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Meeting date: Wednesday, December 1, 2021

Meeting of the Parliament (Hybrid) 01 December 2021 [Draft]

Agenda: Portfolio Question Time, Queen Elizabeth University Hospital (Patient Safety), Ventilation in Schools, Point of Order, Scottish Land Commissioners, Business Motions, Parliamentary Bureau Motions, Decision Time, World AIDS Day 2021


Contents


World AIDS Day 2021

The final item of business is a members’ business debate on motion S6M-02100, in the name of Jamie Greene, on world AIDS day 2021. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises that 1 December each year marks World AIDS Day; acknowledges that this provides an opportunity for people across the world to unite in efforts against HIV, to show support for people living with the virus and to commemorate those who have died from an AIDS-related illness over the years; notes that a recent investigation reported that John Eaddie, who was commonly known as “Patient Zero” prior to his identification, was the first person from the UK to die from AIDS, passing away on 29 October 1981; understands that the most recent estimates suggest that more than 105,000 people in the UK live with HIV, with an estimated 6,600 not knowing their status; welcomes the huge advancements in medicine, which have resulted in people in receipt of the correct treatment being given the viral status, “undetectable”, meaning they are untransmittable and cannot pass the virus on; praises efforts to promote the U=U campaign, which aims to highlight this; believes that the successful provision of treatments such as PrEP and PeP have substantially reduced infection rates, and expresses its gratitude to the many third sector and charitable organisations in Scotland, such as the Terrence Higgins Trust, HIV Scotland and Waverley Care, and others across the UK and beyond that seek to raise awareness of the importance of testing, knowing one’s status and pursuing a holistic approach to prevent, treat and destigmatise HIV/AIDS.

17:31  

Presiding Officer,

“Freddie Mercury’s generation was senselessly taken from us by a disease, one which we have still not found a cure for. The disease is bigotry”.

That was eloquently summed up by the writer Austin Bond, in the shadow of the movie “Bohemian Rhapsody” when it came out. It was a film that sought to celebrate the life and work of a great showman, but which, many people think, controversially attributed the manner of his death to the manner of his life, and not for the first time. Anyone who watched “Freddie Mercury: The Final Act”, the recent BBC documentary commemorating 30 years since Freddie died, could not help but be moved by its content. Freddie, gaunt yet defiant, sang till he could no longer stand.

They called it the “gay plague”; the red tops ran with “Freddie’s got AIDS”. Looking back, it is almost as though they rejoiced in the scandal of it all, without acknowledging the sadness or the tragedy. Of course, that was after they had endlessly hounded him and those around him before he died. I do not need to name and shame them—they know who they are.

Anyone who watched Russell T Davies’s “It’s a Sin” on Channel 4 could not help but be moved by that, too. As one of the 6.5 million people in the United Kingdom who watched it, I make a confession: I could not, and did not, watch it till the end. I tried, but it made me sad, then angry, and then sad again—so many young lives gone too soon.

I still cannot watch documentaries about the AIDS crisis in the 1980s and 1990s because many of the protagonists—young men and their friends—remind me of me and my friends. We were a couple of years too lucky, I think. It is hard to believe that it has been 40 years since the first cases of HIV were discovered, and to believe that the same prejudice towards the virus still exists today. It is hard to believe that we were able to find a vaccine for Covid-19 in less than a year, but not one for HIV in 40 years. It is hard to believe that one in 10 people who are living with HIV today still do not even know that they have it.

The story of HIV and AIDS is one of constant disbelief, which, I think, encompasses both the misery and the marvel of that story. There is misery in the bigotry and—let us be honest—the blatant homophobia that many, including those who died in the 1980s, suffered, and which many still face today.

However, there is also the marvel. There is the marvel of the morning-after pill, which was launched in the mid-1990s. It is called PEP—post-exposure prophylaxis—and it has, no doubt, prevented the inevitable infection of so many over the years. There is the marvel that people can now take a pill each day that prevents them from becoming positive on exposure to HIV. It is called PrEP—pre-exposure prophylaxis—and more than 4,500 Scots have benefited from it. It has been a game changer, but it has also been dubbed the “promiscuity pill” by some of the tabloids. It seems that some things, or indeed some people, never change.

