| Characteristic[2] |
Evidence gathered and Strength/ quality of evidence |
Data gaps identified and action taken |
| Age |
- As people can live longer, healthier lives with HIV we have seen the number of people with an HIV diagnosis who are aged 50 and over increase in recent years. In the UK, the largest age group living with HIV is 50-64.[3] Among those diagnosed with HIV in Scotland for the first time in 2022, the median age range was 28-42.
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- The HIVTE Delivery Plan seeks to prevent people from acquiring HIV regardless of their age and increasing testing, treatment, and support for those who are living with HIV.
- The Plan seeks to bolster education and awareness around HIV for young people and tackle awareness and stigma around HIV for all ages.
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| Disability |
- Under the Equality Act 2010, living with HIV is recognised as a disability.[4]
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- The Plan seeks to eliminate HIV transmission and reduce the risk of people living with HIV as a disability. The tertiary prevention actions seek to ensure that people living with HIV receive appropriate treatment and care, thus reducing the impact of HIV and enabling them to live healthy lives.
- The Plan also seeks to make HIV testing more accessible and equitable.
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| Sex |
- In 2022, over two-thirds of the people accessing HIV care in the UK were men, with women representing 31.7% of all people accessing care.[5]
- Of the individuals prescribed PrEP for the first time between 2017 and 2022, women were significantly underrepresented.[6]
- In 2023, a workshop co-chaired by Mr Grant Sugden, CEO of Waverley Care, Scotland’s leading HIV & Hepatitis C charity, and Prof Claudia Estcourt, a clinical academic in Sexual Health & HIV at Glasgow Caledonian University & NHS Greater Glasgow and Clyde explored settings for PrEP provision. It was discussed that women (especially women from minority ethnic groups) find it harder to attend sexual health services, are not well engaged with PrEP and prefer to access sexual health care from their GP due to trust and confidentiality. [7]
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- Central to this Delivery Plan is eliminating transmission across all groups regardless of sex.
- Relatively few women are currently accessing primary prevention services for HIV, possibly because of difficulties accessing sexual health services, or a misconception that HIV transmission is more common in men who have sex with men (this is no longer the case). This Delivery Plan seeks to expand access to PrEP for people whose needs are not currently being met.
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| Pregnancy and maternity |
- HIV affects pregnancy and maternity as there is a risk that, without appropriate treatment and care, the virus can be transferred to the baby through pregnancy, childbirth or breastfeeding.[8]
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- Routine antenatal testing and the availability of effective treatment for HIV has been successful in eliminating vertical transmission of HIV in Scotland.
- Actions in the Plan focussed on identifying and supporting people with HIV will help to ensure that people living with the virus can receive appropriate care and support – including in relation to family planning, pregnancy and maternity.
|
| Gender reassignment |
- 136 individuals with self-reported trans status accessed HIV PrEP for the first time during the period July 2017 to December 2022.
- The multi-sector workshop highlighted that waiting for gender affirming care is a barrier to accessing other healthcare. Additionally, we want to reach trans people who are already accessing NHS gender services but do not feel comfortable talking to healthcare professionals about their sexuality, as well as trans people who have had no contact with NHS services for gender care or sexual health. A tailored pathway could be a way to reach trans people who will not engage with standard NHS services.[9]
- At the workshop, a range of barriers and facilitators to trans people accessing PrEP were identified. Of these, the key barriers were waiting for gender care and a lack of trust in sexual health services. It was discussed that those waiting for gender care, on up to 5 year waiting lists, would likely not be thinking about sexual healthcare, nor be receptive to receiving it when they could not yet receive hormones or surgery. Additionally, historic negative experiences with sexual healthcare has led to an overall mistrust of sexual health services.[10]
|
- Central to the Delivery Plan is the idea that individuals have equitable access to support, regardless of gender identity or reassignment, or other protected characteristics.
- This Plan aims to explore ways of broadening PrEP access through settings other than sexual health services which trans people may be reluctant to access.
- The self-testing and online postal self-sampling actions within the Plan will allow individuals who do not wish to visit sexual health services, to access free HIV testing from their own homes.
|
| Sexual orientation |
- Public Health Scotland produces annual statistics on HIV and PrEP which are broken down by demographic characteristics and exposure categories including ‘Gay, bisexual and other men who have sex with men’ (GBMSM) and ‘Sexual intercourse between men and women’. Until 2022, GBMSM made up the largest cohort of new HIV diagnoses. However, in 2022, this was overtaken by heterosexual transmission as the most frequent mode of acquisition.[11]
- Despite this, research shows that GBMSM are significantly more likely to be taking HIV tests and taking PrEP compared to women or men who have sex with women.[12]
- HIV testing data (SMMASH2 and SELPHIE), and sexual health service attendance and risk behaviour data from NATSAL suggest that GBMSM with unmet need are older, younger (i.e. the very youngest), and non-GBMSM identifying. Non-identification as GBMSM was seen as being particularly significant, so a potential way to improve population knowledge and the reach of PrEP would be to focus more on the behavioural aspect i.e. anal sex with a man/risk and need rather than identity.[13]
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- As the group with the most new HIV diagnoses, it is vital that we bolster education and testing and encourage primary preventions such as PrEP amongst heterosexual people at highest risk, as well as amongst non-GBMSM identifying men who have sex with men.
- This Plan aims to explore ways of broadening PrEP access through settings other than sexual health services, which may be more likely to be accessed by individuals at risk of acquiring HIV who are heterosexual or do not identify as GBMSM.
- The anti-stigma campaign aims to reduce the stigma around HIV and allow individuals to access services without shame.
- The self-testing and online postal self-sampling actions within the Plan will allow individuals who do not wish to visit sexual health services, to access free HIV testing from their own homes.
|
| Race |
- In the UK, in 2022, 53.7% of the people receiving HIV specialist care were white, with 30.2% being Black African. This shows that HIV is disproportionately affecting Black Africans in the population (as 30% is far higher than the UK percentage of Black Africans).
- Since 2018, the number of late HIV diagnoses has been increasing for Black African individuals.
- Of those heterosexuals previously diagnosed elsewhere, the majority were of Black African ethnicity and, therefore, may have come to Scotland from high HIV prevalence countries.[14]
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- The Delivery Plan seeks to eliminate HIV transmission by 2030, regardless of race and ethnicity.
- Secondary interventions outlined in the Plan, such as optimising our approach to testing, will help to prevent late diagnoses which disproportionately affect Black African individuals.
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| Religion or belief |
- No specific concerns were raised by the strategy steering group or stakeholders.
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| Marriage and civil partnership |
- Not applicable. The Scottish Government does not require assessment against this protected characteristic unless the policy or practice relates to work, for example HR policies and practices.
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