HIV

Background

Human immunodeficiency virus (HIV) is a virus which attacks the immune system. HIV is a chronic, lifelong infection which can be managed successfully by antiretroviral therapy (ART). There's no vaccine or cure for HIV but the current treatment, taking daily tablets, stops the virus from replicating and damaging the body’s immune system. Progression to advanced HIV disease or acquired immune deficiency syndrome (AIDS), which is defined by a number of clinical conditions, can be controlled by good adherence to ART. People diagnosed with HIV and on ART are able to live long and healthy lives. The availability of effective treatments means that it's important to know your status and take an HIV test if you're at risk of being infected.

A person with a sustained, undetectable level of HIV viral load in their blood is unable to transmit HIV to their sexual partners. Evidence from clinical and scientific studies is the foundation of the now universally accepted statement that Undetectable Equals Untransmittable or U=U. The U=U Consensus statement can be viewed on the Prevention Access Campaign website.

HIV pre-exposure prophylaxis (PrEP) in the form of an antiretroviral combination drug became available on the NHS in Scotland in July 2017. PrEP aims to prevent HIV infection among people at highest risk of infection as part of a comprehensive approach to HIV prevention, this is alongside regular HIV testing and safer sex practices. 

The 'Implementation of HIV PrEP in Scotland: First Year Report' describes the first year of the HIV PrEP service - from July 2017 to June 2018. It covers:

  • implementation
  • monitoring
  • uptake
  • preliminary data on outcomes

It highlights the successful implementation of an NHS PrEP service across Scotland with nearly 1900 individuals, mostly men who have sex with men (MSM), having been prescribed PrEP at least once in the first year. Further work is required to determine the impact of PrEP on the incidence of HIV and other sexually transmitted infections.

For further information on PrEP, please visit the HIV Scotland website.

Guidance

Good practice guidance on HIV prevention in men who have sex with men (MSM)

The Scottish Health Protection Network (SHPN) has produced Good Practice Guidance on HIV Prevention in Men who have Sex with Men (MSM).

Guidance for health clearance of healthcare workers (HCWs) and management of those infected with hepatitis B, hepatitis C and HIV

Guidance is available from Public Health England (PHE) for health clearance of healthcare workers (HCWs) and management of those infected with the following bloodborne viruses (BBVs):

  • hepatitis B
  • hepatitis C
  • human immunodeficiency virus (HIV)

The guidance has been approved for use in Scotland by the Scottish Health Protection Network Guidance Group (SHPN-GG) and should be used in conjunction with the SHPN addendum.

Read the addendum and access the guidelines on our website

Guidance on testing, treatment and management of people diagnosed and living with HIV

Guidance can be found in the:

Guidance for cost-sensitive HIV therapy prescribing in NHSScotland

The HIV Clinical Leads of the Scottish Health Protection Network (SHPN) have developed guidance to support optimal HIV therapy prescribing and dispensing in Scotland.

View the guidance for cost-sensitive HIV therapy prescribing in NHS Scotland 2018 update​.

Guidance to support opt-out blood borne virus (BBV) testing in Scottish prisons

The Scottish Government updated the Sexual Health and Blood Borne Virus Framework in 2015. The update recommended the introduction of opt-out BBV testing in the Scottish Prison Establishment. A Short Life Working Group produced this guidance to support the delivery and  monitoring of opt-out BBV testing in Scotland’s prisons. The guideline has been developed in line with national guidelines and policies.

View the Guidance to Support Opt-Out BBV Testing in Scottish Prisons

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Publications

The Blood borne viruses (BBV) and sexually transmitted infections (STI) report, produced by our BBV and STI team, describes the epidemiology of Hepatitis C (HCV), Hepatitis B (HBV), HIV and other STIs in Scotland to the end of December 2016. It also describes the impact of interventions in preventing infection and associated disease and highlights public health priorities.

The report also directs readers to other existing Scottish reports and data sources, these are available on our website. The commentary is structured around the outcome indicators detailed in the Scottish Government’s Sexual Health and Blood Borne Virus (SHBBV) Framework, 2015 to 2020.

The first year of the HIV PrEP service - from July 2017 to June 2018 - is described in the Implementation of HIV PrEP in Scotland: First Year Report.

