World AIDS Day

– in the Scottish Parliament on 6th December 2018.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The next item of business is a members’ business debate on motion S5M-14820, in the name of Emma Harper, on the 30th world AIDS day. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that 1 December 2018 will mark the 30th World AIDS Day; recognises that the day offers the opportunity to raise awareness of HIV, to challenge stigma, and to reflect on the progress that has been made in the fight against HIV in Scotland and around the world; understands that, with early diagnosis and effective treatment, it is a manageable long-term health condition; recognises however, that it continues to represent a significant public health concern, affecting some of the most marginalised groups in society and often driven by stigma and discrimination; believes that such stigma has a damaging impact on the physical and mental health and wellbeing of people living with the condition and that it acts as a disincentive to access testing and treatment; considers that this can undermine efforts to reduce new infections; commends the joint work of Waverley Care and Scotland’s NHS boards across to promote the “Undetectable=Untransmittable” (U=U) message, which is that a person living with HIV who achieves and maintains an undetectable viral load cannot pass on the virus through sex; recognises that this message has been endorsed by health professionals, charities and campaigners worldwide, including the British HIV Association, and believes that information around U=U, and other HIV prevention options, including pre-exposure prophylaxis, can contribute to an improved understanding of HIV, a reduction in stigma and fewer new infections.

Photo of Emma Harper Emma Harper Scottish National Party

World AIDS day is marked on 1 December, and I am pleased to be able to reflect on the importance of the day and its 30th anniversary this year. The debate is an opportunity to raise awareness of HIV and the impact of the stigma and prejudice surrounding HIV and AIDS on people who are diagnosed and people who are undiagnosed. I thank colleagues from across the Parliament for supporting my motion and for taking part in the debate. I welcome the people who are in the gallery and those who are watching online.

The debate allows us to reflect on the past 30 years of infection, detection, diagnosis and—now—successful treatment. Today, in Scotland, there are 5,134 people who are diagnosed with HIV, and 350 new cases are diagnosed each year. I cannot stress enough how important it is to get the message across to everyone that, once a person has received a diagnosis and appropriate treatment, and once their viral load of the HIV virus becomes undetectable, they cannot pass on the virus through sexual transmission.

Last week, in Parliament, I met Murray Cheek and Grant Sugden from Waverley Care to discuss their work. Alongside national health service boards across Scotland, Waverley Care does important work to promote the importance of people knowing their HIV status and to promote the undetectable equals untransmittable, or U=U, message, which is a key focus of the 30th world AIDS day. It means that, if a person living with HIV achieves and maintains an undetectable viral load by adhering to their medication, the HIV virus cannot be passed on through sex.

In preparation for the debate, I reflected on my time in the early 1990s at Cedars-Sinai medical centre in the heart of west Hollywood, in Los Angeles. I contacted my former nurse colleague Jacqui Engstrand, who worked as a research nurse in the dedicated HIV and AIDS unit, which was set up in 1991 and was known as “the unit”. That was when the model of care for people with AIDS focused on a palliative end-of-life care approach. By the early 1990s, we knew that HIV is a blood-borne virus that weakens the immune system and, when left untreated, leaves people open to a range of potentially deadly infections.

Back then, I looked after patients with a rare skin condition called Kaposi’s sarcoma and others with pneumocystis carinii pneumonia, which is a rare lung infection that is often seen in people with HIV. The stigma associated with HIV was evident. I recall people referring to the disease as gay-related immune disease—GRID—which was distressing for patients, but we have made progress since then. As a nurse, I knew that the HIV virus was transmitted through sex and sharing of needles and was not just a gay man’s disease. One day, while I was in the pre-op area in the operating room, I had an interesting experience when I witnessed a colleague’s nervous and anxious behaviour when speaking to a patient with a diagnosis of AIDS ahead of surgery. I was dumfoonert when my anaesthetist colleague—an educated, well-trained and very knowledgeable doctor—entered the pre-op area wearing a gown, double gloves, a mask and a face shield and spoke to the patient from 1m away without touching them. He looked like he was in the sort of viral breakout protective gear seen in the movies.

