Meeting of the Parliament

Meeting date: Tuesday, November 28, 2017

Official Report 778KB pdf

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World AIDS Day 2017

The final item of business today is a members’ business debate on motion S5M-08658, in the name of Annie Wells, on world AIDS day 2017. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that the 29th annual World AIDS Day is being marked on 1 December 2017; believes that this offers an important opportunity to remember the estimated 35 million people who have died from AIDS-related illnesses; recognises what it sees as Scotland’s role as a leader in HIV policy by ensuring access to new medicines and treatments to contribute to prevention options; further recognises that, in 2017, the country became the first in the UK to offer PrEP on the NHS; acknowledges the efforts to exceed the UNAIDS 90-90-90 goals to help Scotland contribute to the global mission to get to zero new infections; understands that there are over 6,000 people living with HIV in Scotland; notes with concern statistics suggesting that two young people in the country are diagnosed with HIV every month; further notes the view that it is important to end HIV-related stigma by using Scotland’s HIV Anti-Stigma Strategy to ensure that everyone can access high-quality healthcare and support, and commends the work of HIV Scotland on what it sees as its work in promoting policy changes that are grounded in evidence and for using the experiences of people living with, or at risk of, HIV to help ensure that the voices of communities most stigmatised in society are heard.

17:03  

It is with great pleasure that I open this debate, only three days before the 29th annual world AIDS day. The debate brings much-needed attention to how we remember the estimated 37 million people worldwide who have lost their lives to AIDS-related illnesses, and enables us to consider how we in Scotland can be at the forefront of pharmaceutical care and can contribute to the global mission to eradicate new infections.

World AIDS day in 1988 was the first ever global health day, and it is as vitally important now as it was nearly three decades ago. By wearing the red ribbon as a symbol of solidarity with HIV positive people and those who live with AIDS, we have the opportunity to unite in the fight against HIV by fighting prejudice and improving education. Ultimately, world AIDS day reminds the public and MSPs that HIV has not gone away.

HIV/AIDs is arguably one of the most destructive pandemics in modern history. In 2016, 36.7 million people were living with HIV/AIDS, which resulted in 1 million deaths in that year alone. There were 300,000 fewer new HIV cases in 2016 than in 2015, which gives confidence that worldwide strategies are working. More than 100,000 people are living with HIV in the UK, with more than 6,000 living in Scotland. One of the most concerning statistics is that two young people are diagnosed with HIV every month in this country.

No cure or vaccine exists, but science has come a long way since the 1980s. Antiretroviral treatment has advanced to slow the course of the disease and can lead to a person diagnosed with the disease having a near-normal life expectancy.

I am extremely proud that on 10 April 2017, the Scottish Medicines Consortium announced that the drug Truvada was agreed to be an effective treatment to prevent the transmission of HIV, thus making Scotland the first country in the union to approve the prescription of a pre-exposure prophylaxis on the NHS. We would not be able to declare such a status if it was not for the hard work of HIV Scotland, which spent years campaigning for PrEP provision via the NHS as part of a comprehensive prevention strategy. In 2016, a PrEP good practice guide was published by HIV Scotland as a result of a collaboration between community members, service providers, researchers and decision makers all coming together to learn and work in a multisector partnership.

Many new treatments and strategies will be needed to finally bring an end to the AIDS pandemic, and we will unable to prevent the spread of the disease without bringing treatments to all those who need it, hence the focus in the motion on Scotland attempting to exceed the UNAIDS 90-90-90 goals—90 per cent of all people living with HIV knowing their HIV status; 90 per cent of all people with diagnosed HIV infection receiving sustained antiretroviral therapy; and 90 per cent of all people receiving antiretroviral therapy having viral suppression. Those goals have been set to be achieved by 2020, and, by UNAIDS’ own admission, the target to completely end the AIDS pandemic by 2030 is ambitious. Although it is ambitious, it is certainly achievable if we build on the powerful momentum of the new narrative on HIV treatment.

