World AIDS Day

Part of the debate – in the Scottish Parliament on 6th December 2018.

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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.