Panic fades but the epidemic goes on

An article by Gavin Strang in The Herald

HIV in Scotland – that was back in the 1980s wasn’t it? “Don’t die of ignorance” and Edinburgh shooting galleries of drug misusers come to mind – but we sorted that one out, didn’t we?

Not quite. Anyone thinking that HIV is a thing of Scotland’s past could not be more wrong. The panic of the 1980s may have faded, but HIV is still very much with us. That is why I initiated a debate in the House of Commons earlier this month – to highlight the ongoing epidemic and the need for action across the UK.

The prevalence of HIV in Scotland is higher than ever, and is set to continue increasing. Last year, Scotland saw 216 new cases diagnosed – more than in any year since 1986. Quite simply, people who have unprotected sex are at a greater risk of acquiring HIV than ever before.

Figures published by the Health Protection Agency this week show that the number of people living with HIV in the UK increased by almost one-fifth last year – to 49,500. One-third of these people have not yet been diagnosed.

Of course, a lot has changed since the early days. Back in the late eighties in Scotland, the average length of time between HIV diagnosis and death with Aids was just more than two years. Now, most people on highly active anti-retroviral therapy are living past the 10-year milestone, as research revealed last month. While resistance to drugs is a growing problem, the number of people who die with Aids in Scotland has fallen dramatically, from its peak of 115 in 1995 to 25 last year.

The course of the disease in Scotland has changed, too. The number of cases transmitted through intravenous drug use has massively declined – just 10 cases were diagnosed in Scotland last year, the lowest since records began. The most common way of acquiring HIV in Scotland is now through sex between men – the numbers have not declined, and even increased last year.

The number of people in Scotland newly diagnosed with HIV via heterosexual sex has risen dramatically in recent years – from 51 in 1996 to 120 last year. As has always been the case, most of Scotland’s heterosexual cases were acquired abroad, but medical experts now expect a steady increase in cases acquired here.

Greater Glasgow overtook Lothian for the first time last year as the region with the highest number of new diagnoses. Of course, these figures can only record people who have been tested for HIV. Many people with HIV in Scotland have not yet been diagnosed. More than half the HIV-positive people screened anonymously at Genito-Urinary Medicine clinics last year had no idea they were carrying the virus – and may still have no idea.

So that is the situation out there. How have we responded? It is generally agreed that we did relatively well in the 1980s, but in the past few years it seems we have been distracted from the urgency of HIV prevention work.
We should be driving the numbers of infections acquired in Scotland right down. We know how HIV is transmitted, and we know how to prevent it. It is a tragedy that so many people still become infected with HIV here each year.

Two weeks ago, Malcolm Chisholm, the Scottish health minister, launched a consultation on proposals for a national sexual-health strategy, drawn up by an expert reference group. The consultation will be open until February, and then the Scottish Executive will bring forward a final strategy.

I will single out one point from the draft strategy for commendation. Funds to help prevent the spread of HIV have always been “ring-fenced” – to prevent the money being spent elsewhere. Last year the Westminster government removed the ring-fence from England’s HIV prevention funds, to the dismay of people working in the field. Happily, the expert reference group recommends keeping the ring -fence on Scotland’s money to prevent the spread of HIV and other blood-borne diseases.

Scotland’s HIV epidemic has changed unrecognisably, but it has far from disappeared. The more people who engage in the development of the sexual-health strategy the better. They are needed to tackle the sexual-health challenges facing Scotland today.

Gavin Strang was the architect of the Aids (Control) Act 1987.

The draft strategy, Enhancing Sexual Wellbeing in Scotland, can be viewed online at www.scotland.gov.uk/publications or ordered through the Stationery Office Bookshop, 71 Lothian Road, Edinburgh, 0870 606 55 66.