Growing up in Ecuador, I’ve witnessed the difficulty that marginalised communities face trying to access basic health services and quality education. I learned that the implications of these inequalities are vast, leading to higher prevalence of disease, homelessness, and negative health outcomes, including vulnerability to HIV. I’ve just recently moved to Edinburgh and my experience has informed my work at HIV Scotland and the research I conduct. Now, I am not saying Scotland is anything like Ecuador – the social dynamics are different – but the underlying inequalities that prevent people from living a full and healthy life are universal in scope.
What I’ve learned is that HIV has a complex relationship with health, poverty, inequality, and education. Poverty can make people more vulnerable to HIV; lack of sexual health education can lead to being misinformed about the risks of HIV; inequality and stigma can discourage people from getting tested for HIV, and so on. Let’s take, for example, education. Inclusive and equitable quality education is a critical element in equipping our young people with accurate sexual health information that is aligned with the contemporary needs of people today. This also means equipping our teachers with the confidence to deliver clear key sexual health messages, which we all know can sometimes be awkward. This is a collaborative process across the education sector to ensure that everyone gets quality, up-to-date sexual health information on a level playing field. Without inclusive and equitable quality sexual health education, we will limit our ability to reduce HIV transmission and challenge stigma.
Now, the United Nations Sustainable Development Goals (SDGs) is key to ensuring that everyone, regardless of who you are, has access to the best possible livelihood and future – it leaves no one behind. For those unfamiliar with the SDGs, they’re a set of seventeen goals that tackle a range of issues; from improving health, ending hunger, poverty, and inequality to taking action on climate change. HIV is directly aligned with the outcome of the third goal of ensuring healthy lives and promoting the well-being of all by 2030. However, to achieve SDG three, the health and well-being of all people need to be met, including the needs of people living with or affected by HIV. The principle behind the SDGs are that no one goal can be achieved in isolation – if one fails, they all fail. What I am trying to say is that you can find a response to HIV in almost all the SDGs; it’s cross-cutting and involves multiple sectors. There’s no scaling back. To achieve the best possible outcome for all, Scotland needs to see a more unified, collaborative approach in realising the outcomes of the SDGs, which brings me to my next point…
There are people experiencing inequalities on a daily basis across Scotland. Marginalised groups are often experiencing multiple forms of stigma and discrimination, and not necessarily HIV-related. And, people living with HIV are often members of communities most affected by stigma, and it is clear that this can contribute to negative health outcomes. Now, challenging stigma and inequality is an interdisciplinary exercise and involves tackling it from all angles: in the workplace, in schools, healthcare settings, and everywhere in between. There are many SDGs that play an important role in minimising stigmatising attitudes and behaviours, including HIV-related stigma. What all this boils down to is committing to work collaboratively across sectors on achieving all SDGs to improve the lives of people across Scotland.
Now, this is a pretty big ask, but we’re feeling optimistic. Scotland’s sexual health and blood borne virus’s framework is a step in the right direction and it provides an opportunity for Scotland to achieve the SDGs by focusing on the root causes of HIV transmission. And, as ambitious as it sounds, Scotland has the capacity and potential to ensure the best possible outcome for people living with HIV.
Let’s remember that this isn’t a one-size-fits-all kind of approach – it’s meant to engage multiple sectors and actors in the spirit of partnership and solidarity to improve the lives of everyone. There’s no room for complacency; the SDGs are challenging and ambitious, yet achievable. One thing is certain; without real cross-sector collaboration and strong political will, achieving the SDGs by 2030 will be an up-hill battle. We have much work to do!