I totally agree that stigma is a major issue—although it is, of course, not the only issue. We should put things in context and look at HIV separate from hepatitis C.
As far as HIV is concerned, nearly 90 per cent of the infected population have been diagnosed. We are a bit short of the World Health Organization target, but Scotland has done extraordinarily well on that front. I am not saying that there are not challenges—we still face challenges in diagnosing the 10 to 15 per cent of individuals who remain undiagnosed—but, over the past three decades, Scotland has done extremely well on HIV.
As far as injecting drug use is concerned—we know that there is a small outbreak of HIV among injectors in Glasgow—harm reduction services for injectors in Scotland have been absolutely outstanding. The general prevention of HIV among injectors over the past three decades has been one of the great public health achievements of all time. It is a phenomenal achievement that has saved the country incalculable human and economic costs. We must bear that in mind.
We must also accept that, when it comes to HIV and men having sex with men, a lot is being done on the pre-exposure prophylaxis front: a lot of new work is being done to reduce transmissions. Although there are challenges on the HIV front, we must recognise that health services and the Government have done a great deal. That said, I accept that there is more to be done.
The hepatitis C virus is a different ball game. The action plan came out in 2008. At that point, 38,000 people in the country were infected. Ten years on, 34,000 people are infected, so its prevalence has come down. The figure would have been much higher than 38,000 had it not been for the action plan, but the situation is a huge challenge. In 2008, 38 per cent of the estimated hepatitis C infected population had been diagnosed; now the figure is nearly 60 per cent.
A really good job has been done in contacting infected individuals, but there is a massive job still to do. As John Dillon pointed out, thousands of people have been diagnosed but are not engaged with services or able to take advantage of the new therapies.
The critical issue is making bespoke services for that very vulnerable and chaotic population group. NHS Tayside has done that extremely well: I would like to see its approach being rolled out to the rest of Scotland. There are islands of excellence and outstanding practice in other health boards, but that is not enough. We must tailor our services and make them user-friendly. We should not expect these guys to come to us in our hospitals; instead, we should get out into community settings and make sure that they are diagnosed and treated. By doing that, we will handle the problem.
Part of the issue is stigma, but other factors come into play.