Let us marvel at the fact that, today, an HIV diagnosis means that people can still live a long, happy and healthy life. Some will now no longer even need daily medication, with the arrival of bimonthly intravenous jabs, which have just been approved by the national health service in England and Scotland in the past couple of weeks.

Let us also talk about disbelief. There is still disbelief among many that HIV cannot be caught from kissing, using toilet seats or cutlery or holding hands. There is my own disbelief that we still have to say those things as a public message. There is disbelief that those on the right medication with a low, or no, viral load simply cannot transmit HIV. That is called U=U, and if people do not know what that means, they can look it up. There is disbelief that young people still use the word “AIDS” as a derogatory or insulting term, and disbelief that HIV-positive elderly people in care homes still face stigma and fear around disclosing their status.

We now identify as patient zero John Eaddie, who died of AIDS in 1981, when I was just one year old. We now know his name, but he was the first of many names. I would list them all, but there are nearly 50 million of them; 33 million is a conservative estimate. That is an awful lot of names, and it would take me an awful long time to read them out, but perhaps today we can remember them: both those names known to us, and those unknown.

Let us be clear: HIV is not a gay disease, nor a disease of drug users or one that affects only people in sub-Saharan Africa. It can affect anyone, anywhere in the world. Were it not for role models on TV shows, chat shows or social media—or even for parliamentary debates, if anybody watches those—perhaps we would never talk about it in public.

Those role models include Gareth Thomas, Magic Johnson, Billy Porter and, more locally, James Bushe, whose groundbreaking fight for equality has allowed him to fulfil his dream to fly planes over our heads in Scotland, possibly even as we speak. They all came out, so to speak, about their HIV-positive status, bravely sharing their stories, but how many others had to disclose their status because of fear of being outed in the media or publicly, or at work? How many lost their jobs or their families, lost their medals, or sadly lost their lives, being unable to cope with the stigma?

If there is one thing that we have all learned this year, it is the importance of knowing our status. Getting tested for things has become normal, and we know that, when we do a test, there is no shame in a positive diagnosis. If we can all take three lateral flow tests a week to check for Covid-19, surely we can get checked for HIV just once, or maybe twice, a year. That is not too much to ask.

Vitally, that also gives us a smidge of a chance to meet our ambitious targets of eliminating new cases of HIV by 2030. If you do not test, you do not know; if you do not know, you cannot get treatment; and if you are not on treatment, you can pass it on. We have all been faced with the stark reality of epidemiology during the past 19 months, so my message today should make more sense to more people than the last time that I made a speech on this subject in the chamber.

I have one specific ask of the Government. Sexual health services in Scotland are creaking at the seams. Some people used to go for check-ups or tests every quarter, but they have not been for nearly two years now. The phone lines are clogged and appointments are few and far between, which could mean that some people are going undiagnosed. There are 4,500 people in Scotland on PrEP and more than 5,000 on HIV medication, and that is putting huge strain on dedicated services. In addition, I am afraid to say that many general practitioners have received little or no training on PrEP, PEP or HIV treatment, not least GPs in rural areas, where—anecdotally—stigma and, I am afraid, ignorance levels are, regrettably, much higher.

I thank colleagues for joining me in this debate. I make a specific and direct wider call to the public, and to anyone who is watching or listening to the debate. One, know your status; two, let us end the stigma; and three, please—please—go and get tested.

17:39  

I thank Jamie Greene for securing this debate.

Let us put AIDs in its context in the world today. In 2020, 37.7 million people were living with HIV, 680,000 people died from HIV or related causes and 1.5 million people were newly infected.

The theme of this year’s world AIDS day is “End Inequalities. End AIDS”. Today, the World Health Organization is

“calling on global leaders and citizens to rally to confront the inequalities that drive AIDS and to reach people who are currently not receiving essential HIV services.”

