Key messages and background

HIV transmission elimination
Public Health Scotland

Key messages:

PrEP does not prevent against other sexually transmitted infections (STIs), therefore, condom use is still important. Regular testing for HIV and other STIs is essential.​

Studies conducted within the UK and international settings have found HIV PrEP to be highly effective in reducing sexual acquisition of HIV5-8. These studies were initially in gay, bisexual men and other men who have sex with men (GBMSM); however, current evidence supports its effectiveness across all gender and sexual orientation populations. ​

PrEP is suitable for most people who request it and, in most situations, offering and initiating PrEP is appropriate.​

Uncommon exceptions include where individual risk of HIV infection is low and clinical risk of PrEP outweighs benefit.​

 

Background:

HIV remains a public health challenge for Scotland1. In 2024, the second highest number of new reports (375) was recorded in 10 years; 125 of these were first ever diagnoses2. ​It is important to note, however, that since 2017 the annual number of first ever diagnoses recorded has nearly halved (decreasing from 225 in 2017 to 125 in 2024).​ 

Majority of HIV infections are sexually transmitted, with gay, bisexual and other men who have sex with men (GBMSM*) previously being the group at highest risk of transmission in Scotland (until 2021 accounting for 50% of all diagnoses - first ever and those previously recorded elsewhere but reported for the first time in Scotland). Between 2022 and 2024, however, heterosexual transmission accounted for  the majority of new diagnoses (55% in 2024 compared to 29% acquired via GBMSM sexual transmission2).  ​

Since July 2017, NHS Scotland has offered HIV PrEP through specialist sexual health services to individuals who meet eligibility criteria as part of a wider targeted national prevention programme3.​

PrEP is an effective HIV prevention intervention which uses anti-retroviral drugs to protect individuals at highest risk of acquiring HIV – reducing HIV transmission by up to 99%4.​

The medication widely used for HIV PrEP is a single fixed dose oral combination tablet. The combination tablet comprises of two antiretroviral drugs; tenofovir disoproxil and emtricitabine5. 

 

*The term GBMSM used here includes Gay, Bisexual and Men having sex with men and includes transgender men who have male sexual partners. ​

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