World Aids Day: HIV is now a manageable condition like diabetes, yet stigma and ignorance remain – Stewart McDonald

A straight person is more likely than a gay person to contract HIV and also more likely to get a late diagnosis

One cold December in 1964, a baby was born to Martha and Doug Puryear. Twenty-three years later, Duane Puryear would crouch on the National Mall in Washington DC holding a quilt he had sewn himself. “My name is Duane Kearns Puryear,” it read. “I was born on December 20, 1964. I was diagnosed with Aids on September 7, 1987. Sometimes it makes me very sad. I made this panel myself. If you are reading it, I am dead.”

World Aids Day has been marked on December 1 every year since 1988. Duane saw just two more Decembers before he died, with his parents by his side, at the age of 26. Across the world, millions of lives have been cut short with the same unimaginable sense of grief and loss since the first person died of Aids-related illness in 1969. But that chapter has almost come to a close. The world has changed so much since Duane died.

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The stories of HIV and Aids are no longer stories about gay men and stories of death. The real story is this: in Scotland today, and across the UK, a straight person is more likely than their gay counterpart to contract HIV. They are likely to acquire it by having unprotected sex. They are more likely than their gay counterpart to diagnose it late. And every single person who tested positive for HIV in Scotland will live long, happy, healthy lives thanks to the near miracle of modern medicine.

Infamous 1980s’ tombstones

An HIV diagnosis has not been a death sentence for years. The NHS now places it in the same category as diabetes: a condition easily managed and suppressed by medication and regular check-ups. The scariest thing about an HIV diagnosis in Scotland today is the stigma – not the virus itself. Stigma that feeds on ignorance.

This message was at the heart of the Scottish Government’s recently launched campaign, featuring the first television adverts about HIV since the 1980s’ infamous tombstones. Polling commissioned ahead of the campaign found that just one-third of Scots would be happy to kiss someone living with HIV – despite it being known for four decades that HIV cannot be transmitted through saliva. But more than that: as long as a person with HIV is taking their prescribed medication, which lowers the levels of the virus in their body to levels medically classed as “undetectable”, they cannot even pass it on through having unprotected sex.

People who are deemed at high risk of contracting HIV – men who have sex with other men, people who inject drugs, and people who sell sex – can also take a pill called PreP. PreP is a bit like the birth control pill: taken every day, or even on demand, it is 99 per cent effective in stopping the transmission of HIV. First made available by the Scottish Government in 2017, three years before it was rolled out across the UK, this medication has been instrumental in driving down diagnoses of HIV in Scotland. You can see it for yourself on Public Health Scotland’s website: their line graph of diagnoses takes a sharp turn towards the bottom right of the page as soon as that treatment becomes available on the NHS.

World Aids Day is marked on December 1 (Photo by China Photos/Getty Images)World Aids Day is marked on December 1 (Photo by China Photos/Getty Images)
World Aids Day is marked on December 1 (Photo by China Photos/Getty Images)

Target of no new HIV cases by 2030

But as I wrote above, decades of public information campaigns targeted at the gay community and community-led work to raise awareness of HIV transmission and testing have meant that the number of gay men testing positive for HIV is steadily decreasing. What the recent figures from Public Health Scotland make clear is that a new approach to tackling HIV is needed, if the Scottish Government is to succeed in its goal of no new transmissions by the year 2030.

Following the recommendations made by the Terrence Higgins Trust, the Scottish Government announced this week that they will introduce opt-out testing in Scotland’s emergency departments – meaning that incoming patients are tested for HIV as a matter of course – and they must open up PreP to anyone who wants it, promoting it through the same kind of community outreach campaigns that have been so successful in driving down transmission rates among the gay community. The goal of no new transmissions by 2030 is within touching distance, but it doesn’t just happen by magic.

People in the 1980s spoke about this day like a promised land – a shining city in the distance that they would never themselves set eyes on. But they knew that it would come. “Someday, the Aids crisis will be over,” the academic-turned-activist Vito Russo told a crowd in 1988. “Remember that. And when that day comes – when that day has come and gone, there'll be people alive on this earth who will hear the story that once there was a terrible disease in this country and all over the world, and that a brave group of people stood up and fought and, in some cases, gave their lives, so that other people might live and be free.”

The image of Duane Puryear and his quilt panel, which I would urge you to take a few moments to search up and look at, reminds us of all those who fought so hard to take our society to where it is today with HIV and Aids – those who transformed HIV from a death sentence into a manageable medical condition like any other.

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While the science has evolved, it is painfully clear that public attitudes have yet to catch up and that ignorance and stigma surrounding HIV are still all too rife. Combatting this ignorance and stigma requires a new generational mission that we can all be a part of. Public Health Scotland’s figures make it clear that the virus does not discriminate. Neither can we.

Stewart McDonald is SNP MP for Glasgow South



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