HIV is not transmitted through the airborne route. Standard precautions are required and no double gloves are needed. However, only yesterday, I was shocked to hear from Nathan Sparling of HIV Scotland that double-gloving recommendations are still made today in relation to dealing with elderly HIV-positive persons. The prejudice and stigma remain. Persons with HIV are still placed on the end of dental lists or clinic reviews, which is not needed. The standard precautions for dealing with any patient with a blood-borne virus are adequate. I am therefore pleased to endorse HIV Scotland’s “Road Map to Zero” document, which contains important information about tackling stigma, and I encourage health professionals across Scotland to view it.

At a world AIDS day event in Parliament last week, I sat next to James McAbraham, who recited his poem from the wee book “Disclosures: Rewriting the Narrative about HIV”. The opening lines of James’s poem describe how it had been a long time since someone had touched him, and his poem reminded me of my experience in the pre-op area 28 years ago.

As time progressed, new drugs started to become available. Phrases such as “protease inhibitors”, “antiretrovirals” and “highly active antiretroviral therapy” have become common in our vocabulary.

While I was in Los Angeles, a famous basketball player, Magic Johnson, announced that he had an undetectable viral load. Undetectable does not mean cured, as the media touted; undetectable equals untransmittable—we must remember that. He was a heterosexual man, and this was huge news. Magic Johnson could not pass on the virus through sex. That is the message that we need to share today: undetectable equals untransmittable.

I am pleased that Scotland is a leader in the fight against HIV and AIDS. We are meeting the United Nations 90-90-90 targets, which are that, by 2020, 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people diagnosed with HIV will have access to sustained antiretroviral therapy and 90 per cent of people in receipt of antiretroviral therapy will have viral suppression or a negative viral load.

If we can find, reach and test the 10 per cent of Scots who have not been tested, we can initiate treatment so that the virus will not be passed on. Once a diagnosis is made, treatment can begin. Today, in Scotland, HIV is considered to be a manageable long-term health condition, with treatments such as pre-exposure prophylaxis—PrEP—allowing people to be protected.

Testing has a central role to play in reducing the number of new infections, particularly by helping to reduce the proportion of HIV cases that are undiagnosed. Testing is as simple as a finger-prick blood sample, results are known immediately and people can be tested at sexual health clinics, at general practitioner surgeries, by home self-testing and at community projects.

I emphasise the importance of the need to fight the stigma that is attached to the disease. It has a damaging impact on the physical and mental health both of people living with HIV and of those who are thinking about being tested. I look forward to hearing my colleagues’ contributions, and I reiterate that U=U—undetectable equals untransmittable. I encourage everyone to know their HIV status.

Photo of Miles Briggs Miles Briggs Conservative

I thank Emma Harper for bringing this members’ business debate to Parliament.

I am pleased to take part in a debate on the 30th world AIDS day, which raises awareness of HIV, challenges stigma and is a chance for all of us to reflect on the progress that has been made in tackling HIV and AIDS.

Since the first world AIDS day, on 1 December 1988, when I was just five, huge progress has been made to end the AIDS epidemic and to tackle the stigma surrounding HIV. With early diagnosis and proper treatment, HIV is now a manageable long-term health condition. We need to talk about that more, and so do medical professionals.

As Emma Harper has rightly stated, as well as being manageable, HIV is also untransmittable by people who achieve and maintain an undetectable viral load. I very much agree with Emma Harper that the U=U message needs to get out there. It is crucial for an improved understanding of HIV and a reduction in stigma, as well as for achieving fewer new infections in the future.

