Scottish Government commit to ensuring every person has good sexual health and blood borne virus care, but must act now.
This week, the Scottish Government committed to ensuring every person in Scotland can access sexual health services and blood borne virus care. The commitment comes following the publication of a Sexual Health and Blood Borne Virus (SHBBV) Action Plan, which sets out plans aiming to end hepatitis C transmission by March 2025, and end new HIV transmission by 2030.
During a debate to mark World AIDS Day 2023, the Minister for Public Health and Women’s Health Jenni Minto announced additional intentions to introduce measures like opt-out testing to help reach these targets. However, we remain concerned that progress is moving too slowly, and that Scotland risks falling behind other nations in reaching crucial targets.
Grant Sugden, Chief Executive of Waverley CareWe welcome the publication of the SHBBV plan ahead of World AIDS Day, the government’s announcements, and their attention to improving Scotland’s health and wellbeing. However, we remain concerned that progress is moving too slowly and the ambitions to reach zero new transmission are unlikely. With just over a year to eliminate transmission of Hepatitis C, and just over 6 years to go to reach the goal of 2030 for HIV, urgent action is needed now to avoid these becoming missed ambitions.
Opt-out testing
The SHBBV Action Plan highlighted the ongoing successes across Scotland around reducing transmission and increased access to treatment. Zero new transmission can only be achieved if everyone is aware of their HIV status, and those living with undiagnosed HIV in Scotland have access to care, treatment and support appropriate for them.
During the World AIDS Day Parliamentary Debate (2023), Minister of Public Health Jenni Minto stated the Government’s commitments to fund three pilots in Scotland for opt-out testing. Opt-out testing means those attending A&E departments and having a blood test taken will also have a test for blood borne viruses (HIV, hepatitis B & hepatitis C) unless they opt-out. This is a significant moment, which brings Scotland in line with the British HIV Association’s guidelines for opt-out testing. The announcement comes following efforts from healthcare professionals, researchers, and other experts, and campaigns from charities including Waverley Care, Terrence Higgins Trust, and National AIDS Trust.
However, action through opt-out needs to be rapid to ensure that Scotland can get to zero new HIV transmission by 2030, and that the nation does not fall behind the turbo-charged expansion of opt-out testing in England. We also need to make sure that support is available in training A&E staff on opt-out testing and ensure that additional resource is available for charities supporting people who receive a diagnosis. This support is vital to enabling people to live well.
PrEP
The introduction of PrEP (Pre-Exposure Prophylaxis)* on Scotland’s NHS in 2017 has been a game-changer in HIV. But, PrEP access continues to be underpinned by issues of inequality – over 90% of those accessing it since 2017 in Scotland have been men who have sex with men, and White. Missed opportunities for women and ethnic minorities accessing PrEP has potentially devastating consequences.
The announcement of an e-PrEP clinic on World AIDS Day last year offers opportunity to ensure that access to the drug is available more widely. But digital access will not work for everyone. To reach those most at need and hardest to reach/easiest to ignore, PrEP must also be more easily available in communities and spaces beyond sexual health clinics.
Elimination of hepatitis C
Alongside commitments to end HIV, the Scottish Government have committed to eliminate new transmission of Hepatitis C by March 2025. Evidence of work in health boards such as Tayside shows that reducing transmission is possible. However, we continue to have concerns around how the elimination target can be achieved without consistent data, and how it can be monitored and sustained. This must be done in conjunction with continued investment in services which provide support for those at highest risk and facing additional barriers in accessing treatment.
Human first, every time
As Karen Adam MSP highlighted during the 2023 World AIDS Day debate, it is vital that developments do not forget the ‘Human’ in HIV, and indeed all BBV’s. Too often we know services and support do not give people the dignity which they deserve. To ensure that a human rights approach is central in practice, there needs to be human first, every time – in projects funded, in services developed, and in approaches taken.
There is also important but so far missed scope to pay greater attention to the support and quality of life for those living with HIV. A human-rights based approach must be attentive to how we not only reach a point where there is no new transmission, but also ensure that there is consistent access to medical treatment, and post diagnosis support centred around dignity, support, and care for everyone living with HIV in Scotland.
* PrEP (Pre-Exposure Prophylaxis) is a pill taken by people who are HIV negative to reduce the risk of HIV transmission and is almost 100% effective as a preventative measure.