Education is the most powerful resource that we have in our battle to reduce the risk of HIV infection in Scotland. The United Nations Educational, Scientific and Cultural Organization places the utmost importance on access to sexual health education, which is its number 1 strategic priority. Article 17 of the United Nations Convention on the Rights of the Child states that children have the right to information that is of vital importance to their health and wellbeing. Even though those international human rights organisations see sexual health education as a young person’s right, sexual health lessons in Scotland are still not compulsory. Such lessons are taught via relationships, sexual health and parenthood education, but teaching inconsistencies can be found throughout Scotland’s 32 local authorities. On 22 October this year, I asked the education secretary what the Scottish Government's response was to the reported inconsistencies among Scotland’s local authorities. We all respect the response, which was that the curriculum for excellence provides flexibility for teachers to decide what children learn within a broad framework, but we would welcome a consistent approach to RSHP education among local authorities.

Scotland could also lead the way in significantly reducing HIV-related stigma via a reformed sexual health curriculum. Radical initiatives must be sought to reduce HIV-related stigma and to respect the human rights of populations who find themselves stigmatised in many ways. According to Scotland’s HIV anti-stigma strategy, the recent outbreak of HIV among injectable drug users in Glasgow was compounded by the multiple stigmas attached to both HIV and drug use. Stigmatisation that is based on gender, sexual preference, race, culture and religion, class and poverty, and criminalisation can be profound and lasting for people living with, and affected by, HIV. It is down to us to understand how and where people experience stigma to properly legislate against it, and to promote successful intervention strategies.

Finally bringing an end to the AIDS pandemic is more than an enduring commitment that we have to the 37 million people who have lost their lives to this preventable disease. It also represents an incredible opportunity for us to lay the foundations for a healthier, less stigmatised and more equal world for the young people of tomorrow.

17:10  

I thank my colleague Annie Wells for securing the debate and bringing such an important topic to the chamber. I apologise for having the wrong ribbon on—this one is from the previous debate. I have a red one in my office, which I will put on later.

The debate is an opportunity to reflect on the estimated 35 million people who have died from AIDS-related illnesses and on how we can support and care for the more than 6,000 people who live with HIV in Scotland. I commend HIV Scotland for its excellent work to raise awareness about HIV and promote evidence-based policy changes to support those living with or at risk of HIV.

As Annie Wells mentioned, stigma is perhaps the biggest issue facing those living with HIV in Scotland. Many people are left ostracised and with poor health and social outcomes, such as mental ill health, anxiety and suicidal feelings. Stigma is also one of the biggest barriers to testing, treatment and support. HIV Scotland estimates that around 13 per cent of people with HIV in Scotland are unaware of their status. Fear of a positive diagnosis discourages individuals from getting tested and engaging with health services.

The member raises an important point about stigma and the fear of testing. Does she agree that it is incredibly important that we effect a cultural shift so that we no longer look at an HIV diagnosis as a death sentence, as it once was, but as a manageable condition—indeed, one with which people can now expect to live full and relatively healthy lives?

Absolutely. I whole-heartedly agree. It is important to note that we all have an HIV status—it is not something just for other people.

The stigma and fear around testing can lead to late diagnosis, which negatively impacts on a person’s quality of life and life expectancy. It is of concern that HIV Scotland’s recent report “HIV and Education: Guaranteeing Lessons for All” highlighted that, every month, two young people in Scotland are diagnosed as being HIV positive—Annie Wells mentioned that statistic, too. I raised that issue in the chamber last month and was pleased that the Minister for Public Health and Sport, Aileen Campbell, made it clear that national health service boards will continue to work with schools and local authorities to deliver change and stage-appropriate RSHP education on the risks of HIV, and that existing work will be built on as we move forward.

We must all continue to work hard to end HIV-related stigma, through education in our schools and through Scotland’s wider HIV anti-stigma strategy. We must continue to raise awareness about the fact that everyone has an HIV status and encourage people to get tested. We must continue to ensure that people living with HIV have access to the medical and emotional support that they need to lead fulfilling and healthy lives.

