Section One: Introduction
HIV is a major public health challenge for Scotland.
More people are living with HIV in Scotland than ever before as a result of increased testing, leading to earlier diagnosis, particularly in genitourinary medicine ( GUM) clinic settings and of more effective management of those living with HIV. By 2012, the number of people living with HIV and requiring specialist care is likely to increase by 5-13% (some 150-350 persons) per year 1 and the average age of individuals living with HIV will increase over time as effective drug regimens sustain and improve their quality of life. Providing treatment and care for all those who require it is one of Scotland's most pressing HIV challenges 2.
Despite record numbers of new diagnoses in recent years (refer to HIV Action Plan Epidemiology supporting paper) principally as a result of the Respect and Responsibility 3 opt-out HIV testing policy, there is evidence of: (i) transmission of infection; (ii) undiagnosed infection; and, (iii) high risk behaviour in certain groups of the population ( 4,5,6,7). Thus, effective, evidence informed HIV prevention is key to reducing the risks of HIV transmission.
Whilst HIV was included in the wider context of the actions under Respect and Responsibility3, Scotland's first sexual health strategy, there is a need to renew our focus on HIV at both a national and local level. This Action Plan therefore builds on the draft proposals developed by the multi-agency HIV Action Plan Group, the Treatment and Care Needs Assessment commissioned by the Scottish Government and produced by the Scottish Public Health Network (Scot PHN) and the extensive feedback received from key stakeholders and individuals, including those living with HIV.
The HIV Action Plan is a strategic framework which addresses the need for refocused action across Scotland in response to these issues. The overarching aims are to:
- Improve the effective co-ordination of prevention, diagnosis and treatment and care activities across health, social care and voluntary sectors
- Reduce levels of HIV transmission and undiagnosed HIV
- Develop appropriate accountability and reporting arrangements together with increased opportunities to evaluate and research practice.
This Action Plan will facilitate the co-ordination and pursuit of best practice in prevention and models of care across Scotland, whilst at the same time allowing local and regional needs to be identified and addressed. It aims to overcome organisational and professional silos to ensure effective co-ordination and, where necessary, re-design services to improve effectiveness and efficiency. An integrated approach which includes harnessing the distinct and valuable contributions of both the voluntary and statutory sector is core to this Action Plan.
Lessons have been learned from the development and implementation of other strategies such as the Hepatitis C Phase II Action Plan for Scotland. 8 This has highlighted the value that could come from adopting a similar approach - albeit with more modest funding - for HIV.
This document is a practical plan highlighting what must happen and who must be involved if the overall aims are to be achieved through:
- Integrating HIV prevention, diagnosis and treatment and care
- Reducing HIV transmission and undiagnosed HIV through social marketing, education, service provision and guidance; and
- Improving performance management and accountability.