Meeting of the Parliament

Meeting date: Wednesday, November 30, 2016

Official Report 1079KB pdf

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World AIDS Day 2016

The next item of business is a members’ business debate on motion S5M-2404, in the name of Kezia Dugdale, on world AIDS day 2016. The debate will be concluded without any question being put. Members who wish to speak in the debate should please press their request-to-speak button.

Motion debated,

That the Parliament notes the 28th annual World AIDS Day is being marked on 1 December 2016; believes that this is an opportunity to remember the estimated 35 million people who have died from AIDS-related illnesses since the start of the epidemic; recognises the importance of high-quality treatment for the 36.7 million people currently living with HIV across the world; supports efforts to meet the UN 90-90-90 goals, which would help end the global AIDS epidemic, and understands the need for innovative HIV policy solutions for Scotland to fully achieve these targets, which it has yet to reach; further understands that there are approximately 6,150 people living with HIV in Scotland, with an average of one person every day being diagnosed, and considers that ending HIV-related stigma by guaranteeing access to quality sexual health education and increased HIV awareness is crucial to ensure that more people access testing services, and commends the work of HIV Scotland in promoting policy changes that are grounded in evidence and experience of people living with, and at risk of, HIV.

17:40  

I start by drawing the chamber’s attention to my entry in the register of interests, where it is listed that I am a member of the Terrence Higgins Trust. The trust is named after Terrence Higgins, who was the first person to die of AIDS in the United Kingdom, succumbing to the disease in London’s St Thomas’ hospital aged just 37.

I am very grateful to all members who have decided to stay in the chamber to listen to or participate in the debate, which is designed to mark world AIDS day, which is tomorrow. I am particularly grateful to HIV Scotland for all the work that it has done ahead of tonight’s debate and, indeed, ahead of tomorrow’s lunchtime reception in Hemma, which members are most welcome to attend.

Having cornered several friends across the chamber and encouraged them to speak tonight, I know that we are in for an excellent debate. For Labour’s part, Anas Sarwar will pick up the global and international development dimension of the battle against HIV and AIDS. Monica Lennon will discuss issues to do with HIV services for drug users, and Daniel Johnson will talk a little bit about Waverley Care here in Edinburgh and some of the work that the University of Edinburgh is doing to find a cure for the disease.

That leaves me with plenty of scope to reflect on how we got here. I have had a long-standing interest in HIV/AIDS—an interest that predates my experience of knowing dear friends who are HIV positive; being at ease with my own sexuality; and understanding the history of the lesbian, gay, bisexual and transgender community’s relationship with the disease. My interest also predates all the fundraising efforts on our television screens to tackle the spread of AIDS, as it savaged, and continues to savage, sub-Saharan Africa.

I am very much a child of the 1980s, having been born in 1981, which was the year in which AIDS was first clinically observed. It was not called that at first. The working title, so to speak, was 4H—named after the four groups most likely to get it: heroin users, homosexuals, haemophiliacs and Haitians. That was replaced with GRID, which stood for gay-related immune deficiency—a name which, fortunately, had a very short lifespan.

We are all aware of the UK Government TV campaign of the time, which warned of a disease that was spreading—a disease for which there was no cure. There was a terrifying advert that started with an explosion and ended with a giant tombstone with the word “AIDS” engraved on it and the slogan “Don’t die of ignorance”. A leaflet version of that advert was posted through every letterbox, on Margaret Thatcher’s command.

I personally recall watching Mark Fowler try to tell his mum and dad in “Eastenders” that he had a virus—that it was just one of those things; that it did not mean that he was ill, just that he could get ill—but all they could hear was “AIDS” and all they could think of was the death sentence that came with it.

What I did not, and could not, appreciate, though, was how HIV/AIDS was affecting this dear city that I now have the great privilege to represent. We cannot, and should not, forget that Edinburgh was, during the 1980s, the AIDS capital of Europe. If Edinburgh was the capital, Muirhouse was the epicentre. It was a community with deep-rooted poverty, appalling houses and mass unemployment that was exploited by drugs, and the heroin brought HIV. A study of around 230 drug users from Muirhouse in the 1980s showed that 52 per cent of them were HIV positive. Sharing needles was literally a game of Russian roulette, as was brought vividly to life for all of us who have seen Irvine Welsh’s “Trainspotting”.

Such a density of cases forced the Scottish AIDS Monitor into existence, and soon support services that we now know as Waverley Care were established. In 1991, Milestone house was opened as a hospice for people dying of AIDS. On Friday night, I attended a Waverley Care event to raise funds to keep it going, 25 years on. The difference now, of course, is that it has evolved from caring for those who are dying to assisting so many more people in living their lives positively.

In preparing for tonight’s debate, I took some time to look properly at some of the press cuttings from the 1980s. It is hard now to grasp the outrage that was sparked when Princess Diana was photographed holding the hand of a man who was dying of AIDS in Canada. How brave and groundbreaking it was of her to say, in 1986:

“HIV does not make people dangerous to know. You can shake their hands and give them a hug. Heaven knows they need it.”

