Ending HIV Transmission in Scotland by 2030 - elimination delivery plan 2023-2026: equality impact assessment

Equality Impact Assessment Record

Title of policy: Ending HIV Transmission in Scotland by 2030: HIV Transmission Elimination Delivery Plan 2023-26

Lead Minister: Minister for Public Health and Women’s Health, Jenni Minto MSP

Lead official: Rebekah Carton

Officials involved in EQIA: Caroline Pretty, Morgan Callaghan, Amy Watson

Directorate: Population Health Directorate

Division: Population Health Resilience and Protection Division

Team: Sexual Health and Blood Borne Virus Policy Team

Is this new policy or revision to an existing policy? New policy

Screening

Policy Ai3m

Our vision is to end HIV transmission. This means achieving the ambitious target of zero people contracting HIV within Scotland by 2030. This aligns with wider global strategic aims, including UNAIDS’ goal “to end the AIDS epidemic as a public health threat by 2030.”^[1] The Scottish HIV Transmission Elimination Oversight Group defined HIV transmission elimination as the point when there are zero individuals acquiring HIV within Scotland, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, deprivation or disability status.

1. To prevent people from acquiring HIV, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, deprivation or disability status.

2. To find people living with HIV in Scotland (some of whom are undiagnosed) and support entry or re-entry into equitable and accessible HIV care and treatment, thereby improving health and quality of life, as well as preventing onward transmission of HIV.

3. To reduce stigma that makes some people less likely to access HIV prevention, testing and treatment services and adversely affects quality of life.

• Who will it affect?

This policy affects anyone in Scotland living with HIV (diagnosed or undiagnosed), health and social care workers, as well as those at risk of acquiring HIV.

• What might prevent the desired outcomes being achieved?

There are currently significant gaps in our data, intelligence and research to inform elimination planning, many of which will be addressed by actions already underway and those outlined in this plan. A large amount of the delivery plan, for example reducing stigma and raising awareness, is hard to quantify, so we are less able to track progress in these areas. We do not currently have robust prevalence estimates in Scotland, which makes it harder to target interventions based on epidemiological evidence.

Due to the changing epidemiology of HIV in Scotland, a dynamic approach to HIV transmission elimination (HIVTE) is required. Broad approaches addressing the wider population are a valuable step in the initial stages, however as the number of new HIV diagnoses reduces further, local interventions focused on smaller groups of sub‑populations and individuals will be required. At very low levels of new transmissions, interventions focused on outbreak response and individual case investigation will become a key factor to achieving the ‘zero’ transmission goal. A person-centred approach is required at all stages of the epidemic. We must also ensure that the needs of the individual, anonymity and data protection are given the highest priority, particularly as the number of new diagnoses becomes very few. At all stages it is important that we consider the needs of people living with HIV to ensure that they can live longer, healthy lives free from stigma and harm.

As HIV incidence declines and interventions become more localised, it is important that we consider the potential barriers and other key considerations to be addressed at each stage including resources, staff training and skill maintenance, developing and maintaining knowledge and skills across the workforce – at a local level as well as a national level.

The recovery from the COVID-19 pandemic is ongoing. The NHS continues to face unprecedented challenges and pressures, and this includes Sexual Health and Blood Borne Virus services. Waiting lists and waiting times continue to have an impact on services and service users throughout Scotland. It is acknowledged there are no easy solutions to the challenges currently facing services, particularly given the current economic climate with the associated budget challenges. Equally, there may be future challenges or emergent issues, such as STI outbreaks or further particularly challenging winter periods, that may provide further pressures that make the Delivery Plan more difficult to implement. Scottish Government has granted funding for a two year project at Glasgow Caledonian University to examine the impact of the COVID-19 pandemic on the uptake of HIV PrEP and effectiveness in preventing HIV infection, and how funding difficulties and pressures within the NHS are exacerbating this. This may also have relevance to wider SHBBV services.

One of the biggest barriers to the outcomes of this Plan is that it relies upon individual participation in primary, secondary and tertiary interventions. As part of the Delivery Plan, we are aiming to reduce stigma and increase awareness and education on HIV so that individuals living with or at risk of acquiring HIV are well-informed, appropriately supported and motivated to engage with prevention, testing and treatment.