Stigma is probably the biggest obstacle in the fight against HIV/AIDS, making people living with HIV feel isolated. I have often been told that by people to whom I have spoken about the issue. It can also prevent people from getting tested and accessing treatment. I thank HIV Scotland for all the excellent work that it is doing to change the narrative around HIV and AIDS, and I congratulate it on the launch of its new book “Disclosures: Rewriting the Narrative About HIV”, which has been mentioned. I am thankful to HIV Scotland for giving me a copy last week. I have not yet had a chance to read it, but I look forward to doing so over the winter recess.

I find it shocking that the recent survey by Waverley Care revealed that 14 per cent of respondents did not have sympathy for those living with HIV. That reinforces the fact that more still needs to be done to tackle stigma, and I hope that this debate helps to highlight that.

Last week, in the House of Commons, Labour MP Lloyd Russell-Moyle announced to the nation that he is HIV positive. In his speech, Mr Russell-Moyle spoke about when he was diagnosed as being HIV positive, 10 years ago, and everything that went through his head during that time. He also talked about how the medication that he now takes means that he can be healthy and that any partner that he may have can be protected, promoting the message that undetectable equals untransmittable.

Mr Russell-Moyle’s bravery in talking about his diagnosis, and his message that the status of being HIV positive does not define a person, will go a long way towards reducing the stigma associated with HIV and AIDS. I repeat his important message, which Emma Harper highlighted, that people need to look towards their status and be tested, instead of not doing that out of fear. It is better to live in knowledge than to die in fear.

I fully support the goal of having zero new infections, and I believe that we, in Scotland, can work to achieve that. In 2017, 368 new cases of HIV were reported, and in 2018, up to September, 218 new cases have been reported. On the UNAIDS fast-track strategy 90-90-90 targets, it is estimated that 87 per cent of infected people in Scotland know their status and that, of those who do, 98 per cent are receiving antiretroviral treatment and about 97 per cent have achieved viral suppression.

This is an important debate, and I am pleased to take part in it every year, because Scotland can lead the way in eliminating new HIV infections. However, to do that, more work still needs to be done. First, and most important, we need to fight the stigma around HIV and AIDS so that more people have the confidence to get tested and we can stop the spread of the virus.

I thank Emma Harper once again for bringing the debate to the chamber and look forward to listening to the other contributions.

Photo of Ruth Maguire Ruth Maguire Scottish National Party

I thank Emma Harper for securing this important debate on world AIDS day, and for giving us the opportunity to come together across the chamber to show support for people living with HIV and to commemorate those who have died from an AIDS-related illness.

I will use my time to speak about women and HIV, and give particular mention to the excellent report by the Terrence Higgins Trust, “Women and HIV: Invisible No Longer”.

I am grateful to Waverley Care for its briefing on the work of the African health project, which was established in 2003 to meet the needs of Scotland’s growing African population. The African health project provides information, advice and support to Africans living in Scotland. Despite the lack of specific figures for Scotland, we know that HIV disproportionately affects African communities and that late diagnosis, which can lead to health complications, is common for people from those communities. Those inequalities are largely driven by HIV stigma and a lack of awareness about the condition, which can sometimes be reinforced by cultural and religious beliefs. For Africans living with HIV, the stigma can lead to isolation from the community, a breakdown of relationships and negative impacts on their physical and mental health. The project aims to improve health and wellbeing, and to support people to access healthcare services, including HIV treatment and care.

Waverley Care works closely with community groups, businesses and churches to raise awareness of HIV and to promote sexual health. That includes making condoms freely available in community venues in the areas where Waverley Care works, alongside offering testing for HIV, hepatitis B and hepatitis C. Waverley Care also supports people with other issues affecting the African community, including immigration, housing, managing money and employment.

Women make up one third of all people living with HIV, and one quarter of new HIV diagnoses in 2016 were in women. Despite that, it is fair to say that women living with HIV have not been particularly visible in the narrative and the response to HIV in the United Kingdom, and we do not know very much about what it means to be a woman living with HIV in Scotland.

