How can Scotland and Ireland achieve HIV transmission elimination?

Scotland and Ireland have committed to eliminating HIV transmission by 2030 (1,2), but it is unclear whether current prevention efforts are sufficient to meet this goal across all population groups. Our modelling study predicts future HIV transmission, by population groups, under current intervention levels and explores whether realistic increases in prevention interventions could accelerate progress. While both countries have already achieved the UNAIDS HIV transmission elimination target for their total populations, our findings indicate further action is needed to ensure progress is equitable, particularly for gay, bisexual and other men who have sex with men (GBMSM). This work was commissioned and funded by Gilead Sciences. The work was carried out independently by Aquarius Population Health.

2nd June 2026

Funded by: Gilead Sciences

McGreevy A, Bates L, Yajamin R. How can Scotland and Ireland achieve HIV transmission elimination? Aquarius Population Health. June 2, 2026. Available here: https://aquariusph.com/reports/how-can-scotland-and-ireland-achieve-hiv-transmission-elimination/

Key Takeaways

Current data indicate Scotland and Ireland are already meeting the UNAIDS HIV transmission elimination target for their total adult populations.
Population-specific UNAIDS targets are also being met for heterosexual men, women, and people who inject drugs in both countries.
Though transmissions are projected to decline under current intervention levels, neither country is on track to meet the 2030 transmission elimination target for GBMSM.
With moderate increases in prevention intervention levels, Scotland could reach HIV transmission elimination for this group by 2030 and Ireland by 2035.
Our findings highlight the progress both Scotland and Ireland have made towards the elimination goal. However, increased investment in a combination of prevention interventions is needed to achieve the goal for all population groups and provide support for affected individuals.

Both Scotland and Ireland have expanded HIV prevention efforts in recent years, including increased access to PrEP and expanding HIV testing services in new settings (1,3). Despite this progress, uncertainty remains about whether current efforts are sufficient to meet the countries’ commitments to eliminate HIV transmission by 2030. We used an adapted version of a previously published Markov state transition model to project future HIV transmissions in Scotland and Ireland (4). The model focused on transmissions acquired within each country, included adults aged 16 years and over and used 2023 data as the baseline.

Outcomes were assessed for the total population and for four population groups: GBMSM, heterosexual men, women of all sexual orientations, and people who inject drugs. Transmission elimination was defined using the UNAIDS goal of fewer than one new transmission per 10,000 population per year (5).

Six intervention indicators were included in the model, including PrEP uptake, HIV testing, timeliness of diagnosis, treatment initiation, and viral suppression. We modelled outcomes under current intervention levels and, where targets were not met, under a scenario with “moderate” increases in intervention levels. This scenario reflects what would be considered a substantial, yet realistic, increase from the current levels.

Current data indicate Scotland and Ireland have already achieved the UNAIDS HIV transmission elimination targets for their total population, as well as among heterosexual men, women, and people who inject drugs. However, our modelling suggests that for GBMSM, neither country is expected to meet the 2030 target under current intervention levels. We predict that with “moderate” increases in intervention levels among GBMSM, both countries can achieve elimination in the near future.

Our findings highlight the progress both Scotland and Ireland have made towards the elimination goal. However, further expansion and access to prevention services is needed for transmission elimination among GBMSM in both countries.

Additionally, while few new transmissions are occurring within both countries among non-GBMSM population groups, annual diagnoses remain higher due to acquisitions outside of the countries. Alongside prevention interventions, access to treatment and support for these individuals should be considered as part of the countries’ action plans.

References

Ending HIV Transmission in Scotland by 2030: HIV Transmission Elimination Delivery Plan 2023-26 [Internet]. Scottish Government; 2024. Available from: https://www.gov.scot/publications/ending-hiv-transmission-scotland-2030-hiv-transmission-elimination-delivery-plan-2023-26/
Programme for Government 2025: Securing Ireland’s Future [Internet]. Department of the Taoiseach; 2025 [cited 2025 Oct 30]. Available from: https://www.gov.ie/en/department-of-the-taoiseach/publications/programme-for-government-2025-securing-irelands-future/
HSE-Health Protection Surveillance Centre [Internet]. 2023 [cited 2026 Jan 21]. Update on Epidemiology of HIV in Ireland, to the end of 2022. Available from: https://www.hpsc.ie/a-z/hivandaids/hivdataandreports/2022reports/title-23563-en.html
Massey K, Vardanega V, Chaponda M, Eddowes LA, Hearmon N. Investigating zero transmission of HIV in the MSM population: a UK modelling case study. Arch Public Health. 2023 Nov 20;81(1):201.
HIV response sustainability primer. Joint United Nations Programme on HIV/AIDS (UNAIDS) [Internet]. 2024; Available from: https://sustainability.unaids.org/wp-content/uploads/2024/06/HIV-response-sustainability-response-primer_web.pdf