An article by Gavin Strang in the Edinburgh Evening News
TWENTY years ago, in the United States, the first case of Aids was officially reported. Since then, 3312 people in Scotland have been diagnosed HIV positive, and 793 have died.
Edinburgh and Lothian have seen more than their fair share of HIV – 1440 people have been diagnosed with HIV here. More cases are still diagnosed in Lothian than in any other region of Scotland.
Some people have been tempted to think that Aids has gone away, and that HIV is a threat of the past for Scotland. They could not be more wrong.
Certainly, the dreadful predictions of the early 1980s didn’t come true, and the lives of people with HIV have been transformed by “combination therapies” – cocktails of drugs.
But HIV is very much here in Scotland today. And we forget about it at our peril.
Three times as many people are diagnosed with HIV in Scotland through sex between men and women than there were in 1986. Heterosexual sex is now the most common transmission route.
And, while Scotland was successful in reducing the number of cases of HIV transmitted through drug use, the Public Health Laboratory Service has warned that the rate of “works sharing” is thought to be worsening.
The UK did relatively well at fighting HIV in the early years. Public awareness was high and health agencies made major HIV prevention efforts. Nowhere was this more so than in Lothian, where the number of cases of HIV caught through drug injecting fell from 117 reported in 1984 to just 13 by 1990. But complacency set in. Perhaps because the new therapies were keeping people alive, perhaps because the apocalypse did not happen.
For whatever reason, public awareness waned and HIV prevention work was allowed to go off the boil. As Peter Piot, the head of the UN’s Aids Programme said, just when we know most about how to prevent HIV infection, there has been a weakening of the global effort to do something about it. Until this year, funding in Scotland for HIV prevention work has been frozen, year after year. In England and Wales, HIV prevention budgets did not keep up with inflation.
THERE are still many people doing good work in HIV prevention. But there is a real sense that prevention work has not kept up with the changes in how HIV is spreading.
In Scotland, we could be facing a second wave of HIV. This summer, Jamie Inglis, a director at the Health Education Board for Scotland, warned that a delay in educating people about unprotected sex could lead to a dramatic increase in the spread of HIV.
“HIV infection has never gone away, and is in danger of coming back with increased vigour,” he said. “While we may have been successful in containing the first wave of HIV, the stage is set for a second wave and, unless we step up our efforts to educate the public, we will not avoid it.” As Susan Deacon MSP, when she was Scottish Health Minister, pointed out: “A generation has grown up since the first wave of HIV and Aids awareness campaigns in the 1980s. As a result, some of the impetus behind the safe sex messages of that era may have been lost.”
The problem among young people came to light just a fortnight ago. A Schools Health Education Unit survey of nearly 4000 schools revealed that two in five 11-year-olds have never heard of Aids and one in five 15-year-olds is unaware that having sex without a condom is high risk.
And Dr Dan Clutterbuck at Edinburgh University warned in August that, despite evidence that gay men had reduced sexual risk-taking in the mid-1990s, there is concern that unsafe sex is on the increase again.
We must step up our HIV prevention work. Life with HIV on combination therapy is often hard.
And resistance to the drugs is growing – around 20 per cent of newly-infected people are infected with a resistant virus.
Prevention makes financial sense too – the monetary value of preventing one case of HIV is estimated at between £500,000 and £1 million.
SO we should welcome the fact that the Scottish Executive launched an HIV strategy in January, and the Westminster Government published its National Strategy for Sexual Health and HIV for England in July. There are some helpful proposals , but there is room for improvement.
For years, Government money which is budgeted for HIV prevention work has been “ring-fenced”.
But the Executive has announced that it will review the ring-fence, and the Westminster Government proposes abandoning it altogether. If it is scrapped, past experience shows the most vulnerable work would be crucial areas such as health promotion with gay men. That is why I and other MPs urged the Government in Parliament last month to keep the ring-fence.
It is disappointing that our programme of HIV prevention lost its momentum. The fact that more new cases of HIV were recorded in the UK last year than ever before must be a matter of concern.
But of course the scale of our problem is hardly comparable to that in other parts of the world. In Botswana, 36 per cent of adults are HIV positive . Aids has orphaned more than 12 million children in sub-Saharan Africa. Eastern Europe is seeing the fastest increases in HIV cases in the world.
In Scotland in 2001, every new case of HIV must represent a failure of prevention. By taking HIV/Aids more seriously we would not only be reducing a huge source of suffering in our country, we would also be setting an example which could help other countries with much larger epidemics.
Dr Gavin Strang is MP for Edinburgh East and Musselburgh, and was the architect of the Aids (Control) Act.
Please follow this link to see the Parliamentary debate initiated by Gavin Strang on Sexual Health on 30 October 2001.