From my constituency work, and as reported in “Women and HIV: Invisible No Longer”, we know that existing HIV services are rarely designed with women in mind. People living with, and affected by, HIV are not a homogeneous group. To treat them as such will result in services that do not meet their needs and, worse, could risk not reaching those for whom the safety net already has massive holes. It is estimated that 1,300 women are living with undiagnosed HIV. It is critical, for both individual and public health, to improve rates of early diagnosis, and HIV testing is key to achieving that. I echo Emma Harper’s call for everybody to know their HIV status.

If they are diagnosed early and receive effective treatments, people with HIV can have a normal life expectancy. If they are diagnosed at a late stage, and if significant damage to the immune system has already occurred, those people will have poorer health outcomes and potentially a much-reduced life expectancy. If someone is unaware of their HIV status and is not on treatment, it is much more likely that they will unknowingly pass on HIV to others.

The HIV prevention drug, PrEP, is currently almost exclusively accessed by men. In the first eight months during which PrEP was available on the NHS in Scotland, only 10 out of the 1,299 people who accessed the drug were women. Waverley Care told me that one in 21 heterosexual African women in Scotland are living with HIV, and we know that a third of all people who are living with HIV are women. Therefore, in closing, I ask the Scottish Government what is being done to redress the imbalance of access to the drug and I offer to bring together interested parties to assist the Government in that work, if it would be helpful.

Photo of Mary Fee Mary Fee Labour

I am grateful for the opportunity to contribute to this important debate and I thank Emma Harper for bringing it to the chamber.

Last Saturday, 1 December, marked the 30th anniversary of world AIDS day. That landmark provides an opportunity for us, as parliamentarians, and for Scottish society more broadly, to reflect on the significant progress that we have made over the past three decades in the fight against HIV through prevention, treatment and destigmatisation.

As we have heard, HIV is now a manageable long-term health condition. With proper treatment, individuals can live long, healthy lives and experience either very few, or no, adverse symptoms of their illness. However, that was not always the case. During the 1980s, when the diagnosis rate of HIV increased substantially in a short period, the virus was viewed by many people as a death sentence and was perceived to significantly shorten the lives of people who were diagnosed.

The story of HIV in Scotland and across the UK was shaped by homophobic and moralistic rhetoric.

Throughout the 1980s, HIV was labelled the “ gay plague” as homophobic misinformation spread quickly. It was a commonly held view that HIV was spread primarily by men having sex with men. The original public health campaign that emerged during the 1980s to raise awareness of HIV included television advertisements, posters and pamphlets that frequently evoked the imagery of intimate homosexual relationships. Those images fed in to wider homophobic societal assumptions that homosexuality was wrong and immoral. The public health campaigns disproportionately focused on the spread of HIV through sex between men and they completely omitted discussion of other means of spreading HIV, including heterosexual intercourse and injected drug use.

As a result of much protest and fighting and the active challenge of the spread of homophobic misinformation, the stigma around HIV has thankfully weakened significantly over the past three decades. Although much work still needs to be done in order to eradicate the scourge of homophobia from Scottish society, it is unquestionable that our country is now a more inclusive, tolerant and welcoming place for all lesbian, gay, bisexual and transgender people. Earlier this year, the European region of the International Lesbian, Gay, Bisexual, Trans and Intersex AssociationILGA-Europe—ranked Scotland as the best country in Europe for LGBT equality, for the second year in a row. The moralistic scare campaign around HIV of the 1980s is thankfully over.

It is now widely accepted among the scientific community that a person who is living with HIV can take medication to manage their illness, which allows those individuals to achieve and maintain an undetectable viral load. That means that they cannot pass HIV on to sexual partners.

As we have heard, that situation is known as undetectable equals untransmittable. The U=U status is a vital step that helps to challenge the stigma around HIV and highlights that people with HIV can live long, active and healthy lives. It is now our duty to ensure that that information becomes more widely known in society and that it is not known and understood by only the scientific community.