However, there is quite a bit to take pride in. We can take pride in the fact that, by ensuring access to new medicines and treatments to treat HIV, we are a global leader in HIV policy. We can take pride in becoming the first country in the United Kingdom to offer PrEP on the NHS. We can take pride in the fact that last year’s figure for new reported cases of HIV, at 317, was the lowest annual figure to be recorded since 2003. We can take pride in Scotland’s HIV anti-stigma strategy, “Road Map to Zero”. Created by the HIV anti-stigma consortium, the strategy is a unique document produced by people living with and affected by HIV, in collaboration with academics, the NHS and the third sector. It provides the foundations for Scotland’s HIV anti-stigma strategy action plan, which will be published in 2018.

I look forward to seeing that strategy and, in the meantime, would encourage everyone, particularly all MSPs, to use whatever influence we have to tackle HIV-related stigma wherever we see it and whenever we can.

17:15  

I am pleased to have been given the opportunity to speak in this debate and help colleagues on all sides of the chamber in highlighting the need to end HIV-related stigma and contribute to the ambitious new infections target of zero.

For many people of my age, their first real knowledge of AIDS will have come from the apocalyptic and highly controversial advert that was aired on television in 1986. For those who do not remember the advert, it is worth watching. It certainly got the message across that AIDS was potentially a lethal disease, but it also frightened those who saw it into avoiding people who had AIDS. It took a huge amount of time to reverse that view—a change that was undoubtedly assisted by the work of people such as Princess Diana.

In 1982 to 1983, I unwittingly came into contact with AIDS sufferers when I went to Africa. As a young soldier, I was sent to Uganda to work with the Ugandan national liberation army. Before I flew out, I was given a very short briefing by the Foreign and Commonwealth Office, which I have to say did little to prepare me. I was, however, given a much more extensive briefing by the regimental doctor, Lt Col Anthony Page. He spent a considerable amount of time teaching me basic medical skills so that I could at least help my colleagues in difficult situations.

My tour in Uganda was spent in the jungle—unlike some, I could not claim to be a celebrity, and there was no way out. My daily routine included holding a sick parade for soldiers and their families. The parade was supervised by a Ugandan medical officer, who at every opportunity would dust off his one syringe and one needle. The needle was sharpened before and after each injection on the inside of a glass. I had no idea what the medical officer was injecting in most cases, but he assured me that it would work.

My task at the sick parade was to treat minor injuries using a medical pack that the FCO had given me. There were no gloves and no anaesthetic, but there was plenty of improvisation. The outcomes for our patients were without doubt better than they would have been if we had done nothing, and probably better than if they had experienced the trusty needle. They were also better than the outcomes that the local witch doctor achieved; he had a bit more of a kill-or-cure approach. Sadly, sometimes our lack of knowledge showed, but we did our best.

During my time there, we saw a few cases of a disease called “slim”, and there seemed to be no positive outcomes for those who suffered from it. It would affect husbands and wives and often the youngest children, but not all the children. For those whom it affected, there were more often than not tragic consequences.

Little did I know that what we were seeing and trying to deal with was AIDS. If I had known that, I wonder whether we would have looked at things in a different way; I suspect that we might have done. I also suspect that my colleagues and I would have dealt with things differently if we had seen the advert that was aired in 1986. That is the point that I am making. We had no worries about what we were doing, because of our lack of knowledge. Today, we have the knowledge, and we know that there is more that we can do for those who have AIDS and those who live with HIV. There is no need, or any excuse, to stigmatise them. They are the same as you and me, and we must end all stigma relating to their conditions.

On Friday, I will take a moment to remember the 35 million-odd people who have died from AIDS-related illnesses, and those with whom I might unwittingly have come into contact. To me, they were, and will always remain, fellow human beings who needed help, and that is all they should ever have been.

17:19  

I, too, thank Annie Wells for lodging her motion, which provides members with the opportunity to mark world AIDS day on 1 December through today’s debate. The UN theme for this year’s world AIDS day is my health, my right. I will use my brief comments to highlight the right to proper health and social care for older people who are living with HIV. It is worth pausing for a moment to think about that statement. For many of us who were growing up in the 1980s and 1990s and who witnessed the emergence of AIDS, the letters “HIV” were seen very much as a death sentence, and not something that people grew old with.