She seemed to know instinctively that what was needed was compassion and understanding, not fear and ignorance. How applicable that is to so many of the problems that we face in the world today.

The first debate in the House of Commons on HIV/AIDS took place in November 1986—serendipitously, 30 years ago almost to this very day. Having read the full Hansard report, I would like to share some excerpts with members.

The Secretary of State for Social Services, Norman Fowler, was the first to speak. He told members that AIDS was a “serious threat”, and highlighted that there were 565 cases in the UK and 284 people had died. He said:

“The likelihood is that it is a problem for at least the next 10 years, probably for the rest of the century ... Even if no one else becomes infected from tomorrow, there are still the estimated 30,000 carriers”.

Little did he know that, just five years later, there would be 10 million people living with HIV. Today, the figure stands at 36.7 million people.

Sir David Price MP rose to ask for some clarification from the minister. He asked whether the disease could be transmitted through saliva or tears. What about breast milk? Was it safe to hug, to kiss, to cry or shake hands? He concluded:

“There is no ... evidence to treat them as lepers, although some elementary precautions should be taken.”

Anna McCurley MP—the Tory member for Inverclyde, no less—suggested that homosexual surgeons, dentists and even people working in the food handling industry should withdraw from their jobs and be compensated by the Government for doing so in order to reduce the risk of transmission. My dear friend Gavin Strang, who served as the Labour MP for Edinburgh East for 40 years, was the first to demand specific help for prostitutes such as counselling, alternative work, free condoms and dedicated healthcare. Those are just four of the demands that he saw as necessary, having seen at first hand the disease take hold of Edinburgh.

Frank Dobson warned that the threat facing the heterosexual community was underplayed. He said:

“That is partly because of the ... presentation by The Sun and other newspapers of AIDS as a gay plague. The people responsible for that sort of reporting must bear a great deal of the blame for helping heterosexuals to believe that AIDS was no threat to them.”—[Official Report, House of Commons, 21 November 1986; Vol 105, c 800, 818, 860.]

I could read from the report of the debate all night, but I suspect that the Presiding Officer is keen for me to conclude at some point soon, not least to let other members have a go. I will tweet the link to the full report of the debate so that folk can read it for themselves.

Fast forward 30 years to today, and we have made vast progress. HIV is now one of the most scrutinised viruses in the world, and we probably know more about its transmission, spread, management, treatment and prevention than we know about any other disease, yet we have no vaccine and no cure—but we are close. Medical advances have given us antiretroviral therapy, which has transformed the lives and life chances of people who are living with HIV. Testing is critical, because early detection combined with early adoption of antiretroviral medication means happy, healthy lives. In fact, someone on antiretroviral medication may now have a viral load that is so low that the disease becomes undetectable again, and the risk of transmission to others is so small as to be statistically unquantifiable.

An HIV infection is no longer a death sentence. People who are living with HIV today say that it is not the infection that is the hardest thing to live with—it is the stigma, and the fear of how people will treat them. Fear and ignorance are two concepts that were the drivers behind how this country spoke about and dealt with HIV and AIDS in the 1980s, and they still exist today. However, we know that they can be defeated by education, whether that is formal education for pupils in schools; the information that is given to those working in saunas; informal conversation, compassion and understanding; or nights like this and days like tomorrow.

In marking world AIDS day this year, I conclude that, while so much has been done to tackle HIV, there is so much more to do. I pay tribute to all those individuals in HIV Scotland, THT and Waverley Care who have made tackling HIV and AIDS their life’s work.

17:50  

Tomorrow is world AIDS day, and the first day to raise awareness of HIV was 1 December 1988—that was the first world AIDS day. While working in the USA in 1990, in the surgical environment, I learned a lot about the harm that HIV could cause to my patients. I learned about the presenting symptoms of the opportunistic infections called Kaposi’s sarcoma and Pneumocystis carinii pneumonia. Nobody talks about them any more.

When I worked in trauma theatre, emergency surgery often meant the potential to be exposed to blood. Wearing personal protective equipment such as gowns, gloves, masks, face shields and goggles, and safely handling scalpels and sharps, meant that healthcare workers were protected from exposure and risk was reduced for us.

People who had the virus were stigmatised; it was easier to avoid them than to care for them. Many of the doctors and staff I worked with avoided operating theatres or even speaking to patients without suiting up. That was daft, because HIV was already known to be transmitted via blood and not to be airborne, but people were feart.

The disease has no cure. My best friend, Jacqui Pitt, worked as an HIV research nurse in Los Angeles. She helped me to understand the disease and how I could use my knowledge to care for human beings in the best way that I could.

In 1991, Earvin “Magic” Johnson, who was a famous basketball player for the LA Lakers, announced that he was HIV positive. He was not gay; he was heterosexual and he had a wife and weans. He highlighted that HIV and AIDS was not just a gay man’s disease and, for me, that highlighted the need to address the disease and not judge or stigmatise the person.