Despite the impressive progress made in Scotland over the past 30 years in preventing, treating and managing HIV, the illness remains a critical public health issue in many countries across the globe, and particularly in those in the global south. Recent figures from Avert illuminate the continuing prevalence of HIV, with more than 36 million people living with HIV across the globe, including more than 1.5 million children. We cannot celebrate our progress in isolation. Although it is important that we recognise our own success, we must not become complacent in the fight again HIV. It is time that we redoubled our efforts to work at not only a national level but an international level to educate and to prevent and treat HIV in pursuit of the United Nations AIDS 90-90-90 target, which is to be achieved by 2020.

Photo of Patrick Harvie Patrick Harvie Green

I, too, warmly thank Emma Harper for bringing this debate to the chamber.

We have had three decades of world AIDS days, which is an extraordinary fact. I find it extraordinary, too, that I have been a member of the Scottish Parliament for half that time. I recently read the

Official Report of the world AIDS day debate that I took part in in 2003, which was brought to the chamber by a former Labour colleague, Des McNulty, whom I bumped into the other day and exchanged a “Hello” with. As I have reflected at a couple of world AIDS day events this year that I have spoken at, the fact that we have debated world AIDS day so many times has made me recognise not only how much has changed but how much things have stayed the same.

Back in 2003, we were debating Scotland’s first-ever sexual health and relationships strategy, which was still in draft and not yet in place. Although progress has been made since then, we still see a great deal of patchiness around sex education and relationships education in our schools. We must continually drive to put pressure on all political parties and the Government to improve that situation.

Before I was elected as an MSP, I worked in an HIV agency during the years when we were starting to see the first effective antiretrovirals becoming more available. However, at that time, the antiretrovirals had many problematic side effects. Treatment usually involved a more complex combination of drugs than is used today, which was much more problematic for people, especially those with chaotic lifestyles. We have now got to the point, though, where we have so many more effective remedies and tools in the box for treatment that leads to people being unable to pass the virus on through sex, as other members have mentioned. We also have new tools in the box for prevention, and members have mentioned pre-exposure preventative prophylaxis—PrEP—in that regard. There is now the opportunity to prevent HIV being transmitted among people who are in the highest-risk groups. I could not have imagined when I worked in the HIV agency that we would now be at a point where we have those new tools in the box.

We still see, however, issues around stigma. When I was a student, I was probably in a lucky generation, because if I had come out a few years earlier, before condom provision was widespread and people were aware of HIV, I might have been at much more risk. However, when I was a student, James Anderton—“God’s Cop”—was the chief constable of Greater Manchester and he was protected by the United Kingdom Government for his homophobic and bigoted comments about HIV and AIDS. He authorised raids on gay clubs in Manchester—I was reminded of this when Emma Harper talked about a medical professional using surgical protective gear—that involved police being sent into clubs wearing biohazard equipment in order to manhandle people who were just there for a night out. It was an extraordinary level of ignorance and prejudice, which was being cultivated deliberately at the time by those in power as well as by those with influence in the media.

Much has changed, but there are still problems with stigma and there are still pockets of severe ignorance and prejudice. I pay tribute to Lloyd Russell-Moyle—as Miles Briggs did—for coming out publicly, in the House of Commons, as someone who has a positive diagnosis of HIV. For an MP to say that not only are they willing to challenge the stigma of HIV, but that someone with HIV can and does lead an active, healthy and long life and that it is something that HIV positive people can expect, is in itself an important thing to do in challenging stigma.

As Mary Fee said, we have made progress, but there is still a huge way to go on the international aspects. We are still a long way from achieving the 90-90-90 target around the world. A great deal has changed, but a great deal is still the same.

The Scottish Government has a sexual health and blood borne virus framework, which runs to 2020. That means that, next year, the Government will be doing the work on the next update. I urge the Scottish Government, recognising the new tools for prevention and treatment, to make a policy commitment to setting a target of zero new infections of HIV in the next update. That would be an important step forward and would drive the progress that we need to make.