Still, today, to all our utter shame, tragically a million people a year die from AlDS. Those deaths are unnecessary. Thanks to the wonders of science and the tireless campaigning of charities across the world, with early diagnosis and the right treatment, those with HIV can—and do—have near-normal life expectancy, as Tom Arthur highlighted earlier in his intervention.

In fact, the median age of people living with HIV in Scotland has risen from 36 in 1997 to 45 in 2015; and the proportion of people living with HIV aged 50 or over increased from one in eight in 2003 to one in four in 2014. Of course, that brings with it the challenges of ensuring that older people living with HIV have the health and social care that they need.

Levels of poverty among people living with HIV aged 55 and over are double those seen in the general population, and those people are significantly more likely to have other health problems. In fact, two thirds of people over 50 with HIV receive treatment for other long-term conditions—again, a rate that is almost double that of the general population. Mental health problems and depression are also more common among older people living with HIV than in the population as a whole.

Tackling those inequalities requires meaningful action and a multiagency approach in health and, crucially, social care, but we know that across Scotland, social care services are under pressure. A report by HIV Scotland called “Making the Vision a Reality” highlighted concerns in some local authorities that funding and budget constraints

“may result in fewer people with support needs being able to receive support”.

In the report, one local authority stated:

“Due to current budget constraints ... not all people with HIV may meet the critical eligibility criteria we can currently fund, therefore may not be able to access social work funded services”.

We need to properly resource social care and we have to ensure that staff are equipped with a strong understanding of HIV because, as HIV Scotland’s report also highlighted,

“There is a lack of specialist training for social care staff in relation to HIV and supporting people living with this.”

The care must be dignified. Although there is no doubt that most care is of a high standard, a report by the National AIDS Trust called “HIV: A guide for care providers” highlighted experiences that some people with HIV had in care homes and the discriminatory treatment that they received. One resident with HIV was made to have the last bath of the day and was given separate cutlery, another described difficulty in getting a staff member to assist them in the shower, several highlighted breaches in confidentiality, and, in one instance, a care assistant advised a resident’s visitors not to let their children see him because of his HIV.

Ruth Maguire, Annie Wells and Edward Mountain all commented on the stigma surrounding HIV and, in particular, on Scotland’s anti-stigma strategy, the “Road Map to Zero”. Not only can that stigma be isolating and distressing but it can act as a barrier to receiving the care and support that people with HIV need. There remains a great deal more to be done to improve the provision and the standard of social care for those living with HIV.

The integration of health and social care will fundamentally change how care is delivered, and it is an opportunity to address some of those challenges. Taking a more collaborative approach to delivering care for those with HIV is in itself a step in the right direction, but we must ensure that we expand expertise in and knowledge of HIV among those delivering that care. Equally, structural changes through integration must be backed up with the funding that is needed to deliver services. Social care is an increasingly critical aspect of care for those with HIV, in particular older people living with HIV. That may be a good challenge to have—it is certainly not one that we faced 30 years ago—but it is a growing challenge, and we all have a duty to make sure that our health and social care services fully meet it.

17:23  

I am pleased to take part in the debate and grateful that the motion has been brought to the chamber. Like a couple of other members, I was going to reflect a little on how things have changed over the years. I was growing up when those TV advertising campaigns that Edward Mountain referred to were being shown. I had not come out at that point—I had not, let us be honest, started my sex life at that point—and then there was that set of ideas around fear. Certain aspects of that campaign may have been well meant, but certain aspects, I am sure, exacerbated the fear and the stigma that arises as a result of fear. I was certainly very aware of that.

A little later—as I had cause to reflect in an earlier debate—I was a student in Manchester when God’s cop was sending police wearing biohazard gear to raid gay clubs there. I was reminded of the ignorant and prejudiced attitudes that informed that behaviour, sadly, when Colin Smyth mentioned some of the practices in care homes, which were also grounded in needless and ignorant attitudes toward HIV and in the stigma that arises from that ignorance.

A few years later, I spent a few years working in an HIV agency in Glasgow. When I think about what has changed since those days, I see that immense scientific and medical progress has been made. As others have mentioned, treatment, in particular, is dramatically more effective, and many more people are living long and healthy lives. At least here, in wealthy countries, that is the case—it is not the case everywhere.

