotland and the need for action. One area of work in which members will be particularly interested is the development, in partnership with key stakeholders, of an HIV action plan for Scotland. The plan, which will be published early next year, will be overarching and will encompass not only HIV prevention but actions for care and treatment of people who are living with HIV. Its actions will aim to reduce HIV transmission, to reduce the number of undiagnosed cases of HIV, and to reduce stigma and discrimination. It will also aim to ensure effective co-ordination of prevention, care and treatment.

I want to reassure members who raised issues about testing in primary care. The professional associations that work on sexual health and HIV recently produced the UK guidelines on HIV testing, which cover testing in primary care and other national health service community settings. We will take that forward.

It is worth noting that, despite the availability throughout Scotland of a comprehensive range of anti-retroviral therapies to prevent HIV disease progression, the disease still has no cure.

Marlyn Glen noted the lack of awareness and of public understanding about HIV in Scotland. I agree that, in recent years, HIV has not been as high on the public agenda as it should be. That is why the Scottish Government has allocated funding to the first national sexual health social marketing campaign since the tombstone campaign of the 1980s. It is in the developmental stages, but the campaign will focus in its first stage—from spring next year—on encouraging the public to talk about relationships and sexual health in general. Our aim is to create a more positive culture in which a more targeted approach can be used. As part of those social marketing efforts, we will undertake targeted work that is aimed at men who have sex with men, and at HIV. That work will use the important learning that has emerged from the successful HIV comeback tour and the equal campaign to develop materials for use throughout Scotland. That approach will be delivered locally through a range of community settings, to ensure effective targeting.

I have mentioned the importance of working closely with key stakeholders to deliver change. The Scottish Government funds Oxfam Scotland to work with communities in Malawi to assist the most vulnerable people who are affected by HIV. We also provide funding of more than £350,000 a year to several voluntary organisations, including the National AIDS Trust, to undertake not only general HIV prevention activities, but specific work with African people and men who have sex with men. I cannot overestimate the value and importance of the work of the voluntary sector, which has expertise in campaigns and in supporting individuals who need that support most. The voluntary sector also makes efforts to make a much wider impact on society, for the benefit of all.

I am happy to consider the calls that have been made for a full debate on sexual health. I will look at opportunities for that.

Meeting closed at 17:42.