By Nicoletta Policek

Having lived and worked in Scotland since the early 1990s, I am proud of the progress we have made for better outcomes for people living with HIV. But although we are considered to have some of the best treatment outcomes in the world, HIV Outcomes’ Beyond the Virus report, published today show that there is still much more to do.

It is known that mental health conditions increase the likelihood of a person acquiring HIV, and that people living with HIV are disproportionately affected by mental health conditions. So it is disappointing that the Scottish Government’s HIV Transmission Elimination Delivery Plan, running from 2023 to 2026 does not include specific measures to strengthen mental health support. Current gaps in psychological support are getting in the way of Scotland’s goal to end new HIV transmissions by 2030.

Effective support can not only make sure people living with HIV are able to lead fuller and more fulfilling lives – surely a human right for everyone – but it has also been shown to improve physical health outcomes, by improving engagement with HIV care, for example.

And the ‘postcode lottery’ for mental health and HIV support services across Scotland, further compound this problem, meaning that the opportunity of receiving effective mental health and HIV support depends on which part of the country you live in. This is unacceptable.

Today’s report is timely and important. It outlines the key measures that the Scottish Government must take, if it wishes to realise its vision of being a world leader on mental health provision.

People living with HIV must be able to avail themselves of well-resourced and staffed support. The Scottish Government should work to equip HIV services to deliver care in line with the BHIVA Standards of Psychological Support for Adults Living with HIV. This should include embedding specialist mental health care in HIV clinics, and optimising pathways for referral between HIV clinics and mental health services. Healthcare professionals must also be better educated around the realities of HIV today. This will help reduce the stigma that is still all too prevalent and compounds existing mental ill health for people affected.

Tackling intersecting health inequalities and discrimination must be at the heart of Scotland’s HIV response. Underserved communities – including women, global majority communities and older people – face inequalities which impacts on their mental health, and barriers to accessing care. Our report highlights that women’s sexual and reproductive health are often not well linked, meaning that menopausal symptoms can go unmanaged, impacting on the mental health of women living with HIV. In addition, concerns around immigration status, racism, stigma and financial insecurity add additional pressures that negatively impact the mental health of migrants living with HIV. The Scottish Government and NHS Boards must ensure that people living with HIV are meaningfully involved in the design, delivery and evaluation of psychological support services for our community.

The report showcases some of the really great person-centred and community-led practice that already exists across Scotland. For example, NHS Lothian provides evidence-based psychological therapy for patients living with or at risk of HIV; and Terrence Higgins Trust’s Peer Support Scotland initiative has provided important one-to-one support by and for people living with HIV.

These kinds of initiatives must be made more widely and consistently available across Scotland. This, alongside the recommendations of the report, will ensure that people living with HIV are supported not just in their physical health, but also in their mental wellbeing, regardless of their circumstances, to live as well as they can in our country.

I’m looking forward to chairing the launch event for the report this evening where we’ll be discussing action with Government Ministers, MSPs, communities and those working in the HIV response. By integrating mental health promotion, prevention and treatment into Scotland’s HIV response, we can support communities to live well whilst strengthening efforts to end transmissions by 2030