Magic sought treatment and, in 1995, he announced that he had zero viral load. The media grabbed that and said that we had a cure, but it was not a cure. However, the treatment has advanced. We now have antiretroviral drugs, post-exposure therapies and even pre-exposure treatments for those who are deemed to be at high risk.

HIV Scotland says that HIV stigma is one of the biggest barriers to testing, treatment, care and support. Earlier today, I spoke with one of NHS Dumfries and Galloway’s blood-borne virus nurses, Liz Kent. That wee health board is doing great work for all its patients with the resources that it has, but she said that stigma is still attached to persons with HIV. Those people must not be discriminated against. She also said that we need to continue to raise the awareness of many young people who do not know the history of HIV evolution.

The theme for world AIDS day is losing the stigma that is associated with HIV.

Communities such as those that Emma Harper is talking about in Dumfries and Galloway can be quite intimate, and stigma can be more pronounced as a result. Is there a case for increasing the availability of home testing so that people can avoid having to present at a clinic for testing among people who they might know and who might be aware of the reasons why they might be in that clinic?

The issue of addressing stigma is interesting. If home tests are available, the idea could be pursued. Other home and point-of-care testing can be done with devices that are already on the market; I used some when I worked in cardiac surgery. I would be interested in hearing more about anything that would help to address the stigma.

Today most people with HIV live healthy lives. On world AIDS day, I thank the specialist nurses, the blood-borne virus nurses and the infectious disease doctors, as well as all other healthcare providers, for their selfless work. Let us remember the people who have lost their lives and families, and continue to support and not stigmatise the people who are living with the disease. They are our fellow human beings.

17:55  

I thank Kezia Dugdale for lodging the motion for debate and I note the significant fact that tomorrow is world AIDS day.

As a child of the late 1970s—I am slightly older than Kezia Dugdale, but not by much—I, too, well remember growing up with AIDS in the news, the pictures of Princess Diana and so on. Even at that age, it was impossible not to be aware of the high-profile hard-hitting advertising campaigns and the growing public knowledge and understanding, albeit sometimes slow and cautious, of the condition. Perhaps we thought that we had done enough, that we had won the battle and that there would be no need, three decades later, to continue to talk about it. Of course that is not the case; it is more important than ever.

The National AIDS Trust has chosen as the theme of this year’s awareness day a focus on the stigma that continues to surround the issue, and I will talk about stigma. Many things have improved since the initial outbreak of the condition in the late 1970s, such as the way in which we talk about it, the ease with which most people can be tested and the way in which we manage and treat the condition, but one aspect that remains a problem is how people view HIV/AIDS and how people who have the condition are treated by society at large. One statistic that the trust produced particularly surprised me: it is that two out of five people in Britain believe that their manager should tell them if a colleague is living with HIV.

Attitudes such as those are archaic and ill informed, but we cannot rely on simple condemnation to bring an end to such views. Education is fundamental. The Terrence Higgins Trust reported that three out of five children receive no information on HIV at all in school. There is clearly a need to improve the way in which we communicate on the matter but, beyond that, there are issues with how we approach sexual health education in schools. For many parents, it can be a taboo subject—I understand that as a parent. I support a collaborative approach in our schools between parents, young people and teachers to addressing sexual health and relationships, so that by the time that my children are of a certain age, they will not fear talking openly about those subjects.

I had the pleasure of meeting HIV Scotland last month to discuss a variety of issues that relate to HIV/AIDS and in particular its positive persons manifesto 2016. We discussed HIV prevention and what we in Parliament can do to help to fight HIV/AIDS. Tackling stigma is fundamentally linked with prevention. As HIV Scotland notes, about 17 per cent of people living with HIV do not know that they are living with it. HIV Scotland adds that

“one of the biggest barriers in getting people to get tested, is HIV stigma”.

There is a great need to increase access to safe testing. Public awareness campaigns are now significantly better compared with the sombre and off-putting adverts in the 1980s that I recall growing up with. It is incumbent on the Government to ensure that such preventative methods continue to be supported.

One issue that can be missed in the debate is that we tend today to focus more on the sexual aspect of HIV/AIDS and to forget to discuss the continuing problem of HIV infection as a result of drug use. Jamie Greene and I visited Inverclyde royal hospital on Monday and met NHS staff who treat drug addicts. The staff talked of the fact that the cohort of drug users who are at risk is ageing, and they demonstrated the various methods that they use to facilitate safe injecting as well as improved mental health. They spoke of the particular problem in the greater Glasgow area of a recent alarming spike in cases.

I end on an optimistic note. We have travelled far and there is more to do, but people with HIV are living longer and healthier lives and, with treatment, they have full life expectancy. That is a world away from the world of the late 1970s and early 1980s. Let us keep talking about the condition and keep campaigning. I am delighted to support the motion and to participate in the debate, and I commend Kezia Dugdale for driving the issue forward.

17:59  

The tone and content of the debate have demonstrated the very best of our Parliament. The speeches have been fantastic, and I am sure that that sends a strong message to the people of Scotland.

I put on record my thanks to HIV Scotland, which has done so much tremendous work in the run-up to the debate and for years on this important issue.

