As part of the Programme for Government 2025-2026, the Scottish Government announced the roll-out of opt-out blood borne virus testing in NHS Lothian and NHS Greater Glasgow and Clyde, the two Scottish health boards with a high HIV prevalence.

This commitment will see thousands more people tested for HIV, boosting efforts to end new cases of HIV in Scotland by 2030 and placing us in prime position to become the first country in the world to achieve this historic feat.

This is a landmark moment in our journey to end the HIV epidemic and it would not have been possible without you, our supporters.  

Here’s how we did it.

Opt-out testing is when patients who come into emergency departments are routinely tested for HIV when having blood taken, unless they ask not to be. Already a proven success in maternity wards, effectively eliminating mother-to-baby HIV transmission, opt-out testing was first trailed in South London emergency departments, with funding from The Elton John AIDS Foundation (EJAF) and National Lottery.

Following the success of the opt-out pilots, we campaigned for the introduction of A&E opt-out testing in all A&E’s in areas with a high HIV prevalence and, in December 2021, the UK Government committed £20 million of investment to A&E opt-out HIV testing in four cities with the very highest prevalence. 

In London, Brighton, Manchester and Blackpool, more than 4,000 people with HIV, hepatitis B and hepatitis C were found through this approach in only 18 months, including 934 people who were living with undiagnosed HIV or had been disengaged from HIV care. In short, opt-out testing was working.

We used this evidence to campaign even harder for a further expansion of the intervention to more hospitals across England where HIV prevalence was high, resulting in nearly £50 million more of funding from consecutive UK governments. Over eighty A&E’s across England have now received funding for opt-out HIV testing and are finding and supporting people living with undiagnosed blood borne viruses every day.

In 2020, the Scottish Government to ending new cases of HIV by 2030, going on to announce the formation of the short-life HIV Transmission Elimination Oversight Group. As a dedicated member of this group, we advocated for bold action to ramp up HIV testing and urged the Scottish Government to learn from the early successes of emergency department opt-out HIV testing elsewhere in the UK.

To mark World AIDS Day 2022, the Oversight Group published a set of 22 recommendations to the Scottish Government, setting out a framework on how Scotland’s 2030 goal could be met. A key recommendation within this Plan was the call for opt-out testing pilots in emergency departments where HIV prevalence was at its highest.

We headed to the SNP, Scottish Labour, Scottish Green and the Scottish Conservative’s respective party conferences to make the case for opt-out testing in Scotland. We talked to party members, government Ministers, MPs and MSPs about Scotland’s 2030 goal and the action that was needed to get across the line.

We made sure our message was heard and it worked. In partnership with the SNP’s youth and LGBT+ affiliates, in 2023 we went on to change SNP party policy to back an expansion of HIV testing across Scotland through the roll-out of A&E opt-out testing and a National HIV Testing Week for Scotland.

We advocated for a laser sharp focus on tackling health inequalities in Scotland’s HIV epidemic and worked with MSPs to secure an inquiry by the Equalities, Human Rights and Civil Justice Committee into HIV in Scotland.

The Scottish Parliament inquiry launched in March 2024, hearing from a range of sector experts and people living with HIV. Our Head of Scotland Services, Alan Eagleson, gave evidence to the Committee and warned that succeeding in ending new transmissions of HIV in Scotland by 2030 would not happen by accident and called for the urgent scaling up of HIV testing, including through an opt-out approach in emergency departments.

Following the publication of the HIV Transmission Elimination Oversight Group’s recommendations, we geared up our campaign for a funded HIV Action Plan for Scotland. We spoke with government Ministers, civil servants, MSPs and MPs about the need for a route map to achieving our shared 2030 ambition.

The Scottish Government published its HIV Transmission Elimination Delivery Plan in March 2024, setting out a range of actions the Government are set to take to deliver on their 2030 commitment. Key to these actions was the short piloting of emergency department opt-out blood borne virus testing in three health boards across Scotland: NHS Lothian, NHS Grampian and NHS Highland.

Evidence from these pilots, alongside existing data from the intervention in England, was to be used to make a final decision on rolling out op-out on a permanent basis in Scotland. The work of our NHS colleagues in these health boards was vital in demonstrating the workability of opt-out.

In October 2024, in partnership with our friends at Waverley Care, we brought HIV testing to the Scottish Parliament. Our message was loud and clear; an expansion of HIV testing was needed if Scotland was to succeed in ending new cases of HIV by 2030.

The Public Health Minister was one of many MSPs to take a HIV test on the day.

To mark the start of 2025, and five years until 2030, we worked with a cross-party coalition of MSPs and MPs in Glasgow and Edinburgh to write to the Cabinet Secretary for Health and Social Care, Neil Gray MSP, calling for investment in A&E opt-out HIV testing in their respective cities.

The letters, led by Paul Sweeney MSP and Scott Arthur MP, warned that, everyday A&E opt-out HIV testing was not on offer in Scotland, opportunities to find and support people living with HIV were being missed.

The campaign was backed by over 20 politicians, including Leader of the Scottish Labour Party Anas Sarwar MSP and Co-Leaders of the Scottish Green Party, Patrick Harvie MSP and Lorna Slater MSP.

A year out until the next Scottish Parliament elections in 2026, the Scottish Government has committed to rolling-out emergency department opt-out HIV and blood borne virus testing in NHS Lothian and NHS Greater Glasgow and Clyde within the next year. This is a massive win and puts Scotland in pole position to become the first country in the world to end new cases of HIV.

It has taken an army of people working tirelessly behind the scenes to get us to this point. We would like to thank our third sector partners at Waverley Care and National AIDS Trust; the First Minister, Cabinet Secretary for Health and Social Care Neil Gray MSP, Minister for Public Health Jenni Minto MSP and their team of civil servants and special advisors; the amazing staff at NHS Grampian, NHS Highland and NHS Lothian who spearheaded A&E opt-out pilots in Scotland; our friends at NHS England who showed us what was possible through front-door testing; the MSPs, MPs and their parliamentary staffers who have time and time again raised the need to expand HIV testing in both Holyrood and Westminster; the coalition of public health professionals that make up the Delivery Plan’s Oversight Group; and the people living with HIV across the country who shared their stories and demanded action to ensure everyone living with HIV in Scotland has access to life-saving treatment and support. Thank you – this is a win for all of us!

Now that we have won this amazing commitment from the Scottish Government, our hard work will continue to ensure the roll-out is supported by the funding and resource to match the scale of our 2030 ambition. It is integral that there is robust HIV awareness training for NHS staff and clear care pathways for those who will receive a diagnosis through opt-out testing.

We will also continue our work to champion calls for a National HIV Testing Week for Scotland, for improved access to PrEP through community pharmacies and so that everyone living with HIV has access to the care and support they need, free of stigma.

The 2026 Scottish Parliament elections are only a year away and our advocacy work will continue to keep HIV on the agenda. But we can’t do this without your support. If you would like to support campaigns like this, donate today.

Together we can make history and end the HIV epidemic in Scotland once and for all.

Thank You.