Update on HIV in Scotland
Health Protection Scotland recently published it's latest update on HIV in Scotland, covering the first six months of 2019. Here we take a look at the key stats and provide some insight into what they mean.
How many people are living with HIV in Scotland?
According to the estimates from Health Protection Scotland (HPS), there are 5,484 people in Scotland who are living with diagnosed HIV.
In terms of the demographics, we know that more men are living with HIV than women (73%-27%) and that, as treatments for HIV continue to improve, the age of the population is rising.
We also know that HIV continues to disproportionately affect particular groups in society. For example, almost half of all people living with HIV in Scotland are gay and bisexual men, one in five are from Scotland's African communities and almost one in 10 are people who inject drugs. The reasons for these disproportionate impacts are closely tied to wider health and social inequalities in society.
Some of these trends are repeated in the stats for new diagnoses in the first half of 2019, where there were 184 newly reported cases of HIV in Scotland.
A majority of new infections in Scotland have been found in the health board areas of our biggest cities. Between them NHS Glasgow and NHS Lothian account for 55% of all new diagnoses. In response to the disproportionate impact of HIV on city regions, the international Fast Track Cities initiative is promoting action on a local level. In September, we were at the Fast Track Cities conference in London, and you can find out more here.
In addition to people who are already diagnosed, there are an estimated 542 people who have never been diagnosed, taking the overall total to 6,026. We know this because of work HPS has been doing to measure how Scotland is performing against UNAIDS' 90:90:90 targets.
What are the 90:90:90 targets?
90:90:90 refers to a series of global targets for HIV diagnosis and treatment. By 2020, the ambition is that 90% of people living with HIV have been diagnosed, 90% of those diagnosed are on treatment and 90% of those on treatment have an undetectable viral load.
Scotland met the 90-90-90 targets towards the end of last year, with 91% diagnosed, 98% of them accessing treatment, and 94% of them with an undetectable viral load.
If we've met the UN targets, is there still more to do?
Absolutely. Meeting these targets has been a great achievement but Scotland still faces significant challenges, including the examples below.
We need to continue promoting testing, particularly among groups who are disproportionately affected, to continue reducing the number of people who haven't been diagnosed. Early figures for 2019 suggest that fewer that one in four people with HIV were diagnosed early. The later people are diagnosed, the more likely they are to experience health issues and also to unknowingly pass HIV on to others.
There is also the issue how to support people living with HIV as they grow older. Thanks to effective treatments we are now seeing people with HIV living longer, healthier lives. However, we need to do more work to understand how HIV will impact on their health and care needs, and to make sure that services supporting older people are sensitive to issues around HIV.
We also have a lot of work to do to challenge the stigma that continues to surround HIV - stigma that not only impacts the emotional health of individuals, but also fuels a reluctance for people to access testing and support. Over the last few years, a number of developments, including PrEP and U=U have added to the positive story we have to tell.
PrEP is a daily pill taken by someone who is HIV negative, that can protect them from becoming infected. It has been available on the NHS since summer 2017 and feedback has shown that it is encouraging people to access sexual health services for the first time with wider benefits for their health and wellbeing. We are part of national groups looking at how PrEP can be made available to people who could benefit from it.
Meanwhile, U=U us a powerful message, backed by global scientific consensus that a person living with HIV, who is on treatment and has an undetectable viral load cannot pass on HIV. It was the focus of our World AIDS Day campaigning last year, and you can find out more here.