With a focus on reaching people who have been left behind, WHO and its partners are highlighting the growing inequalities in access to essential HIV services. WHO says:

“Division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis. Now, COVID-19 is exacerbating inequities and disruptions to services, making the lives of many people living with HIV more challenging.”

Jamie Greene mentioned John Eaddie, who was the first recorded AIDS victim to die in Britain. He was a medical mystery after he died. He was not publicly named and nor was the disease from which he died. John died on 29 October 1981 at the Royal Brompton hospital in Chelsea. The cause of death was recorded as pneumocystis pneumonia, which is a severe form of pneumonia that would later be recognised as a deadly sign of HIV/AIDS. At the time, however, doctors did not even know that a virus was the underlying cause of John’s death.

Until recently, the only trace of John Eaddie’s death was a brief entry in The Lancet medical journal in December 1981. He was described as a “known homosexual”, who had travelled to Miami and was suspected of having died from the mystery illness that was sweeping much of the gay community in America. That is the language that was used in 1981.

ITV traced all the patients who had died with pneumocystis pneumonia that year and found John’s death certificate. It was then able to find the friends who had nursed him in his final days and who had waited 40 years to confirm the mystery of his death. With their support, ITV was able, finally, to tell John’s story: he was a charming man who, in the late 1970s and early 1980s, had run a guesthouse in Bournemouth that was a safe haven where gay men could meet and drink. Such was the stigma at that time, which led to many gay men being victimised in the early 1980s, as AIDS started to devastate their communities. As was the case for most AIDS patients in the 1980s, by the time John Eaddie was diagnosed, his life expectancy would have been just months, or even weeks.

Until recently, the first AIDS patient to be publicly identified in Britain was Terrence Higgins, whose death in 1982 led his friends to set up a charity in his name.

Four decades on from John Eaddie’s death, extraordinary advances in drugs have dramatically reduced the number of deaths. Today, there is no reason why anyone with HIV should not live a full life. The UK’s goal is to cut the number of new infections to zero by 2030—that is to be commended.

However, in the UK, medicine has not cured the stigma that still surrounds HIV and AIDS, 40 years after the first death here, as Jamie Greene said. Much work remains to be done. I commend Jamie Greene for securing this debate.

John Eaddie will be remembered. However, across the world, AIDS is still killing 600,000 people a year, mostly in Africa, where access to drugs is far more limited than it is here. That is 600,000 John Eaddies every year. It is 600,000 people whose friends and families grieve for them. On world AIDs day, we must do more to end inequalities and end AIDS.

17:43  

I thank Jamie Greene for securing this debate. World AIDS day is a moment to pause and remember those who have died—and the many thousands who continue to die—of this preventable and treatable disease. It is also an opportunity to look forward with ambition and hope.

In the mid-1990s, I moved to London as an undergraduate. The height of the pandemic had passed. The tombstone image and the sombre, stark adverts had long since left our screens. The shocking and sad scenes that were recently brought back to life in Russell T Davies’s series “It’s a Sin” had faded from the nation’s consciousness.

However, even in London in 1995, young gay men were still falling ill—the friend, or the friend of friends, who might not have been seen for a while and who had left testing and treatment too late. Those were people such as Patrick, in his late 40s and the life and soul of any party, who, to my knowledge, was the first person I knew who went on to die from an AIDS-related condition.

The challenge today is to harness the progress that has been made since young people such as Patrick died, so that we can finally eradicate HIV transmission once and for all. We need to achieve what campaigners and policy makers hope will be a world in which people with HIV live healthy lives, with undetectable virus levels, and one in which new cases are halted.

I pay tribute to the organisations that work in Scotland to make that a reality. They include Waverley Care, HIV Scotland, the Terrence Higgins Trust and the National AIDS Trust, among others.