Data and surveillance

Surveillance update for January to March 2019

Newly reported HIV diagnoses

From January to March 2019, NHS Scotland laboratories reported positive HIV-antibody test results for 79 individuals not previously recorded on the HPS HIV database. Of these, 41 (52%) were first ever HIV diagnoses and 38 (48%) had been previously diagnosed elsewhere but were newly reported in Scotland during this period. Allowing for the migration of an estimated 1,561 infected individuals, those who have not attended for more than ten years (261), and for the 2,203 (23%) known to have died, 5,431 individuals are estimated to be living in Scotland who have been diagnosed HIV-positive, of whom 73% (3,980) are male and 27% are female (1,451).​

Please note that the HPS national HIV database is under continual review and modification as additional information becomes available. As a result, published data - primarily within the last year – are subject to change.

Download tables 1 to 4 of this surveillance update

Table 1 shows the total number of reports, and first ever reports, of HIV diagnoses in Scotland between 2010 and 31 March 2019.

These data are presented by:

  • exposure category – men who have sex with men (MSM), sexual intercourse between men and women, and people who inject drugs (PWID)
  • likely area of exposure – within Scotland, rest of UK, outwith UK

From January to March 2019, of the 79 new diagnoses recorded:

  • MSM accounted for the largest proportion (46%) with 36 diagnoses
  • 16% (13) were associated with sexual intercourse among men and women
  • 8% (six) were among PWID

The remaining 24 (30%) diagnoses were either associated with other risks or risk information was not available at the time of publication.

Table 2 provides data on first ever HIV diagnoses in Scotland by NHS board of diagnosis from 2010 to 31 March 2019.

Of the 41 first ever HIV diagnoses recorded during the first three months of 2019:

  • the largest proportion (39%) were made in NHS Greater Glasgow & Clyde
  • 15% were recorded in NHS Lanarkshire
  • five or fewer diagnoses were reported by nine other NHS boards

Since April 2014, avidity antibody testing has been rolled out across NHS boards in Scotland to determine the recency of acquisition of newly reported HIV infections. Table 3 presents the number, and proportion, of recently acquired HIV infections (within the preceding three to four months) in Scotland by exposure category between 2015 and 31 March 2019. From January to March 2019, of the 17 HIV-positive samples which underwent avidity antibody testing, six (35%) were recently acquired HIV infections. Given that the numbers presented are small caution must be taken when interpreting these results.

HIV cohort diagnosed and living in Scotland

Table 4 shows a breakdown of the HIV cohort living in Scotland to 31 March 2019 by NHS board and exposure category. As at 31 March 2019, it is estimated that 5,431 individuals are living in Scotland who have been diagnosed HIV-positive.

Of these:

  • almost half, or 2,550 (47%), are MSM
  • 2,142 (39%) are heterosexual men and women
  • 485 (9%) are PWID

Other/unknown risks were recorded for the remaining 254 individuals.

Figure 1 shows that, currently, 43% (2,325) of the cohort are aged between 35 and 49 years and a further 43% (2,338) are aged 50 years and over, reflecting the fact that this is an ageing cohort.

Previous reports

Sexual health and blood borne virus framework

The Sexual Health and Blood Borne Virus Framework, first published by the Scottish Government in August 2011 and updated in September 2015, brought together policy areas on sexual health and blood borne viruses, namely HIV, HCV and HBV. The framework supports improvements in sexual health and wellbeing and addresses the impact of blood borne virus infection in Scotland. The framework seeks to strengthen and improve multi-agency partnerships to address the five high-level outcomes:

  1. Fewer newly acquired blood borne viruses and STIs; fewer unintended pregnancies
  2. A reduction in the health inequalities gap in sexual health and blood borne viruses
  3. People affected by blood borne viruses lead longer, healthier lives
  4. Sexual relationships are free from coercion and harm.
  5. A society whereby the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and blood borne viruses are positive, non-stigmatising and supportive.

Sexual health and blood borne virus (SHBBV) open access data portal

The Sexual Health and Blood Borne Virus (SHBBV) open access Data Portal contains a wealth of information together in a format which allows users to easily monitor Scotland’s progress nationally and locally against the Scottish Government’s SHBBV framework outcomes.