HIV testing in Scotland has failed to recover from the COVID-19 pandemic, according to new data released today from Public Health Scotland.

In 2023, there were 66,125 HIV screening tests conducted in sexual health services across Scotland while new first ever HIV diagnoses saw a 10% increase from rates in 2022. This compared to the 74,975 tests recorded in 2019, representing a 12% reduction. Testing rates collapsed to 31,378 tests in 2020 and have been slowly recovering. 

Leading HIV charity Terrence Higgins Trust warns that this decline risks jeopardising Scotland’s goal of ending HIV transmissions by 2030 and urges greater investment in HIV testing.

There has been no break in the recent trend of heterosexual diagnoses outnumbering that among gay, bisexual and other men who have sex with men (GBMSM). Of the 126 first ever HIV diagnoses recorded in 2023, 49% were heterosexually acquired, 27% were among GBMSM, and less than five were among people who inject drugs. 

The latest Public Health Scotland data also show a growing number of people who are diagnosed with HIV but are not attending HIV treatment and care. At the end of 2023, of the 6,288 people diagnosed with HIV in Scotland, 18% (1,109) were no longer engaged with HIV clinical services – a 15% increase since 2022. There are now an estimated 6,761 people living with HIV in Scotland, 93% (6,288) of whom are diagnosed. Of those diagnosed, 78% (4,926) were recorded as receiving antiretroviral treatment (ART) between 1 July 2022 and 31 December 2023, and, of those on treatment, 97% (4,795) had a suppressed viral load. There are around 500 people in Scotland who are estimated to be living with undiagnosed HIV.

The new data also showed uptake of HIV prevention pill PrEP has reached near record highs. Between July and December 2023, a total of 1,277 individuals attended sexual health services to access PrEP for the first time. Averaging 213 new individuals each month during this period, this is the second highest monthly average in any six months since NHS-prescribed PrEP was made available in Scotland in July 2017. Since July 2017, 11,413 individuals have been prescribed PrEP in Scotland. 

The Scottish Government has committed to ending new transmission of HIV in Scotland by 2030, with interim 2025 targets of achieving 95:95:95 (95% of individuals with HIV to have been diagnosed; 95% of people who have been diagnosed to be receiving treatment; 95% of people who are receiving treatment to have a suppressed viral load). Published this year, Scotland’s HIV Transmission Elimination Delivery Plan highlights testing as a key intervention in identifying new cases of HIV and preventing the onward transmission of the virus – however, today’s data shows that significant focus and investment are needed to increase testing capacity if we are to achieve our national 2030 goal.

Alan Eagleson, Head of Scotland Service at Terrence Higgins Trust, said: 'Today’s data shows some progress on ending new HIV cases by 2030 with PrEP uptake at near record highs – but the reduction in testing and increase in diagnoses should be a wake-up call. Urgent investment in HIV testing is needed to make the 2030 goal a reality.

It is extremely welcome that Public Health Scotland has published testing data for sexual health services, helping contextualise new diagnoses in Scotland. We hope this sets a precedent for future publications. However, testing rates from 2023 must serve as a warning that coming out of the COVID-19 pandemic, we remain on the back foot and our vital services are struggling to recover.

Testing is at the heart of both prevention and detection, that’s why the reduction puts Scotland’s ambition of ending new transmission of HIV by 2030 at risk. HIV tests must be readily available outside sexual health services. Terrence Higgins Trust’s national online self-test service which is funded by the Scottish Government is a positive example of this, but other interventions to promote and expand HIV testing have either yet to come to fruition or have not been actioned by the Scottish Government.

We know that opt-out HIV and hepatitis testing in A&Es has been a phenomenal success in England. In just 18 months, nearly 1,000 people with undiagnosed HIV or previously diagnosed HIV but lost to care were found through opt-out testing in London, Blackpool, Brighton and Manchester. And, while we were pleased that short pilots of opt-out testing have been rolled-out in three Scottish NHS boards this year, the future of this is in question without confirmation from the Scottish Government on whether they will fund its long-term expansion. The absence of a pilot NHS Greater Glasgow and Clyde must also be addressed urgently, with today’s data again demonstrating the prevalence of HIV in this NHS board.

The Scottish Government must also take calls to develop a National HIV Testing Week for Scotland seriously. National HIV Testing Week a key tool in combatting stigma, normalising testing and finding new cases of HIV – this cannot wait and Scotland must join other UK nations in funding this intervention.

The recognition within today’s data of those who are diagnosed but are not accessing HIV services and care is extremely important and assists in reframing our 95:95:95 targets to more accurately represent Scotland’s HIV epidemic. While the inclusion of this is welcome, the statistics themselves raise cause for concern. Much more must be done to identify individuals who are lost to care and support them to access the treatment and support that is right for them. Peer support services are key to this and must be recognised and funded appropriately so that they are able to carry out this vital work.

We have the opportunity to end new cases of HIV by 2030 and we have all the tools we need to get there. We cannot let this moment pass.’

• Terrence Higgins Trust receive Scottish Government funding to provide a national online HIV self-testing service. You can find out more information here.
• The Scottish Government have committed to ending new cases of HIV in Scotland by 2030 and published its HIV Transmission Elimination Delivery Plan in March 2024. You can find out more information here.
• The Scottish Government have committed to meeting UNAIDS 95:95:95 targets by 2025. You can read the full statement here.