It is four decades since the first cases of HIV were diagnosed and fear ran through high-risk communities, before cases spread across continents, as we saw in Africa. The progress that has been made since then has been almost unimaginable: rapid testing; simple but effective antiretroviral treatments; and PrEP and PEP. People who, in the past, would have fallen ill and died are living normal lives. However, although treatment is effective, we should bear it in mind that there is still no vaccine for this virus, and there is still no cure.

We know that there is cross-party and global support to end new cases of HIV within the next decade. To do that, we need to maximise HIV diagnosis, so that people can access the simple treatments that mean that they can live a normal life, often taking only one pill a day.

As Jamie Greene said, the arrival of Covid has brought greater awareness and acceptance of testing. We should harness that and make testing the focus of funding, so that we take it to the next level. Testing should be an everyday norm in our homes and beyond.

Today in Scotland, 5,122 people are living with diagnosed HIV, but an estimated 500 people are living with the undiagnosed condition. Although 47 per cent of infections—the highest percentage—resulted from men having sex with men, 40 per cent of infections resulted from sex between men and women. We know that HIV does not discriminate between those who are gay, those who are straight and those who are bisexual, or between men and women.

I recall the night that a heterosexual friend told me that he had just been diagnosed with HIV. I gave him a hug and, as his tears fell on my shoulder, he talked not of his fears of the treatment that he was about to begin but about how he was scared of the stigma he thought he might face. Testing and treatment are still only two parts of the jigsaw. As Paul McLennan rightly said, we must do more to remove the problem of prejudice if we are to continue to succeed against the virus. Let us be in no doubt that success against HIV and AIDS is possible and that future transmission can be largely eradicated.

I want to close by quoting Russell T Davies, whose recent TV series reminded us of just how far we have come. He said:

“Strange to think. That it might come and go within my lifetime. That a virus can be a moment in history and no more ... It’s possible that one day, HIV and Aids might just be a memory. A story. Like some old drama that was once on TV.”

That should be our goal. It is within our grasp.

17:48  

I thank Jamie Greene for bringing the debate to the chamber as we mark world AIDS day 2021, and I praise him for his very powerful speech.

I also thank all organisations that work to support people living with HIV, to improve sexual health, and to advocate for more services and action to eradicate HIV and AIDS, most notably the Terrence Higgins Trust, Waverley Care, the National AIDS Trust and HIV Scotland. I thank them all for the briefing material that they have provided ahead of our debate today and for the work that they do throughout the year.

As each world AIDS day is marked, I reflect on how far we have come and what we still have to do in Scotland and the UK, and around the world, to meet our ambitious target of ending new HIV infections by 2030.

I wish to begin by remembering all those lost in the 40 years since the first diagnosed cases of HIV. We think of all those who have died from HIV, AIDS and related illness, the pain and suffering caused to those who loved them, and the long-lasting impact of stigma and shame, which has dominated in our society for too long.

I remember only too well when I was growing up the sense of fear that existed: the sense of othering people, particularly those in the LGBT+ community; and the view of many in the mainstream media and more broadly in society that AIDS was somehow about lifestyle choices or some kind of punishment for being gay. The lack of compassion, the refusal to seek to understand and the lack of support led to unimaginable circumstances for people and long-lasting poor mental health.

When I look at my own adult life, I realise that I have been extremely fortunate in the support that is available now for LGBT+ people in particular to talk about the issues, seek advice on safe sex, know their status and now have access to PrEP and PEP. People living with HIV have better support to live a full life and, through advancements in medicine, to reach undetectable viral status, which means that it is untransmittable and they cannot pass the virus on. I think that we would all want to praise the U=U campaign—and, indeed, the work done by charities in that area—and I very much echo Jamie Greene’s comment that, if people do not know about that, they should take some time and look at it.