I was particularly struck by what Kezia Dugdale said in her speech, and I thank her for securing the debate. I vividly remember the “EastEnders” storyline that she mentioned, the message about “Trainspotting” and the Princess Diana photograph. When we were at school, AIDS or HIV was something that people would tease each other about—they would make silly remarks about how you could not shake hands with or kiss someone who had it. I am proud that we have moved away from that, but I do not think that we should be complacent about the stigma that still exists in many parts not only of Scotland and the UK but of the world. We have made great progress, and I think that the way in which we have dealt with HIV is an example to campaigners, charities and international development organisations around the world. However, as I said, we cannot be complacent.

We in the UK have played a leading role. I am proud that it was a Labour Government that, in 2002, actively supported the global fund to fight AIDS, which was funded primarily through the Department for International Development. I am also pleased that the current UK Government has donated to the replenishment of that global fund—it has pledged some £1 billion over the course of the current Parliament to tackling HIV and AIDS around the world. It is important to recognise that, through that global fund, we have been able to support direct intervention in the lives of 20 million people. That has been made possible through the support of UK taxpayers, who have put money towards the global fund and caring for others in other parts of the world.

When I was a member of the Westminster Parliament, I served on the International Development Select Committee. I also had the honour of being a shadow international development minister. During that time, I had the privilege of working with campaigners and charities here in the UK and of making visits to many countries, particularly in Africa, speaking directly to patients who had issues around HIV and learning from them about what different actions we could take to shape our international development response. We must not lose sight of that because, across the world, there are 17 million people who are living with HIV and who are on treatment, more than half of whom have received treatment directly because of the global fund.

However, we should not be complacent about what is happening in Scotland. Although we have been successful in that 94 per cent of those people who have been diagnosed are on treatment, and 95 per cent of those have an undetectable viral load, we have a long way to go, particularly on diagnosis. One in six people in Scotland who are living with HIV are as yet undiagnosed. Across the world, it is estimated that half of the 37 million people who are living with HIV are unaware of their status and what it means for their health, which means that they could unwittingly pass on the virus to others. We have a human responsibility to try to do something about that.

We have made great strides. I want to make two final points, both of which relate to Glasgow. In the past year, there has been a spike in the number of cases of HIV in Glasgow. Research is needed into why that has been the case and what we need to do differently to avoid that continuing for a longer period of time. I pay tribute to Glasgow Caledonian University, whose school of health and life sciences has been doing research on the issue of stigma and discrimination around HIV, on which it has today published a follow-up report.

Mention has not been made of the opportunities of PrEP—pre-exposure prophylaxis—and I hope that someone will raise the issue.

We have a commitment from all parties in the Parliament—and, I hope, from all levels of government across the UK and from international aid agencies—to tackling HIV. We must tackle it not only at home but around the world, because we have a human obligation to do so.

18:04  

As other members have done, I thank Kezia Dugdale for bringing her motion to the chamber for debate and congratulate her on doing so.

Kezia Dugdale began by talking about the advertising campaigns in the 1980s. I am a modest bit older than she is, and I was about 12 or 13 when those iceberg adverts came out. Their principal impact was to accentuate people’s fears, while doing nothing at all to demystify and destigmatise the illness and the virus. That was at a time when a huge amount of vitriol and prejudice was being promoted by the tabloid press.

A few years later, I went to university in Manchester and that odious man, James Anderton, the chief constable of Greater Manchester Police—God’s cop, as he was called—had been describing people as

“swirling around in a human cesspool of their own making”.

That was his description of issues like HIV. When I was a student enjoying the dubious delights of the gay village in Manchester, he was sending cops to raid gay clubs wearing biohazard gear—that was the level of the prejudice and stigma that he was happy to promote, rather than to challenge.

As a student activist, I had many opportunities to get involved in sexual health promotion on campus and, later in life, I had the chance to do that as a professional in PHACE Scotland—Promoting Health and Challenging Exclusion—or PHACE West as it was at that time, which is a project for HIV AIDS care and education based in Glasgow. Like many people doing youth work in that field, I cannot be alone in remembering moments when—despite the successes that I had and the positive work that I did—somebody who I was working with told me that they had had a positive diagnosis. That is not the kind of thing that you can leave at your desk at 5 o’clock, and I would wonder for a long time whether I could have done more. Those memories stay with me.

I was working in the HIV field at the beginning of something new called PEP, or post-exposure prophylaxis. Initially, the idea was that people who were working in clinical settings—those who got a needlestick or stab injury, for example, as was mentioned earlier—could be given a dose of antiretroviral drugs in order to limit their chance of becoming HIV positive. It was the beginning of the thought of applying it in sexual health settings, so that people who had been exposed to the risk of HIV infection through unprotected sex might also use post-exposure prophylaxis to prevent them becoming HIV positive. Although that had a hugely positive impact, it was accompanied by hugely negative stigmatising portrayals in the press.

