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Choose Life – Edinburgh’s Battle Against AIDS

This week, the BBC screened Choose Life: Edinburgh’s Battle Against AIDS, a documentary charting the HIV epidemic that affected the city in the 1980s.

This week, the BBC screened Choose Life: Edinburgh’s Battle Against AIDS, a documentary charting the HIV epidemic that affected the city in the 1980s. Here we reflect on the issues raised in the documentary, and bring the story up to the present day…

What factors led to Edinburgh’s HIV epidemic in the 1980s?

In the 80s, pockets of Edinburgh were, like many inner-city areas across the UK, experiencing wide-ranging social problems around rising unemployment, poverty and deprivation.

Added to this mix, there was a sudden influx of cheap heroin coming into Western Europe – a phenomenon fuelled by global events including the Russian invasion of Afghanistan.

Although lots of cities across the UK and beyond were affected, Edinburgh’s experience was different because there was a rapid increase in injecting drug use.

In response, the city’s police attempted to crack down on the availability of injecting equipment, meaning more people started sharing.

Dr Roy Robertson, an Edinburgh GP working in the Muirhouse area of the city, was one of the first to make the link between sharing injecting equipment and HIV transmission, whereas it had previously been linked primarily with the gay community.

Following Dr Robertson’s research, Edinburgh soon attracted the title the AIDS Capital of Europe.

Was the term AIDS Capital of Europe accurate, and what was its effect?

The situation in Edinburgh was serious, but it wasn’t alone. Other cities had seen HIV infections linked to injecting drug use, but the fact that Edinburgh was one of the first to be documented by researchers made it a focus.

At the time, there was a lot of fear and stigma about HIV and AIDS – Edinburgh’s ‘AIDS Capital’ name fit into that narrative and gained traction.

Along the infamous ‘tombstone’ public health campaigns, the name has stuck, and continues to influence people’s perceptions of HIV today.

Despite the fact that treatment has helped turn HIV into a manageable long-term condition, we still come across people who believe it is a death sentence. There is still also persistent myths about how HIV is transmitted – including the falsely held views that kissing or spitting are risks.

Overcoming this stigma is perhaps the biggest challenge to achieving our ambition for zero new HIV infections in Scotland. For people living with HIV, stigma has a damaging impact on their mental health and can leave them feeling isolated in their communities. Meanwhile, stigma also puts people off accessing testing because they are worried about a positive diagnosis and what it could mean for their health.

What is the situation in Scotland today?

We want people to know that today in Scotland, HIV can be managed well with treatment and to encourage people who may have been at risk to access testing.

HIV prevention has developed significantly in recent years. Alongside continued promotion of condom use, we’ve seen the introduction of PrEP, a daily pill that can prevent HIV transmission, on the NHS in Scotland.

At the same time, we have U=U or Undetectable=Untransmittable – the clear message that a person living with HIV who is on treatment and has an undetectable viral load, cannot pass on HIV to sexual partners.

As a result of these and other interventions, new HIV diagnoses are gradually falling over time and, thankfully, new AIDS diagnoses are incredibly rare. However, we have to guard against complacency. In recent years, we have seen an outbreak of HIV among a population of people who inject drugs in Glasgow city centre.

What is the situation in Glasgow?

Since 2015, we have seen a significant increase in the number of new HIV infections among people who inject drugs in Glasgow city centre.

As was the case in Edinburgh in the 80s, the people affected by the Glasgow outbreak face complex health and social inequalities that affect their health and wellbeing, often leaving them isolated from services that can provide support. This includes issues such as homelessness, addiction and poor mental health.

In response, Waverley Care has launched a Street Support Project to take support directly to people on the street, making it as easy as possible for them to access HIV testing and treatment, along with information and advice to help people access additional support with the challenges they face.

For World AIDS Day this year, we released an update, along with our friends at the Scottish Drugs Forum, highlighting the background to the HIV outbreak.

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