It is important that we look back and acknowledge the pain and suffering of a whole generation. As we have heard, recent TV dramas have helped to do that very well. “It’s a Sin” on Channel 4 very powerfully portrayed the darkest moments of the 1980s and the culture of fear and hate that was created. “Pose” on BBC iPlayer told a similar story, focusing in particular on the discrimination that was faced by transgender people decades ago. As Jamie Greene said, “It’s a Sin” was a difficult watch, but at the time I tweeted that it made me laugh, it made me cry and it made me feel angry for a whole generation of people. These stories must be heard and lives remembered, and we must educate people about how far we have come and what we still have to do.

As for what we still have to do, the fact is that although, decades on, our world is different, and the advances have been remarkable, stigma persists. A poll in 2019 by the Terrence Higgins Trust found that public attitudes to HIV remain stubbornly out of step with scientific progress, with 41 per cent of British adults believing that everyone living with HIV can pass on the virus and 64 per cent feeling uncomfortable having sex with someone living with HIV who is on effective treatment. Almost half would feel uncomfortable kissing someone living with HIV, despite there being no risk of transmission, and 38 per cent of people would feel uncomfortable going on a date with someone who is HIV positive.

We also have more to do to achieve our target of no new infections by 2030. Indeed, organisations such as the Terrence Higgins Trust have said that we need a step change to make that a reality. I know that, in closing, the minister will want to provide an update on developments in the Scottish Government’s work to end new HIV transmissions within the decade and on any considerations with regard to expanding the access of PrEP into other healthcare settings, in particular, and other actions to reach the target.

I am proud to have been able to contribute to today’s debate, to remember the dead, to fight for the living and to strive for a world without new transmissions.

17:53  

I thank Jamie Greene for securing this debate on the 33rd anniversary of world AIDS day, which was the first international health day. I also thank all the organisations and individuals who do such important work in supporting and caring for people living with HIV, their families and their friends, raising awareness about HIV and AIDS and busting the myths around this disease. I would also like to send my condolences to all those who have lost a loved one—or more than one—to the disease or to the stigma and bigotry associated with it.

It is just a little over 40 years since the Centers for Disease Control and Prevention in the United States published a report on the deaths of five previously healthy gay men aged between 29 and 36 that marked the beginning of the recognition of AIDS. As we have heard, a few months later, the UK recorded patient zero’s death. In the intervening years, somewhere between 33 million and 50 million lives have been lost—and probably more, given poor diagnosis in many parts of the world in the past 40 years.

Others in the chamber have spoken movingly and powerfully about the situation in Scotland and the United Kingdom and the work that is needed if we are to achieve the target of zero HIV infections by 2030. I want to speak about some of the more global issues that the virus has presented us with. As we are reminded daily, none of us is safe until all of us are safe.

The global story of HIV/AIDS is multifaceted. Grief and loss are intertwined with activism and rage. Scientific triumph is mixed with futility and resilience. Sadly, a thread of suffering still runs through the story. Underpinning all of that are fundamental questions of equity, discrimination, stigma and justice.

I speak of scientific triumph: in 1996, when the results of the first successful trials of the triple-drug antiretroviral therapy were presented at the international AIDS conference in Vancouver, hope and relief spread across the world like wildfire. I remember the news stories in Zimbabwe: there was a treatment that would save lives.

However, it quickly became clear that the HIV patients on ART were in high-income countries, while most people living with HIV were in low and middle-income countries. The period between 1996 and 2003 saw the peak of AIDS-related deaths, with sub-Saharan Africa being the worst affected region in the world. AIDS care was costly. People with money might survive; people without would die. Issues such as the AIDS denialism of Thabo Mbeki’s South African Government did not help, but that people’s life chances depended on geography and wealth was, and is, morally and ethically unacceptable. Action was needed.

In 2003, George W Bush announced his emergency plan for AIDS relief. With that, and the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2005, the needed billions began to flow. Political campaigns saw the cost per patient of ART plummet from tens of thousands of dollars a year to less than $100 per year. Death rates declined and mother-to-child transmission slowed. New and better drugs and preventative tools were developed thanks to massive public sector investment. Those same HIV research networks and trial sites proved instrumental in the development of a Covid-19 vaccine last year.

