Scottish Government

1. INTRODUCTION

1.1 This study, commissioned by Scottish Government Social Research, on behalf of The Chief Medical Officer and Public Health Directorate, reviewed HIV Scotland in the context of the funding support it receives from the Scottish Government. It was undertaken by the TASC Agency between April and November 2009.

Context

1.2 In 2006, 2,416 HIV infected persons were receiving HIV specialist care in Scotland; the majority of the cases in specialist care attended for treatment in Lothian (986), Greater Glasgow & Clyde (778), Tayside (188) and Grampian (160) NHS Boards. ⁶HIV disproportionately affects key groups of people, notably in men who have sex with men ( MSM) and in African communities.

1.3 Rates of transmission of HIV in Scotland require Government and partner agencies to reflect on how they might renew efforts on prevention, particularly amongst communities most affected by those increases. Alongside prevention, with a growing population of people living with HIV, there is also recognition that there are improvements required in treatment and care. In line with commitments to joined-up policy and practice across public services this demands an integrated approach across voluntary and statutory sectors.

1.4 Recent statistics ⁷ about HIV Infection and HIV testing tell us that:

• In 2008, 412 new cases of HIV were identified in Scotland; this represents a 9% decrease on the 452 cases reported in 2007.
• In terms of most affected groups or communities: there were 155 new diagnoses amongst gay, bisexual or men who have sex with men ( MSM), 204 new diagnoses amongst heterosexual men and women who are not injecting drug users and 19 new diagnoses amongst injecting drug users.
• There is an increased uptake of HIV testing; between 2004 and 2008 there was a 71% increase in the numbers of persons taking an HIV test.

1.5 Living with HIV in Scotland remains a challenge for individuals. People fear the stigma that is still associated with HIV positive status. A positive diagnosis has both social and psychological consequences. Managing drug regimens is difficult and those living with HIV/ AIDS know better than others that it is too simplistic to think of HIV/ AIDS as just a chronic but manageable condition. In Scotland today HIV positive status remains linked to poverty ⁸. Beyond the individual it is also important to recognise that communities most affected by HIV may need different responses.

1.6 The context is complex and in response the Scottish Government has been coordinating efforts to produce an HIV Action Plan in Scotland ⁹. Now published (November 2009) its development has run in parallel with the Review of HIV Scotland. The Action Plan intends to clarify Government and partner agencies roles and contributions towards commitments to ensuring that Scotland reduces HIV transmission and levels of undiagnosed HIV alongside developing more effective co-ordination of prevention, treatment and care.

1.7 The HIV Action Plan further intends to build on commitments made to promoting sexual health and wellbeing in 'Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health' ¹⁰ and 'Respect and Responsibility Sexual Health Outcomes: 2008 - 2011' ¹¹.

Aim

1.8 The Review of HIV Scotland is part of a rolling programme of external reviews of organisations in receipt of major recurring grants of £100k or more at six year intervals which are required under the Scottish Compact of Good Practice Guide 'Advice on Scottish Executive relations with the voluntary sector' ¹². HIV Scotland has welcomed the Review and has cooperated fully throughout the process.

1.9 The Review of HIV Scotland was commissioned to do a number of things. Each of these is listed below and sections of the report which address each are highlighted:

1.10 Finally, before presenting findings from the Review and offering recommendations for the future, it is important to recognise that across stakeholder contributions there has been recognition of the work and commitment of Board members and many members of staff who have been part of HIV Scotland and the Scottish Voluntary HIV and AIDS Forum before it. HIV Scotland's constant presence is a reminder about the impact of HIV in Scotland. This Review will highlight that the agency appears to have struggled in the last couple of years to connect positively to the many and diverse partners which make up the HIV sector but at the same time it has continued to bring a focused and impressively well-informed view to national policy development. It is hoped that this Review process and final report will help the agency and others across the HIV sector to look toward the next phase of action to tackle the epidemic in Scotland.

Report Structure

1.11 Chapter Two describes the methods used to carry out the research. The subsequent chapters present further findings. Chapter Three describes the agency and current activities. Chapter Four examines the aims, objectives and organisation focus. Chapter Five considers planning, management and organisation of HIV Scotland. Chapter Six discusses HIV Scotland's contribution to Scottish Government policy. Chapter Seven presents an analysis of the strengths and weaknesses of the agency. Recommendations for future development of the agency are found in Chapter Eight.