Immense progress has also been made in testing. In the run-up to world AIDS day, I recently dropped by the Terrence Higgins Trust offices in Glasgow. The agency that I used to work for, PHACE West—Promoting Health and Challenging Exclusion—eventually merged with PHACE Scotland and then became THT Scotland after I had left. I was able to catch up with a few colleagues there and take the test. It was just a tiny finger-prick, and it took literally seconds for the result to be clear. It is a cheap, convenient and easy form of testing that was not available when I was working in the field.

As other members have mentioned, not only have treatment and testing improved but so has prevention. We have new tools in the box when it comes to prevention, with the availability of PrEP—post-exposure prophylaxis—in Scotland. I very much welcome the progress that has been made there.

There are some things that I hope have changed, but I do not know whether they have. One of the last things that I was involved in challenging when I worked for PHACE was the pushing of anti-condom messages in schools by an organisation that promoted the Billings ovulation method of birth control, which was basically one step up from the rhythm method. It was complete nonsense to be pushing it in schools. Whether it was motivated by their religious ethos or something else, they also pushed the kind of disinformation that is now being pushed in some developing countries. An example of that is telling young people that condoms have holes in them that will let HIV through, which is, in essence, telling them not to use condoms as a means of protection against HIV transmission. I really hope that no such misinformation is being peddled in our schools today. However, there are those who argue against the comprehensive, equality-based sex education that all young people should have access to, and the Government must show determination to ensure that that education is a reality.

There are also things that have not changed. The stigma, the prejudice and the misunderstanding persist. We all need to take responsibility for challenging those. Partly as a result of the on-going stigma, there are aspects of the law that have not changed. The criminalisation of sex work, of drug use and even of HIV transmission directly harms people’s lives.

The economic injustices in drug access globally have not changed enough, although it would be wrong to say that there has been no change and no progress. The targets that are being talked about for access to treatment are for 90 per cent of people who are living with HIV to know their status, for 90 per cent of people with diagnosed infection to receive sustained antiretroviral therapy and for 90 per cent of all people receiving that therapy to have viral suppression. We are still a long way from achieving that 90-90-90 target globally, as I am told that we are at 70-77-82. On each one of those three targets, progress has been made through the greater availability of generic drugs, but that progress is not nearly enough.

Finally, some things have changed for the worse. Colin Smyth mentioned the economic insecurity that a great many people live with. That can be related to social security cuts, insecure work, the impact that austerity has had on the public services tha3t people who are living with HIV need to access or the inhumanity of our immigration and asylum system, as those things are changes for the worse.

I will give one example: the loss of a needle exchange service in Glasgow will almost inevitably lead to an increase in the number of infections. I agree with Alison Thewliss from the Scottish National Party, who is quoted as saying:

“Evidence from safe injecting facilities in other countries demonstrates that they reduce levels of drug addiction, as well as improving public safety through reducing the level of discarded needles and other”

related items. I hope that the Scottish Government agrees with that comment by Alison Thewliss and will commit to ensuring that safe injecting facilities are available everywhere that they are needed.

The stigma that exists in relation to HIV harms not only individual lives but our collective ability to make political progress on controversial and difficult subjects such as drugs use and sex work and in other areas in which we have not moved in the right direction.

17:31  

I thank you, Presiding Officer, for letting me say a few words, and I thank my colleague Annie Wells for bringing the debate to the chamber.

I welcome to the gallery members of the consortium that HIV Scotland brought together to work on the strategy that will be launched this week. Entitled “Road Map to Zero”, it is about ending the stigma for people who live with and are affected by AIDS.

The debate has been wonderful to listen to. We have talked about AIDS, the challenges that exist in different communities around the world and the reason for the presence of AIDS in different communities. We have recognised that the disease is universal to us and that much progress has been made in identifying, treating and testing for it. In all those areas, we have come a long way since, much like Patrick Harvie, I first heard about AIDS as a young teenager.

I am thankful for the content of “Road Map to Zero”. It is about stigma and HIV, but the document teaches about stigma in any area. It teaches about anti-gay feelings and anti-religious feelings—all the feelings that can be involved in stigmatising people because of certain things. It challenges those attitudes and our beliefs about what we do. It is a powerful document and I thank the consortium for building it that way.