Once again, I thank Emma Harper for securing the debate.

Photo of Gillian Martin Gillian Martin Scottish National Party

I, too, thank my colleague and friend Emma Harper for bringing to the chamber this debate to mark the 30th world AIDS day. It is only a year since the First Minister publicly took an HIV test in a bid to break down barriers to getting tested. That was an incredibly powerful moment and I am sure that it encouraged more people to follow in her footsteps.

As many members have mentioned, we have come a long way in the decades since HIV and AIDS entered the public consciousness. Extraordinary headway has been made, which is due in large part to the bravery of those with the condition in speaking out and to organisations such as HIV Scotland and Waverley Care, which make huge contributions to helping to break down barriers and encourage testing.

The most recent figures show that an estimated 426 people in the NHS Grampian area are living with a diagnosis of HIV. Between 2009 and 2018, the figures for new diagnoses in NHS Grampian have fluctuated from 21 to a high of 35 in 2013, before dropping to 17 in 2015 and rising slightly again to 22 last year. I hope that that rise is a result of more people coming forward to get tested and diagnosed, which—as everyone has mentioned—is hugely important in stopping the spread of infection.

Although we welcome better detection rates, it is important that we do all that we can to educate people about protection and the importance of testing. We know that HIV testing rates among Scottish respondents are “worryingly low”—that is the phrase that is used in a recent report published by HIV Scotland.

When I was researching for the debate, I looked at the support that has been offered to those with HIV in the north-east and in my constituency. I came across the story of Colin McKay, who has dedicated his life to helping to support those with HIV. Colin said that, initially, he became involved with organisations that help to support people, out of guilt. The reason for that guilt was that he had distanced himself from someone he knew who had been diagnosed. He reflected on that and wanted to make amends. He decided to use that feeling and the fear that he had felt and channel that energy into helping people. He realised that he could help, and the more that he became involved with helping, the better he understood the illness and how those who were diagnosed with HIV felt, so he helped to educate. He has helped many people find their own voice and be able to say that they are struggling or that they deserve better support. People such as Colin are admirable because the more that we choose to break down those barriers, the more we can encourage others.

I agree with Mary Fee about the messaging. I was reflecting that I was in my first year at university when the don’t die of ignorance campaign ran, with its icebergs and its ridiculous scaremongering messaging. That campaign was stigmatising and deeply homophobic. Its legacy still causes damage; it stops people coming forward for testing and blinds them to how the virus is actually spread, which is dangerous. As Ruth Maguire said, women were rarely considered in any of the public health messaging. The situation is improving, but such approaches are still lodged in people’s minds.

Thirty-five years on from the discovery of HIV, we know much more about the virus. We know that people can live with it, but we also know that it is a diagnosis that is still rife with stigma. We are miles away from the era that I described, as everyone has said, but the public health measures and messaging on HIV still need to be communicated continuously, loudly and clearly. I thank Emma Harper again for playing her part in that by allowing us all to talk about HIV today.

Photo of Jamie Greene Jamie Greene Conservative

Presiding Officer,

“In the bed was a skeletal young man, wasted away to less than 100 pounds ... he wanted to see his mother before he died.”

I said, “He wants his mother,” to the nurses, who laughed and said,

‘Honey, his mother’s not coming. He’s been here six weeks. Nobody’s coming.’”

I phoned his mother, who hung up on me. I called her back and said,

“‘If you hang up on me again, I will put your son’s obituary in your hometown newspaper and I will list his cause of death.’ Then I had her attention.”

The woman told me that her son was a sinner.

Those are the words of Ruth Coker Burks. In the mid-1980s, she was a brave young woman who cared for young men in the US who were dying of what was then known as GRID.

The story that Ruth Coker Burks tells is sad. She said that she had a little spade and that she would dig a hole to bury people herself. She would hold a

“do-it-yourself funeral. I couldn’t get a priest or a preacher. No one would ... say anything over their graves.”