As we sit here now, it might be desirable to think that we have overcome that. However, as we begin to debate pre-exposure prophylaxis—using existing antiretroviral drugs to protect somebody who is at an existing high risk of infection—we again see stigmatising treatment from the likes of the Daily Mail. It had a big banner headline not so long ago saying that there was a “skewed sense of values” in the NHS considering funding PrEP, and contrasting HIV AIDS with other conditions that would go without treatment, notably children’s conditions, as if children going without treatment would be the simple trade-off. What nonsense. I know that the decision lies ultimately with the Scottish Medicines Consortium on the point of an application, but we all have a responsibility—if that decision comes to be made—to openly and vocally challenge the prejudices that still exist among those who would seek to misrepresent PrEP and the opportunities to use it.

As HIV has moved closer to being a chronic manageable condition in the wealthy west, we must be committed to ensuring that that is achieved throughout the world. Countries with that intention will have to step into the breach when the Trump-Pence regime takes over in America and begins to withdraw funding for sexual and reproductive health from its international development work. We must all commit ourselves to stepping into the breach, too.

There is so much that people want to say in today’s debate and there are still a few members who want to speak. I am happy to accept a motion without notice to extend the debate by up to 30 minutes.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Kezia Dugdale]

Motion agreed to.

18:09  

I welcome the debate on Kezia Dugdale’s members’ business motion, ahead of World AIDS day tomorrow, and the opportunity to highlight some of the important issues around HIV and AIDS.

For those living with HIV in Scotland today, treatment and care is much improved from even a couple of decades ago. However, despite those changes, HIV policy solutions need to be further improved upon in order to help stop the spread of HIV in Scotland and to achieve the ambitious United Nations 90-90-90 goals by 2020.

As we have heard, there are approximately 6,150 people living with HIV in Scotland. Further to that, 217 people have been diagnosed with HIV in Scotland in 2016 so far. However, as Anas Sarwar said, around one in six of those with HIV in Scotland is thought to be living undiagnosed, so the actual figure is likely to be a lot higher. It is important that those new cases of HIV are given particular attention, and that focus is given to the issue of how we prevent new cases of HIV from occurring.

As Anas Sarwar noted, there is an on-going outbreak of HIV in Glasgow among people who inject drugs. That is concerning. In the NHS Greater Glasgow and Clyde area, there have been 72 new diagnoses of HIV related to drug use over the past 18 months. In the first six months of 2016 alone, 18 new cases of HIV in Glasgow were found to involve injected drugs, which was more than the number of new cases that were discovered to have been transmitted sexually.

I would like to pay particular thanks to David Liddell of the Scottish Drugs Forum for his work in highlighting the issue and for the recommendations that his team has made about the actions that should be taken.

Any rise in the number of people contracting HIV is concerning, and this rise among intravenous drug users is a serious public health concern. The risk of similar outbreaks in other areas of the country and the risk of spread to other populations through patterns of imprisonment, involvement in prostitution and the resettlement of homeless people must be taken seriously.

Reducing cases of HIV in Scotland starts with improving education about and awareness of the disease. I echo the view of the Scottish Drugs Forum that an education campaign for drug users and staff in front-line services would be beneficial. As co-convener of the cross-party group on drug and alcohol misuse, I am keen to explore how we can continue to reduce the stigma that is directed at substance users and to increase the uptake of regular HIV testing.

Early detection and treatment is key to the reduction of infection and to better outcomes for patients. Last week was HIV testing week and I was happy to support that. It is important that any education or awareness-raising campaign focuses on the importance of regular testing for people who are involved in drug misuse.

We must do better to raise awareness about HIV by improving how we equip young people with the knowledge that they need to prevent the risk of infection. Current Scottish Government guidance on sex education, and the sexual health and blood-borne virus framework from 2015, acknowledge the importance of relationship, sexual health and parenting education as a means of ensuring that all young people have the information that they need to enable them to make healthy choices. HIV Scotland has been involved in great work on this topic. Its “Positive Persons’ Manifesto” from 2015 highlights sexual health education as a key factor in preventing the spread and contraction of HIV.

Given that acknowledgment that sexual health education is vital, I would welcome moves by the Scottish Government to further consult on making sexual health education compulsory in the Scottish curriculum.

As I stated earlier, the situation for people living with HIV in Scotland today is much better than it was even a couple of decades ago. Despite that, stigma about HIV and those who live with it persists. Improving education about HIV is the way to ensure that the transmission rate continues to reduce, and that people with the infection will be able to receive early treatment.

You are all taking terrible advantage of me now.

18:14  

I thank Kezia Dugdale for securing this members’ business debate on the eve of the 28th world AIDS day. As Donald Cameron said, one of the key messages of world AIDS day this year is:

“HIV Stigma: Not Retro, Just Wrong”.

The campaign is unfortunately all too necessary, as ignorance and misconceptions of HIV/AIDS are still far too prevalent in our society. The debate provides an opportunity to debunk some of the myths and stand up to HIV stigma.

