Next Parliament Crucial to Scotland Ending HIV by 2030

With voters heading to the polls next week, Scotland could become the first country in the world to end new HIV transmissions by 2030, but campaigners say the outcome now rests on the next Scottish Parliament. 

A new manifesto, One Parliament Left, published by Terrence Higgins Trust, Waverley Care, and the National AIDS Trust, warns that the next Scottish Parliament will be decisive in determining whether Scotland meets its 2030 target, describing it as the final opportunity to put in place the policies needed to end new HIV transmissions on time. 

The Scottish Government first committed to ending new HIV cases by 2030 in 2020, with advances in treatment meaning the target is widely considered achievable.

People living with HIV who are on effective treatment cannot pass the virus on, while preventative tools such as Pre-Exposure Prophylaxis (PrEP) and rapid testing are widely available. 

However, significant gaps remain: around 400 people in Scotland are living with undiagnosed HIV, and up to 1,400 diagnosed individuals are not currently engaged in care.

At the centre of the manifesto is a call for urgent, coordinated action to close those gaps and ensure existing tools reach everyone who needs them across Scotland. 

Speaking to oot, Stuart Smith, Devolved Policy and Advocacy Lead at Terrence Higgins Trust, said the timing of the election is critical. 

“The next Parliament after May will be the one that sees us through to that date, and ultimately it’s the last chance to meet that ambition,” he said. 

“We’ve made a lot of progress so far, but there’s always more to do, and if we’re serious about meeting the ambition, then action needs to match that ambition.”

The document argues that without immediate investment and political focus, Scotland risks falling short of what would be a historic public health achievement: ending the transmission of a virus without a vaccine or cure.

One of the central proposals is the expansion of opt-out HIV testing in emergency departments. 

Under this model, patients are routinely tested for HIV as part of normal blood tests unless they choose to decline, removing the need for individuals to request a test.

Evidence from England, where opt-out testing has been introduced in some cities since 2021, shows that the policy can identify large numbers of previously undiagnosed cases while also re-engaging people who have fallen out of care. 

Stuart said this approach is particularly effective at reaching those who may not consider themselves at risk or who avoid sexual health services due to stigma. 

“At the moment, the usual place someone would go for an HIV test is a sexual health clinic,” he said. 

“That’s all fine and well, but not everyone knows much about HIV, or they might not feel comfortable going. 

What opt-out testing does is remove that barrier.”

The Scottish Government has already committed to introducing opt-out testing in NHS Lothian and NHS Greater Glasgow and Clyde, where HIV prevalence is highest, as part of its Programme for Government.

Campaigners see this as a positive step, but argue that a wider rollout will be needed to maximise its impact. 

Alongside testing, the manifesto highlights the importance of prevention, particularly through expanding access to PrEP. 

While PrEP is highly effective at preventing HIV transmission, it is currently only available through sexual health clinics in Scotland, limiting awareness and accessibility. 

The proposed national online HIV prevention service would allow people to order home testing kits and begin the process of accessing PrEP remotely, helping to reach those who may not engage with traditional services.

Another key priority is re-engaging people who have been diagnosed with HIV but are no longer in care. 

Without treatment, individuals are at risk of becoming unwell and may also contribute to onward transmission. 

The manifesto calls for a national programme to identify and support those individuals, alongside sustained funding for peer support and the voluntary sector. 

Activists argue addressing stigma remains essential, with low public awareness still acting as a barrier to testing and treatment. 

Despite decades of medical progress, misconceptions about HIV persist, and many people remain unaware that effective treatment eliminates the risk of transmission.

The issue has begun to feature, to varying degrees, in the manifestos of the six parties currently polling to win seats at Holyrood.

Scottish Labour has committed to ending new HIV cases by 2030, backing opt-out testing in A&E departments in high-prevalence areas, alongside online prevention services and public awareness campaigns to tackle stigma.

The Scottish Green Party has proposed a package of measures, which also includes opt-out testing, whilst also pledging to deliver a national online HIV prevention service, and improve access to specialist support. 

Patrick Harvie, of the Greens, said in a statement to oot that Scotland “can certainly meet the 2030 target”, but warned this would require “renewed effort and commitment”, particularly in scaling up testing and supporting those already living with HIV.

The Scottish National Party has also pledged to expand opt-out HIV testing in A&E departments, widen access to PrEP beyond sexual health clinics, and invest in re-engaging people not currently in care. 

SNP candidate Neil Gray said the party is “committed to ending new HIV cases by 2030” and will deliver on these measures, with opt-out testing already underway in Glasgow.

The Scottish Liberal Democrats, the Scottish Conservative Party nor Reform UK have made any specific reference to HIV in their published manifestos. 

The issue has surfaced more broadly during the campaign, with campaigners arguing debates over access to treatment are directly linked to transmission prevention, after Reform UK leader Nigel Farage said asylum seekers with HIV should be banned from accessing NHS treatment, arguing the health service should prioritise UK taxpayers.

Health charities have warned that restricting access to treatment would risk undermining efforts to reduce transmission, as people on effective HIV medication cannot pass the virus on. 

HIV organisations argue that ensuring access to treatment for all is not only a matter of public health, but a key part of meeting Scotland’s 2030 target.

More broadly, the charities behind the One Parliament Left manifesto have stressed that cross-party support will be essential if Scotland is to succeed. 

Richard Angell, Chief Executive of Terrence Higgins Trust, said the next intake of MSPs “could be the generation that ends the HIV epidemic in Scotland”, while Grant Sugden of Waverley Care warned that although significant progress has been made, efforts must now “go further and faster”. 

Daniel Fluskey of the National AIDS Trust added that while the tools to end HIV transmission already exist, “the medicine and treatment alone isn’t enough” without action to tackle stigma and support people to live well with HIV.

For campaigners, the urgency of the moment cannot be overstated.  

Stuart told oot that while the target is within reach, success is not guaranteed. 

“It is possible, but it’s only probable if the next government is serious about it,” he said. 

Campaigners say the tools to end new HIV transmissions already exist - but whether Scotland becomes the first country in the world to do so may now depend on what happens after next week’s election.

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Parties currently polling to win seats in the Scottish Parliamentary Elections, who were approached for comment, are: Reform UK, the Scottish Conservative and Unionist Party, the Scottish Green Party, the Scottish Labour Party, the Scottish Liberal Democrats, and the Scottish National Party.

The Scottish Green Party and the Scottish National Party responded to the request for comment.

Reform UK, the Scottish Conservative and Unionist Party, the Scottish Labour Party and the Scottish Liberal Democrats did not respond to the request for comment.