That was the situation 34 years ago.

That story is hugely depressing. Attitudes have changed and much that is good has happened in the past 30 years, but it is still important to have debates such as this. In the few minutes that I have, I will talk about some of that good work.

I have a number of people to congratulate. My first set of congratulations is to the city of Glasgow, which has signed the Paris declaration to end new HIV infections by 2030 and do its bit to stop stigma and discrimination. Good on Glasgow for doing that.

Like others, I congratulate Mr Lloyd Russell-Moyle, who is a member of the UK Parliament, on his immense bravery in standing up in his national Parliament to be open to the world about his HIV status. He said that he did that because he wanted to set an example that it is okay to talk about such things in the public domain. He also wanted to talk about what being HIV positive undetectable means.

My next set of congratulations concerns the work that is going on in Scotland on the U=U campaign, which raises awareness that, if someone is HIV positive and is on the right medication, the virus will be untransmittable, because it will be undetectable. That means that a person cannot pass on the virus. The message is simple, but I am not sure that everyone gets it.

The problem is that 9 per cent of people who are living with HIV in Scotland do not know that they have HIV. There is still a huge amount of stigma, and people are still afraid to go to be tested. Campaigns such as U=U tell people that, even if the result is positive, there is treatment out there, they can live a long, healthy and happy life and they can have sexual partners and relationships like anybody else.

On PrEP, I congratulate the Scottish Government. It is incredible that Scotland was the first part of the UK to introduce that treatment and we should all be extremely proud of that. PrEP has revolutionised things—it has been a game changer, especially in the LGBT community. For those who do not know—perhaps for those who are watching the debate—I explain that people who are HIV negative take the treatment before sexual encounters to reduce risk. There are estimates that the reduction can be more than 99 per cent—I do not have the exact number to hand. The times when it does not work are perhaps when people have not been adhering to the regime.

The increased demand for PrEP is putting huge pressure on services, especially in cities. When my office rang Chalmers sexual health centre in Edinburgh to see how long it would take to get an appointment to register for PrEP, we were told that it would take until February of next year, or three months. My office called back this morning, before the debate, and the date has come forward to January, so it is getting better. However, it is clear that the sheer demand for the service is putting a huge strain on those who have to deliver it. I congratulate the people who deliver that incredible service across Scotland.

My fifth and final set of congratulations is to Waverley Care, whose tartan ribbon I am wearing today. I thank the people at Waverley Care for their hospitality at their fundraising dinner on Saturday night. It was a bit of a shindig, and a huge amount of money was raised. Waverley Care has been around for 30 years, since the days of Ruth Burks and those horrific stories of how we used to treat people with HIV. I congratulate Waverley Care on, and thank it for, the incredible work that it has done over the past three decades.

One day, I hope that we will not need debates as sombre as today’s debate. By then, I hope that we will make sure that those who are HIV positive get the treatment that they need, and that we will not be talking about new infections, because there will be none. Perhaps a vaccine is just around the corner—who knows? I am hopeful, but that will need huge amounts of political will.

Photo of Graeme Dey Graeme Dey Scottish National Party

As others have, I thank Emma Harper for bringing this significant matter to the chamber and I thank all members for their thoughtful contributions as we mark the 30th world AIDS day.

This is an important topic and I am pleased to respond on behalf of the Government. I am standing in for the Minister for Public Health, Sport and Wellbeing, Joe FitzPatrick, who was disappointed that, owing to long-standing ministerial business, he could not be here.

As Mary Fee noted and Patrick Harvie so eloquently reminded us, the world has come a long way in relation to HIV and AIDS over the past three decades, and there is much to be proud of in the progress that Scotland has made on that.