As Kezia Dugdale mentioned, just under six months ago, at the beginning of June, we passed the 35th anniversary of the first public reporting of what would later be termed AIDS. Next year will mark the 30th anniversary of when human immunodeficiency virus—HIV—was confirmed by the International Committee on Taxonomy of Viruses. Most importantly however, July 2016 this year marked the 20th anniversary of the 1996 international AIDS conference in Vancouver, where the successful development of the first effective antiretroviral therapies was announced. Since then, there has been significant progress, with new and less toxic drugs developed and, importantly, the pill burden reduced.

I bring those dates to the attention of members to illustrate the very simple point that, for the majority of time that we have been aware of HIV/AIDS, we have also been able to treat it and to turn it into, as Patrick Harvie said, a “chronic manageable condition”. Although a vaccine and a cure have so far proved elusive, we are getting closer. Only last month, we learned of encouraging early results from the kick and kill strategy. When HIV is still in the blood but at undetectable levels, perhaps because of the blood-brain barrier, that new method is getting in there and removing the last vestiges of HIV when it is hidden from detection. In the last few days, it was announced that the biggest ever HIV vaccine trial has begun in South Africa.

The reality is that, for the vast majority of people who receive ART, HIV is no longer a death sentence. The British HIV Association has said that successful ART is as effective as consistently using a condom in limiting transmission. The reality is that, in the developed world, we are winning the fight against HIV. However, we cannot be complacent. As was mentioned, of the approximately 6,150 people living with HIV in Scotland, it is estimated that 17 per cent are unaware of their status. HIV positive individuals who do not know their status are at risk of inadvertently passing on the infection. For the majority of those infected, if left untreated, HIV will progress to AIDS.

In tackling HIV, prevention is still exceptionally important and our first line of defence. That is why, as Monica Lennon discussed, it is vital that our young people are equipped with the skills to talk confidently about relationships, sexual health and parenthood. Additionally, the development of PrEP represents a significant advancement in our ability to prevent transmission. I have been encouraged by the Scottish Government’s approach and I urge the manufacturer to make a submission to the SMC at a fair price as soon as possible.

We must continue to be alert to developments and remember that new challenges may emerge. Last year, it was reported that the most aggressive strain of HIV ever studied had been found in Cuba. Of the 73 patients initially studied, all progressed to AIDS within three years, with a median latency period of only 1.4 years, compared to a median time of 9.8 years for average HIV strains. So far, that variant has been limited to relatively small numbers, but it serves to remind us of the challenges that may emerge in the future and the need to keep HIV/AIDS at the top of the political agenda.

In closing, I reaffirm my support for the continued fight against HIV/AIDS and welcome the plans to re-form the cross-party group on sexual health. Together, we can end HIV stigma, continue to create a supportive and inclusive society for HIV positive people and take another step towards a world where AIDS is found only in the history books.

18:19  

I thank Kezia Dugdale for bringing the debate to Parliament. There have been some excellent contributions from all parties.

Earlier this month, I was honoured to speak at the youth stop AIDS campaign’s big weekend in Glasgow. The young volunteers there had come from across the United Kingdom and had given up their weekend to support one another on a peer-to-peer basis. We heard some really moving and inspiring speeches. One was by a young man called Robbie Lawlor, who shared his experience of testing positive in Ireland, and told us about the relative lack of support that was available to him after his diagnosis. That is something that I took away from the event and have thought a lot about since.

We can all be thankful that antiretroviral therapy means that people who live with HIV today are enjoying healthier and longer lives than was possible 20 or 30 years ago. Being diagnosed with HIV today means something very different to what it meant in those days, but we are very much mistaken if we think that it is a problem of the past, which is why one of the hashtags for world AIDS day this year is “#HIVnotRetro”.

Like Kezia Dugdale, I am a child of the 1980s and I remember many of the campaigns that we have spoken about being on television and in print, and in a lot of the gay media at the time, as well. They made the public aware of the importance of taking charge of their own sexual health. Admittedly, it was a fear campaign, but there is a generation of young sexually active people today who do not have those images ingrained in their brains in the way that I and some of my friends do.

In the Greater Glasgow and Clyde area alone, there have been 77 new cases reported this year. Young men in particular need to be made aware that the risks are still very real. Donald Cameron mentioned the meeting at Inverclyde hospital. I want to add some further thoughts about that, because we were also told about increases in other blood-borne viruses among certain groups, including young professionals who are social drug users and who snort drugs, and men who are gym goers and steroid users. We should not ignore the growing prevalence of intravenous drug use during sex, which is becoming an epidemic in certain parts of the world among men who have sex with men. It is not just people who are living in depravity and injecting drugs who are at risk; a whole bunch of other people out there are at risk, but we tend not to talk about them so much when we discuss the issue.

It is important to note that, of the HIV-positive individuals who have been reported in 2016, 81 per cent are male and 60 per cent are aged between 25 and 44. Those facts strike a very personal note with me. I have many friends who are HIV positive and I know their personal stories and experiences. I know of many who, as a result of their diagnoses, have found it really difficult to cope and have turned to alcohol or drugs. Many suffer from depression and anxiety and in some cases have been suicidal—in one case, unfortunately, successfully so. Particular attention should be given to how we help people who have recently been diagnosed.

