The Scottish Government has today published its long-awaited HIV Transmission Elimination Delivery Plan, setting out how it intends to achieve the life-changing goal of ending new HIV cases in Scotland by 2030, as well as 2025 interim UNAIDS targets of 95:95:95.

Until today, Scotland was an outlier in the UK, with both England and Wales having published their own respective HIV Action Plans. The Scottish National Party promised this Delivery Plan four years ago in their 2021 manifesto commitment.

In 2022, Scotland’s HIV Transmission Elimination Oversight Group published 22 recommendations as part of the Ending HIV Transmission in Scotland by 2030 proposal, setting out a route map to achieving Scotland’s 2030 goal and delivering on 2025 interim UNAIDS targets of 95:95:95. However, the proposal didn't make clear what the Scottish Government would commit to and how progress would be tracked.

The Delivery Plan prioritises its commitments into short, medium and longer term actions and includes addressing HIV stigma, with the ‘Stigma is more harmful than HIV’ campaign made in partnership with Terrence Higgins Trust forming the basis of this work, pilot projects to expand access to PrEP in primary care, introducing opt-out HIV and blood borne virus testing in emergency departments as well as prisons and drug services, and making PrEP available online. It also includes the creation of a new steering group to oversee and advise on delivery, coordinate national outcomes and support NHS Boards and partners with local actions.

Earlier this month, Holyrood’s Equalities, Human Rights and Civil Justice Committee heard from Alan Eagleson, Head of Scotland Services at Terrence Higgins Trust, who warned that delays in publishing the Delivery Plan jeopardises progress in ending HIV transmission. Alongside Waverley Care, Alan urged the Scottish Government to ramp up efforts to tackle HIV stigma and to set out a comprehensive package of funding to support the delivery of measures to end new cases by 2030.

Head of Scotland Services Alan Eagleson said: ‛The publication of Scotland’s HIV Transmission Elimination Delivery Plan today is marks a vital step in our national journey to end new HIV transmissions by 2030. However, bold words must be met with bold action and although we now have a plan, we do not have the funding resource to make this ambition a reality. The actions promised in the Delivery Plan must be fully funded to match the scale of the challenge that we face.  

‛We welcome the Government’s commitment to addressing HIV stigma. Our charity’s ground-breaking ‘Stigma is more harmful than HIV campaign’ – developed in collaboration with people living with HIV and delivered in partnership with the Scottish Government and colleagues across the sector – has already started this work by educating millions on the reality of HIV today. While it’s also promising to see the Government commit to considering a National HIV Testing Week for Scotland – a key tool in combatting stigma, normalising testing and finding new cases of HIV – this cannot wait and Scotland must join other UK nations in funding this intervention. The expansion and normalisation of testing is fundamental if Scotland is to achieve the historic goal of ending HIV transmissions.

‛It’s also great to see the Government pledge to pilot emergency department HIV opt-out testing programmes in three health boards by June 2024 as well as develop an opt-out testing programme in Scottish drug services and in prisons. We are however deeply concerned that the short lifespan of the emergency department opt-out testing pilots will considerably limit the extent to which proper evaluation can take place.

‛We already know that opt-out HIV testing has been a resounding success in England, changing and saving the lives of people unaware they are living with undiagnosed HIV as well as re-engaging people in care and in tackling wider health inequalities. We need to catch up and match our ambition with proper investment, ensuring that pilots are substantial and that all health boards that wish to implement this intervention have the support to do so.

‛The availability of PrEP has been crucial in Scotland’s mission to end new cases of HIV and has been revolutionary in helping reduce transmission among gay and bisexual men. We welcome the Governments’ commitments to widening PrEP access, including by updating eligibility criteria and making it available online. It’s also encouraging to see that the Government will “explore the potential” for PrEP to be made available via primary care and community pharmacies, including through a feasibility pilot of primary care PrEP access in NHS Grampian. However, the clock to 2030 is ticking. This is a key intervention and more must be done to rapidly expand access to PrEP across the country.

With less than six years left to 2030, Scotland can – and should – be the first country in the world to end HIV transmission. But without sustainable investment and resource, we risk jeopardising this once-in-a-generation opportunity.’