Yet, the global pandemic continues. Parts of eastern Europe, central Asia, the middle east and north Africa are seeing increasing infection rates. The absence of life-saving, life-extending antiretroviral therapies means that needless deaths continue to mount up. HIV is, increasingly, an infection affecting more marginalised communities: poor people, sex workers, men who have sex with men, transgender people, those who inject drugs, adolescents, and prisoners and detainees. Stigma and prejudice live on. Covid-19 has exacerbated those challenges.

We must recognise what we learned in the 1980s and 1990s about the value of sustained investment in science, but we also must recognise the importance of global solidarity and of activism, and advocacy. That is why today, and this debate, are so important.

17:58  

I welcome this debate on world AIDS day, which this year has the theme of “End inequalities. End AIDS. End pandemics.” I congratulate Jamie Greene on securing the debate and commend his contribution. I led the debate in 2019 and am pleased to continue my support for world AIDS day and the opportunity that it presents to raise awareness 40 years since the emergence of HIV and AIDS.

I encourage everyone to access the Waverley Care and HIV Scotland websites and to learn about their work, including the generation zero campaign by HIV Scotland.

I cannot stress enough how important it is to get the message across to everyone that, once a person has received a diagnosis and had appropriate treatment so that they have no detectable load of the HIV virus, they cannot pass on the virus through sexual transmission. Waverley Care, along with NHS boards across Scotland, is doing important work to promote the importance of people knowing their HIV status, as well as promoting the undetectable equals untransmissible, or U=U, message.

In preparing for this debate, I reflected on my time working at the Cedars-Sinai medical centre in the heart of west Hollywood in Los Angeles in the early 1990s. I was in LA when Magic Johnson was diagnosed, which was huge news at the time. The stigma associated with HIV and AIDS was absolutely evident back then. I recall how people who were HIV positive or who had AIDS were negatively affected by attitudes of the public and of healthcare professionals, who should have known better. That was very distressing for people and their families and truly stigmatising. I am glad that we have moved on since then.

I also reflected on the lives that have been lost and the people I have known who have lost their lives. My condolences go out to all.

LGBT Scotland, Stonewall and even the recent Channel 4 show “It’s a Sin”, which others have mentioned, have had a huge impact in tackling the stigma, and that is welcome.

Scotland is leading the way in the fight against HIV and AIDS. When I led the debate in 2018, I spoke about the progress that was being made in Scotland to meet the United Nations 90-90-90 targets. The UN stated that, by 2020, 90 per cent of people living with HIV would be diagnosed, 90 per cent who were diagnosed would be receiving treatment, and 90 per cent would have an undetectable viral load. Despite the pressures that have been caused by the Covid-19 pandemic, Scotland has met those targets. Ninety-one per cent of those people are now diagnosed, 98 per cent are receiving treatment, and 94 per cent have an undetectable viral load. I pay tribute to NHS Scotland staff, such as the NHS Dumfries and Galloway sexual health and blood-borne virus nurse Marie Murray, who has just received a nurse consultant post for her work.

Today in Scotland, HIV is considered to be a manageable long-term health condition with treatments such as PrEP, which allows people to live long and healthy lives. On PrEP and other HIV and AIDS treatments, it is extremely reckless that the UK Government has cut UNAIDS funding by 83 per cent. A recent International Development Select Committee report laid bare the devastating impact that those cuts are having on the global fight against HIV. It said that the cut would reverse decades of hard-won progress in cutting transmission rates and death rates. Today, on world AIDS day, I repeat the Scottish National Party’s calls on Boris Johnson’s Government to reverse the cuts to UK funding for crucial AIDS and HIV treatment, as we continue to battle that other deadly pandemic.

Testing has a central role to play in reducing the number of new infections, particularly by helping to reduce the proportion of undiagnosed HIV cases. Testing can be as simple as taking a finger prick blood sample, and the results are known immediately. My ask of the Scottish Government is not to take the foot off the pedal and to continue public awareness campaigns about the importance of sexual health tests, including for HIV and AIDS.