As we know, about 17 per cent of the people who live with HIV in Scotland do not know their status. Stigma has a big part to play in that, but so does fear. I can talk only from my experience, but I know that fear of going for a test is fear of what the result might be. It is fear of having to tell people about a positive result, and it is fear of how one might cope internally and whether one has the mental strength to deal with a positive result. We need to help people to get over that fear. HIV Scotland is producing a draft strategy on stigma; I hope that the Scottish Government will heed any recommendations that come out of that.

I am also pleased to be, alongside Kezia Dugdale, Patrick Harvie and Ben Macpherson, a co-convener of the cross-party group on LGBTI+, and I hope that we can work with other cross-party groups and find mutually interesting areas so that we can discuss issues and help one another.

World AIDS day is still important, because it reminds the public and Governments that the problem has not gone away. It is still important that we raise money, increase awareness, fight prejudice and improve health and education services, and it is our duty as legislators to ensure that we do everything in our power to take the lead on prevention, treatment and awareness. Tomorrow, I will remember those who sadly have passed, and I will remember with sorrow that medicine could not help them in their day, but I will also remember them in hope that debates such as this will bring the issue to the forefront of people’s minds and that the hard work will continue.

18:24  

I am hugely pleased to be speaking in this debate, not just because it is always a good idea to be supportive of a motion that one’s leader puts before Parliament but because, as so many members have said, AIDS is something that people of my generation have grown up with. One interesting aspect of the debate is how so many of us have brought up the same experiences. I, too, remember the TV ads; I must have been nine or 10 when they came on, and they scared the living whatever out of me. I hope that that is parliamentary language, Presiding Officer.

The subject of HIV/AIDS has been defined and is haunted by that fear. What I find remarkable is how far we have come, and how far we have still to go. We can tell much about a society’s prejudices from the names that children call each other in the playground. It is absolutely right that we have moved on from HIV/AIDS being used as a playground taunt. People are now surviving and living with HIV-positive status.

As I have said, however, we still have far to go. When I was talking to people from HIV Scotland at a photo call earlier, I remarked on how HIV/AIDS has been a defining issue for people of my generation. They said that although that is true and interesting, the fact is that people of my age and demographic are most likely to acquire HIV infection.

That says something about where we are, because as members have pointed out, the condition is defined by marginalisation and stigma. That is understandable, given that the primary vectors by which people acquire HIV are sex and injecting drug use. The first is an issue that we are obviously very sensitive about, while the second is, by definition, about a very marginalised group of people. However, as the conversation that I had today made clear, there is also the issue of complacency to address. We cannot be complacent, because HIV/AIDS is a condition that preys on marginalisation, stigma and complacency.

Like Kezia Dugdale, I want to highlight the work of two organisations that are based in my Edinburgh Southern constituency. The first is Waverley Care, which was set up when Edinburgh was acquiring the title of AIDS capital of Europe. In 1991, it set up Milestone house, the very first AIDS hospice, which was opened by Princess Diana, who in her very direct, human and physical way did so much to break down the barriers of HIV/AIDS.

The story of Waverley Care, which I am very pleased to be visiting on Monday, tracks the story of HIV/AIDS in that it has gone from being an organisation that was focused on end-of-life care to one that is focused on outreach support, respite and helping people with HIV and AIDS to live well. Moreover, it is not only working very hard to speed up discharges from the NHS, but is doing much to address the stigma that members have highlighted. For example, it is working with marginalised communities and focusing on the damaging effects to the individual, as they live with fear of the judgment that HIV status might bring, as well as the damaging effects that are caused by not talking about the issue with other people, by not acquiring information about it and by being scared to be tested. All of those lead to later diagnosis and promote the spread of HIV—in other words, the fear itself drives infection.

I want to highlight two projects in particular. The first is the HIV Always Hear project, which works with church groups and schools to ensure that people have information about HIV. Likewise, the caring conversations project works with general practitioners and other healthcare professionals to ensure that best practice and understanding of the healthcare implications of HIV/AIDS are shared well.

I also want to mention briefly the work of the University of Edinburgh, specifically the HIV, human rights and development network. Its first seminar was hosted here in Parliament by my predecessor Jim Eadie in 2013. It is the UK’s first such network of academics and professionals. They have been brought together to focus on the intersection of HIV and the conditions of powerlessness, poverty, inequality and exploitation, and to look at the social, political and cultural elements that lead to the spread of HIV, and how they can be used to tackle that spread.

As I have said, many members have talked about marginalisation and stigma. I would add complacency to those as the issues that we need to examine and tackle. However, in order to tackle marginalisation, we need to understand that this is an issue that affects people. That approach will breed better understanding, but any such understanding must, in turn, rely on better information and communication. In that way, we will demystify HIV/AIDS and take away the fear and the stigma that contribute so damagingly to the condition.

18:30  

I sincerely thank Kezia Dugdale for securing the debate and for the very informed, passionate and emotional way in which she addressed us. That approach has been echoed by every member who has contributed to the debate.