The strategy asks us to challenge ourselves in five areas. It asks us to challenge ourselves as individuals with our own feelings and knowledge and to become better educated about matters around which there might be stigma. On interpersonal relationships, it asks us to challenge family, friends and partners on some of their attitudes. Organisationally, we can challenge stigma anywhere in our workplaces or social institutions where we see it being applied to people living with AIDS. We must also take account of community and cultural values. Each community will have its own experience of AIDS. For some, it will be a sexual health issue; others will have experience of it from drugs issues. We must recognise and understand those experiences before we can not only reduce infections but reduce stigma to zero. Of course, there is also a structural level: our national laws and public policy must reflect the need for the anti-stigma message to be at the heart of what we do.

I will close by mentioning the five things that the partners have committed to do, which are important. They have committed themselves to ending HIV-related stigma in Scotland; to participating fully in designing, implementing and monitoring programmes to reduce stigma; to working collaboratively with other partners to introduce necessary policy changes; to strengthening and making meaningful the involvement of people who live with and are affected by HIV; and to holding one another accountable for progress towards zero-stigma goals. Those five asks are powerful and important, and I wish the consortium all the best moving forward.

I should also mention the funding from the MAC AIDS Fund, which made the report possible. It is a powerful document that we should all read and take on board in our jobs as politicians.

17:34  

Like others, I thank Annie Wells for securing the debate. I also thank all the members who took part in it for their contributions.

This is a welcome opportunity, ahead of world AIDS day on Friday, to consider how far we have come in tackling HIV. As members have noted, world AIDS day provides us with an opportunity to show our support for the millions of people worldwide who are living with HIV, and to remember those who have died over the years since the virus emerged.

Over the past 30 years or so, huge scientific advances have been made in the treatment of HIV. However, although we have come a long way, new HIV infections are still being diagnosed in Scotland every week. Despite all the progress that we have made, some of those at risk still do not know how to protect themselves. Some—too many—hold outdated views about the facts of HIV, leading to the needless stigmatisation that many members have talked about. Therefore, we must make sure that we continue to raise awareness.

The theme of world AIDS day this year is “let’s end it”. We must work together to end isolation, stigma and HIV transmission. Sadly, stigma remains a problem for many people living with HIV. For some, that means that they live in fear of their HIV status being revealed to those they live, work and spend time with. It is vital that we take an evidence-based approach to addressing stigma. We need to take into account what has—and has not—worked, here and elsewhere in the world. I believe that providing everyone with the facts about HIV has a significant part to play in tackling stigma. Government, third sector organisations, practitioners and those infected with HIV need to continue to collaborate with our efforts to tackle the problem.

Annie Wells mentioned the importance of education and raised the consistency of RSHP education. I reiterate the words of Ruth Maguire, who continues to take an interest in the matter. We are making sure that we develop the consistency that Annie Wells asks of us. NHS boards are working with local authorities and other partners to support the delivery of high-quality, consistent and inclusive RSHP education in schools across Scotland. Boards are also working with authorities to produce a national RSHP resource to support effective teaching. That new resource will cover a range of issues, including consent, healthy relationships and the impact of digital technology. It will also be fully inclusive of lesbian, gay, bisexual, transgender and intersex issues—all based on facts, not the myths that Patrick Harvie is right to say that we need to guard against.

It is also important to ensure that good-quality education is available to professionals. For example, I am glad that the Scottish Government has supported successful training initiatives such as the caring conversations training resource developed by Waverley Care, which encourages NHS staff to think about how they interact with patients and promotes honest and caring conversations. It focuses on HIV and uses case studies from HIV patients themselves, but the learning is also relevant to people who work with patients living with any long-term condition. To reiterate the point that Colin Smyth made, we need to recognise the opportunity that we have, through the integration of health and social care, to ensure that such support is also available to those in caring roles and that we enable them to have that education and enhance their ability to deliver care.