As Emma Harper and Miles Briggs highlighted, it emerged last week that we had not just met the UNAIDS 90-90-90 target, but that we had exceeded it. An estimated 91 per cent of HIV-positive people in Scotland know their status; 98 per cent of those people are receiving treatment; and 97 per cent of people who are receiving treatment are achieving viral suppression. That is real and significant progress, which deserves to be recognised and celebrated. I want to take a moment to do that before moving on to the work that is still to come, because the Scottish Government agrees that we cannot and we must not stop now.

A key area of progress has been on testing for HIV. It is important that people who are at risk of HIV get tested, and that we remove any barriers to that testing. In Scotland, there are many people across the national health service and the third sector who have worked incredibly hard to find new ways to promote and provide testing, and to challenge the misinformation and stigma that can hold people back from coming forward for testing.

Another significant milestone in the effort to tackle HIV in Scotland was met in July last year, when PrEP became available on the NHS. As others have noted, PrEP occupies a valuable place in our toolkit to prevent new HIV transmissions. As Jamie Greene noted, we should take pride in the fact that Scotland was the first part of the UK to make PrEP available on the NHS to those who need it. NHS colleagues have worked exceedingly hard to make it available to those who could benefit from taking it. I note Jamie Greene’s comments in that regard. Over 1,800 people have started on PrEP in the first year of its availability. That is 1,800 people whose risk of getting HIV is now dramatically lower. That achievement is well worth celebrating.

However, the statistic highlighted by Ruth Maguire—that only 10 women have accessed the drug—is a concerning one. I will ask Mr FitzPatrick to write to her in response to that. I will also draw to the minister’s attention Patrick Harvie’s point about the next strategy, covering the post-2020 period.

Although we have made fantastic progress, I agree with Miles Briggs that we cannot rest on our laurels. It is important to recognise that there are still challenges ahead, and it is critical that we work collaboratively in order to keep making progress. Emma Harper reminded us of that when she mentioned that double gloving still takes place and that HIV patients are still placed at the end of dental lists.

Given that an estimated 9 per cent of people who live with HIV are unaware of their status, there remains a challenge around testing. Working across organisational boundaries will be key here. We must ensure that third sector organisations are empowered to offer testing, and we need to support NHS colleagues across different specialties to be aware of HIV and to know when to offer testing, so that we can meet Emma Harper’s challenge of finding, reaching and testing people.

The Scottish Government is providing more than £2 million to organisations that deal with sexual health and blood-borne viruses between 2018 and 2021. The organisations that are being funded include Waverley Care, HIV Scotland and the Scottish Drugs Forum, all of which have a role to play in promoting testing to the different communities in Scotland that are most at risk.

The outbreak of HIV among people who inject drugs in Glasgow serves as an important reminder that we cannot afford to be complacent. Last week, my colleague Joe FitzPatrick paid a visit to the staff in NHS Greater Glasgow and Clyde who have been involved in tackling the outbreak there. He was impressed by their dedication and by the collaborations that they have established to tackle the outbreak.

However, we want to do more. As we stated in the alcohol and drugs strategy that was published last week, the Scottish Government will support measures that might initially seem controversial or unpopular—including the introduction of supervised drug consumption facilities—that are driven by a clear evidence base. Mr FitzPatrick met the UK Government a few weeks ago. Regrettably, its stance continues to be that it will not allow such an initiative to proceed. We will continue to press for a change in the law or the devolution of the necessary powers.

As many colleagues have rightly said in their contributions to the debate, HIV stigma has no place in Scotland today. We must all commit to seeing the individual person and must never reduce or define someone by their HIV status. We must continue to challenge misinformation and to spread the word that a person who is diagnosed with HIV in Scotland today can expect to live a full life and to have near-normal life expectancy. We must share the message that an individual with a sustained, undetectable level of HIV viral load in their blood is unable to transmit HIV to their sexual partners. As colleagues have repeatedly made clear in the debate, undetectable equals untransmittable.

I will finish where I started by again thanking Emma Harper and everyone who has contributed to the debate.

13:32 Meeting suspended.

14:30 On resuming—