Is Scotland on track to eliminate HIV transmission by 2030?

As a cleaner in a hospital back in her native Portugal she had struggled to cope when rumours about her HIV status spread through the faculty.

“I was diagnosed at the same hospital I worked at,” she said.

“Word just spread.”

The people she worked with couldn’t comprehend that someone like Marques – an olive-skinned woman with typically Mediterranean features– could be HIV positive.

One might think that those who work within a healthcare setting would understand that the virus doesn’t discriminate.

Yet, decades of association of HIV with gay men and people of colour tainted their rationality.

Monica Marques's request for an Australian visa was declined due to her HIV status (Image: Waverley Care)

“People have this idea of what a person living with HIV should look like or what their lifestyle is,” she told The National.

“But I don’t look like the very wrong idea they have in their head.

“So, it wasn’t just that people were talking about my health. Suddenly, there were rumours about Monica’s ‘dark side’ that nobody knew about.

“People were making up stories, saying ‘Oh, maybe that’s why she’s so quiet’”

The situation became unbearable and Marquez decided to immigrate to Australia.

But the very same thing pushing her to leave resulted in her application being rejected.

She said: “I didn’t get my visa because I was HIV positive.

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“They wouldn’t accept me. I didn’t plan to come to the UK at all.

“At first, I thought about Switzerland but my English was better than any other language so that’s how I ended up here.”

Calling for an end to the stigma surrounding those living with HIV can seem like a platitude.

But with Scotland’s ambitious target to end transmissions in the country by 2030 it remains a very real barrier.

“HIV is now a very manageable long-term condition,” said Grant Sugden (below), the CEO of Waverley Care – Scotland’s leading HIV charity.

“Once people are on treatment they can have very good life expectancies and quality of life.

Grant Sugden is the CEO of Scotland's leading HIV charity Waverley Care (Image: Waverley Care)

“But, sadly, being diagnosed with HIV isn’t like being diagnosed with another long-term condition because of the stigma that surrounds it.

“People fear that kind of judgment to the extent that it prevents them from testing for it in the first place”.

Research published in October found that just 35% of people in Scotland would be happy to kiss someone with HIV, even though it was established back in the 1980’s that the disease cannot be spread through saliva.

Nearly half of those surveyed (46%) said they would be ashamed to tell other people they were HIV positive.

Marques acknowledged that her diagnosis precipitated a battle over her own internalised notions of shame.

However, even when she felt comfortable enough to be open about her status, barriers to acceptance still occasionally blocked her path to a “normal” life.

“When I moved to Edinburgh I got a dentist’s appointment,” said Marques.

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“Initially, they gave me an appointment in the morning but then they called to say that because I was HIV positive I’d have to be the very last person they saw that day because they needed to sterilise the tools.

“I thought: shouldn’t you be sterilising them after every patient anyway? What am I going to catch from this dentist who doesn’t clean their equipment?”

Indeed, many mundane activities continue to be more challenging for people with HIV.

Whether it’s finding an affordable life insurance policy or explaining to a prospective flatmate that they can’t catch the virus by sharing a bathroom.

So, what are we doing about it and will Scotland really reach its target by 2030?

“Scotland is doing really well globally,” said Sugden.

“We’ve got excellent HIV care and treatment services, once people are diagnosed nearly everyone is on treatment straight away.”

PrEP can stop people contracting the virus through sexual contact

The role of medical advancement cannot be understated in the battle against the virus.

The availability of pre-exposure prophylaxis (PrEP) – which, if taken correctly, stops people contracting the virus even if they have sex with someone carrying it – on the NHS has radically reduced the number of gay and bisexual men contracting HIV, with diagnoses in heterosexual people overtaking the group for the first time in 2023.

In truth, it’s not that there are any scientific barriers to achieving the goal. It’s just that certain steps need to be taken to ensure every last person is diagnosed and placed on treatment.

On World AIDS Day last year the Scottish Government announced the world’s first online PrEP clinic, which would allow people to test and manage their medication without attending a specialist clinic.

This week, Public Health Minister Jenni Minto said opt-out blood testing pilots would be rolled out at three accident and emergency units in Scotland – a measure which has proved enormously successful in England, with 1998 people being found with HIV, hepatitis B and hepatitis C in just 12 months.

But the online PrEP clinic still hasn’t come to fruition and 2030 is fast approaching.

“I think it’s fair to say that we’re falling behind England and Wales,” said Sugden.

“Wales has a national online HIV testing service and even a HIV testing week. We don’t have those things.

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“The biggest frustration we have is the speed of implementation. Everything we want to see happen is on the table and being discussed but there’s a lack of speedy progress.

“We had a recent ad campaign funded by the Scottish Government about tackling stigma, which was great, but we need to do an awful lot more.

“We’d like to see a HIV education programme for health and social care staff, for example”.

The Scottish Government is due to publish its “prioritised actions” for HIV elimination before the end of the year.

It awaits to be seen whether this action will be come soon enough for Scotland to reach the goal which, for the moment, is still very much in reach.

There are still an estimated 500 people living with HIV undiagnosed in Scotland.

However, the stories of people like Marques serve as a reminder that everyone has a part to play to ensure those living with HIV are treated with the empathy and equality their forebears were so cruelly denied.