An update published by Public Health of Scotland provides the latest statistics summarising PrEP uptake, HIV diagnoses and access to HIV care and treatment in 2022.
- Between July and December 2022, the monthly-average of first ever prescriptions of PrEP was highest since the programme started in July 2017; an average of 190 individuals per month accessed PrEP during this period.
- During 2022, a total of 317 new reports of people living with HIV were recorded in Scotland. The number of new HIV diagnoses increased in 2022 compared to 2021, reflecting the recovery of HIV and sexual health services post-pandemic.
- Heterosexually acquired first-time diagnoses exceeded those among gay, bisexual and all men who have sex with men for the first time since 2007.
- A significant increase (57%) was observed between 2021 and 2022 in the number of diagnoses previously known elsewhere but reported for the first time in Scotland.
- Of those receiving specialist HIV care, 98% were on antiretroviral therapy, and among those on therapy, 93% had an undetectable viral load.
Uptake of PrEP
Data published in this update confirms the effectiveness of PrEP as a prevention measure, especially among gay, bisexual and other men who have sex with men, reflecting the initial eligibility criteria. While record-high monthly averages of new PrEP users have been observed in 2022, certain groups remain underrepresented in accessing PrEP and further work is needed to ensure equal access to PrEP to those who could benefit from it.
While there was an increase in first-ever HIV diagnoses observed in 2022 compared to 2021, these reflect the number of HIV diagnoses observed pre-pandemic and are most likely due to the increase in HIV testing in 2022. However, of importance is that for the first time since 2007, the number of first-ever HIV diagnoses were higher in heterosexuals compared to gay and bisexual men, emphasizing the need for both local and national action.
A significant number of previously diagnosed cases outside the UK were reported in Scotland, particularly among Black-African ethnicities. This highlights a crucial need to ensure equal access to treatment, services, and education for ethnic minority communities living in Scotland.
Data on HIV diagnoses in people who inject drugs support the need for continuous efforts in HIV testing, treatment delivery, harm reduction and awareness initiatives.
In addition, the persistence of late-stage HIV diagnoses remains a significant concern. To address this issue effectively, we must maintain our focus on testing, which is essential for finding undiagnosed cases, detecting HIV early for better treatment outcomes, and preventing new HIV transmission.
Service delivery and treatment
The report also highlights the changing needs among service users post-pandemic, with the emphasis on online tools and digital service delivery. Capturing all relevant information for surveillance purposes is a challenge and may be reflected in the lower attendance rate observed in 2022; however, through collaboration with HIV services and efforts to modernise national HIV surveillance, work is ongoing to maximise accurate and complete data.
Despite a lower proportion of individuals attending care compared to pre-pandemic levels, high ART uptake and undetectable viral loads demonstrate the effectiveness of treatment in preventing onward transmission.
While Scotland is making progress towards the UNAIDS Fast Track 95:95:95 targets and the Scottish Government’s commitment to ending HIV transmissions in Scotland by 2030, continued efforts among stakeholders and policymakers in tailoring approaches to address Scotland’s specific challenges remain vital.