I again welcome the debate and the progress that has been made so far, and I commend Jamie Greene for bringing the debate to Parliament.

18:03  

I must confess that I felt dismayed listening to Emma Harper’s speech, because I think that we should all come together on this occasion and speak with one voice about things that are of the utmost importance.

I congratulate my colleague and friend Jamie Greene on lodging the motion, and I thank everyone who has supported him in the debate.

There is a time in every person’s life when they are presented with a situation of anxiety. That can be when they are waiting for the first scan in a difficult pregnancy, when they are faced with the loss of their job, or when they are told that a loved one has a terminal illness. However, few situations raise as much anxiety as that in which one is waiting for a medical diagnosis. That is a scenario that many of us and our fellow citizens go through. It is made more bearable with the understanding of the person’s family and the people around them. Friends and people who love them stand by them. Nobody should face a diagnosis alone.

Far too many people face an HIV diagnosis and feel very alone. They are left feeling stigmatised by the diagnosis, and they hide away as a result of other people’s ignorance or their own sense of regret. It is worth reflecting, as Paul O’Kane indicated, that for those whose viral status is undetectable—as mentioned in the motion—the stigma can still remain. What I am saying is that, despite what my friend Jamie Greene rightly describes as huge advancements in medicine, there is still a lot of evidence that those who are HIV positive experience stigma. Too often, they feel alone, which drives a sense of abandonment, isolation and depression. We must be sensitive to the mental wellbeing of those who have been diagnosed with HIV. We must do all we can to support and help them. They need us to stand alongside them and support them with compassion.

As we move towards the target of no transmission by 2030 set by the Scottish Government last year, we must be increasingly sensitive to those who have HIV and to how we can support them. Yes, we should support them through the available treatment, but we must also offer them support as people, rather than as cases. What specific plans does the minister have for mental health support as we move towards the 2030 target? How does the Government plan to ensure that we do not leave HIV positive people behind as we focus more of our efforts on prevention?

The target to remove transmission is ambitious, but it is one that medical technology and better information make eminently possible. The reduction in infection rates as a result of PrEP, as well as treatments to allow people to live with the virus at an undetectable level, already show what can be achieved. However, we must always have a care never to leave anyone behind. Those who continue to live with HIV need our compassion, understanding and support. Perhaps, more than anything else, they need our love.

18:06  

I thank Jamie Greene for bringing this important matter to the chamber. I am struck by the many thoughtful speeches that we have heard today. I will begin by paying tribute to everyone who has lost their life to AIDS-related illness over the past four decades—it has taken too many people. I know that the pain of that loss continues to be felt by many in Scotland today and my heart goes out to them. I hope that we honour those losses with the progress that we have made and will continue to make in tackling HIV and AIDS.

Although those losses can never and should never be forgotten, a diagnosis of HIV is no longer a death sentence. In most cases, it is a manageable condition that does not prevent people from living full, healthy and happy lives. For anyone who remembers the darkest days of the pandemic, that fact still seems remarkable. Thinking about studying for my pharmacy degree in the early 1990s and learning about what was then a relatively new virus and the new drugs that were coming in to treat it, I have to pinch myself when I consider how far we have come.

This afternoon, I want to acknowledge the work over the past four decades that has got us to this point; I am incredibly grateful to everyone who has fought with such passion and dedication. We should all be incredibly proud of the strides that have been taken to detect and treat HIV around the world, including here in Scotland.

In 2017, Scotland was one of the first countries in the world to introduce HIV pre-exposure prophylaxis, offering free preventative medication to those who were deemed at highest risk of acquiring HIV. To date, more than 4,000 people have had PrEP prescribed at least once, and we have seen significant reductions in new diagnoses of HIV among gay and bisexual men in the four years since it was launched.

PrEP is not the only good news story. In October 2021, I was absolutely delighted to see that Scotland has become the first country in the UK to authorise an injection to manage HIV. That can make a huge difference to people with HIV by giving them a choice about the treatment that is right for them.