Kezia Dugdale reminded us that Terrence Higgins died at the age of 37. I will be that age next year. The age at which Terrence Higgins died is a reminder of the tragedy of a life cut short and potential unfulfilled, but his impact has been profound, and the improvements that have been made in his name have been huge.

Like many members who have spoken in the debate—to add to the long list of 1980s children, I was born in 1980—I remember the images that Kezia Dugdale described. I remember the adverts and seeing Princess Diana’s work. That illustrates how far we have come. Thankfully, the awful language and tone that were used in the debate in Westminster in 1986 in seeking homosexual dentists and doctors to give up their work and the general lack of awareness of the condition in that debate are as far removed from this informed, eloquent and heart-felt debate as possible.

No matter how far we have travelled on social attitudes and treatment over the 28 years since the first world AIDS day, world AIDS day is important because HIV is still important. It is important not just in Scotland but around the world. The day provides a moment to reflect on the task that lies ahead and presents a valuable opportunity to raise awareness of HIV. I am sure that many of us will take opportunities tomorrow to demonstrate our support for work to raise awareness of HIV and demonstrate our commitment to stand against HIV stigma. I have been pleased to hear from many members about so many local events and initiatives in their constituencies.

In Scotland, we have very good access to treatment for HIV, as many members have said. However, it is vital that people who are infected but remain undiagnosed are tested and offered treatment. The Scottish Government’s sexual health and blood-borne virus framework, which was updated last year, is clear that normalising testing and expanding the provision of testing is key to that. Although treatment is highly effective, public and individual health in Scotland is best improved by preventing infections, and that must continue to be a priority.

Will the minister address Liam McArthur’s point about how difficult it is for some people in more rural communities to access the sexual health treatment or testing that is required? Might the Scottish Government look further at whether home testing kits using the postal service are a possibility?

I listened to the point that was made by Liam McArthur, who is now away from the chamber, and I take on board the points that Kezia Dugdale has made, of course. I have certainly asked my officials to look into the postal testing kits and to see what progress can be made, if any.

The NHS has a crucial role to play in diagnosis and preventing infection, of course, but I also recognise the important contribution that the third sector makes. Its innovative, hands-on and targeted work to prevent transmission and its holistic, caring and supportive approach with patients do not go unnoticed. That compassion and that caring have been a big theme in the debate, which has been far removed from the language of a

“cesspool of their own making”,

which Patrick Harvie mentioned hearing during his time in Manchester.

Although there is no silver bullet when it comes to HIV prevention, many members across the chamber have discussed the contribution that pre-exposure prophylaxis—or PrEP—might make to reducing the number of new cases of HIV in Scotland in the future. We do well to pay heed to the parallels that Patrick Harvie drew between the negative narratives around post-exposure prophylaxis and pre-exposure prophylaxis. From the debate, I think that all parties are very much up for the challenge that he has set to stand to that negativity.

Across all medicines, we remain committed to ensuring that patients in Scotland get access to the new, innovative treatments that they need. That is why, following the granting of the licence for Truvada for PrEP by the European Medicines Agency earlier this year, the chief pharmaceutical officer has written to its manufacturer, urging it to make a submission to the Scottish Medicines Consortium, at a fair price, so that Truvada’s routine use in Scotland can be considered as quickly as possible.

Stigma has undoubtedly been one of the big themes during the debate tonight. All of us want to live in communities that have positive, non-stigmatising and supportive attitudes towards people living with or affected by HIV. That is why our sexual health and blood-borne virus framework addresses stigma as one of its five outcomes. It is why I am sure that we all agree with the theme of world AIDS day this year, which is that stigma is “not retro, just wrong”. There is no place for HIV stigma in Scotland today but, as Tom Arthur mentioned, campaigning against stigma is still an unfortunate necessity.

Education undoubtedly plays a big part in the effort to reduce stigma. We all want children to learn tolerance, respect, equality and good citizenship in order to address and prevent prejudice, and we want them to learn about healthy relationships. Relationship, sexual health and parenthood education is already an integral part of the health and wellbeing element of the school curriculum. We are supporting improvements in all those areas and doing more to equip our young people with the ability to cope and to emerge into their adulthood with the tools that they need to make informed and confident choices, and we are ensuring that the resources for that are there for Scottish schools.

Presiding Officer, tomorrow is world AIDS day, and I am sure that we will all take a moment to pause and reflect on those who we know have been lost to or affected by HIV. After listening to everybody’s contributions this evening, I am proud that, 28 years from now, those who read our Parliament’s Official Report will read a debate filled with compassion, tolerance and understanding. Our job, though, is to ensure that those things are felt widely across our society, that we make the medical improvements that we need to and that we challenge the stigma that is felt by too many, too often. What we do not want is to still be grappling with those issues 28 years from now. We must do better than that.

Thank you to everybody who has contributed this evening. It has been an informed, emotional and compassionate debate, and I very much enjoyed everyone’s contributions. I thank Kezia Dugdale once again for bringing the issue to the floor of the chamber.

Meeting closed at 18:37.