It is also important to sort fact from fiction when it comes to HIV, and to empathise with those affected. It is vital that we hear directly about what life is like for people living with HIV. I thank every person in Scotland living with HIV who has spoken about their experiences—whether that has been to one friend over a cup of tea or on a stage, in front of hundreds. All that work is valued and appreciated, and helps with our journey towards tackling stigma and enhancing the education offer across the country.

HIV prevention remains key to our sexual health and blood-borne virus framework. With highly effective treatments now in place, and with PrEP now available on the NHS in Scotland, we already have some of the tools that we need to reduce new infections in Scotland to zero. However, getting to the people who are infected but undiagnosed to ensure that they are tested and treated is a significant challenge. Our framework is clear that normalising and expanding testing are key, and we are working with NHS colleagues to do that.

It is also important to remember that some of those who are most affected by HIV are also marginalised in other ways, such as those who inject drugs. When a person has a serious addiction, they might not be able to take steps to protect themselves from infection. That is why we need to ensure that support is in place to address the underlying addiction and to reduce the harm that such addiction causes.

Will the minister give way?

I will, although I am about to go on to talk about needle exchanges.

I will leave it then.

Although challenges remain, it is encouraging to see the significant decline in the number of new infections in 2016 in Scotland. Like Ruth Maguire, I take pride in the fact that Scotland was the first part of the UK to make PrEP available to eligible patients. I pay tribute to the third sector—HIV Scotland, Waverley Care and a host of others—for setting the tone and allowing that to be viewed as an appropriate public health intervention to prevent illness. Based on the evidence, that decision was a good response and a good reaction, and the work of such organisations enabled the discussion to take place. PrEP is making a huge difference to the lives of many people in Scotland, in stark contrast to the way in which people coped as best they could, as Edward Mountain described when talking about his time in Africa.

I turn to needle exchanges. Patrick Harvie was right to raise the issue because the situation poses a significant public health risk. I assure him that we are still working with Network Rail and others, including Humza Yousaf, to achieve a satisfactory solution. I will keep Patrick Harvie updated as that work progresses.

I am grateful to the minister for addressing the point and I look forward to hearing about progress. I appreciate that there are difficulties when a third organisation, such as Network Rail, is involved. Is the Government committed to the principle of needle exchanges, and does it acknowledge, as the minister’s colleague Alison Thewliss has acknowledged, that safe injecting facilities have the potential to make a huge difference? There is extremely strong evidence of that from around the world.

I was also going to go on to talk about such facilities. As with PrEP and the public health approach that we want to take, if there is evidence, we need to make sure that initiatives are enabled. The situation with Network Rail shows the interface between worlds. This is not normally Network Rail’s world, and we need to enable the discussions to be more open so that we can make progress.

On safe injection rooms, earlier today I outlined our refreshed drug strategy. We will continue to work with Glasgow health and social care partnership on the matter. Patrick Harvie is right to make that case, and the public health case has been and continues to be made. The Lord Advocate has provided his advice, and it is welcome. However, we do not have the legislative powers. I have therefore written to ask the UK Government for a meeting to discuss scope for getting those powers to Scotland to help us move the issue forward. I will also keep Patrick Harvie updated on progress with that. This should not be the last word on the matter because of the public health concerns that he is right to outline.

I am clear that those who are affected by HIV in Scotland should have the same level of protection from discrimination and prejudice as anyone else. In line with the world AIDS day theme, our sexual health and blood-borne virus framework identifies the reduction of stigma as one of its five high-level outcomes. We want to live in communities that have positive, non-stigmatising and supportive attitudes towards people who are affected by HIV. World AIDS day helps us to communicate that aspiration, as do debates in our Parliament.

On Friday, I hope that we can all take the opportunity to remember the impact that HIV has had on lives in Scotland and globally, to reflect on the progress that has been made in treating the infection, and to consider what we can do to reduce new infections even further and better support those living with HIV. We should also reflect on the fact that, when we had the debate this time last year, PrEP was not available. That shows how fast progress can be if we collaborate and put our minds to making the improvements that we all seek.

I thank Annie Wells and the other members who have contributed to the debate, and I look forward to continuing to work with them as we make the improvements that we want to see for those who have HIV in Scotland.

Meeting closed at 17:44.