However, while we have come far, our work is not yet done. That is why the Government committed in its manifesto to eliminate HIV transmission by 2030. That is, of course, a challenge, particularly as we emerge from another pandemic that has taken a huge toll on our communities, our people and our health services.

I am in absolutely no doubt that, with the same collective purpose that has transformed HIV treatment in the past four decades, we can reach the next goal. In the coming weeks, we will take an important step towards it. Dr Rak Nandwani will begin his work as chair of the Scottish Government’s HIV transmission elimination oversight group. Its members include clinicians, academics, public health experts, third sector representatives and people living with HIV. It will develop and test a proposal for how we can eliminate HIV transmission, which is due to be published in late 2022. The proposal will contain advice on target setting, outcomes, definitions and building links right across the system to support diagnosis and treatment. To answer a point that was raised during the debate, the group will also consider options for widening access to PrEP across Scotland.

It is great to hear about the advancements that we are making on the medical side of things, but I have heard a lot about the stigma tonight. How do we break that stigma and try to educate people better so that they understand that people with HIV are not a danger to others?

This is a significant and important debate in doing exactly that: tackling the stigma and setting out that HIV is a condition that people live with now and that the disease can be driven down to such a level that it is not a risk to anyone—that it is no longer a transmissible risk.

I recognise that meeting the 2030 target will require concerted and focused effort. We have to act quickly. However, we will succeed only with careful planning, and taking our time now will increase our chances of success in the long term. I am very grateful to Dr Nandwani and the members of his group for taking on the work, and I look forward to providing future updates on its progress.

I acknowledge that continued progress hinges on the existence of resilient sexual health and blood-borne viruses services—which was another point raised during the debate. We have recently published “Reset and Rebuild: A Recovery Plan for Sexual Health and Blood Borne Virus Services” to address the impact of Covid-19 and to identify recovery priorities. To support that, the Scottish Government has already provided almost £900,000 this year to third sector organisations, and we are in the process of allocating additional funding to support specific recovery actions, focused on testing, HIV and hepatitis C elimination.

To further support that work, along with other key priorities, we are beginning work to reinvigorate the framework on sexual health and blood-borne viruses. That has guided our work for 10 years, and it has been a vital tool, but it is really important that we take stock of where we are and update the framework so that it reflects current challenges and priorities.

Will the minister take an intervention?

I think I am in my last minute.

I can give you the time back, minister.

I appreciate the minister’s forbearance, because I want to make an important point. We know that sexual health services are extremely busy, which is partly due to the introduction of things like PrEP, which has been a game changer, and partly to being victims of our own success. I congratulate the Government on that. However, those services are pushed to the limits. The problem is that many people, especially in rural communities, do not feel comfortable or able to go to their GPs, pharmacies or elsewhere for those services. If they are delivered only in those centralised environments, people will be waiting for a very long time. We need to address that now; we do not have time to wait.

That is a valid point. Some of the ways in which we have changed our access to healthcare over the course of the current pandemic will certainly be useful in widening access and reducing the stigma of accessing specialist services in future. The potential to use technologies such as Near Me and the potential to access such support in community pharmacies are likely to offer a real way forward.

In the next few months we will accelerate the work to achieve the new framework and the framework refresh in co-production with third sector clinicians and academics, ensuring that we are considering all the issues and challenges in a systemic, holistic way. Updating the framework must be collaborative. Now more than ever, the framework must be capable of delivering real change, and that means listening to those who best understand what change is needed. I am confident that, if we succeed, the framework, too, will play a vital role in helping us to achieve our 2030 target for HIV transmission elimination.

I once again extend my sincere thanks to all those who have achieved so much over the past 40 years. The AIDS epidemic exacted a tremendous cost, but I am continually humbled by the strength of those who did not give up and who fought for a better future. I commit today to continuing in that spirit and to working towards a future where HIV transmission is eliminated in Scotland.

Meeting closed at 18:15.