GLOBAL HIV prevalence may be levelling off, but Scotland is facing a fresh sexual health crisis as the number of new HIV infections reaches record levels.

Experts believe that if trends continue, the country could struggle to cope with the spiralling costs of anti-viral drug treatments that make life bearable for the rapidly-increasing number of Scots coping with the virus.

Roy Kilpatrick, director of HIV Scotland, expects there to be 450 new diagnoses by the end of year, more than ever before. "The increase is likely to exceed the record levels of 2005," he said. "We've exceeded even the crisis point of the early 1980s, and it's going to be difficult to break the cycle. For certain, the trends are worrying. If they continue, we're going to get a doubling in the rate of new cases in five years.

"It's a crisis that merits urgent attention."

Glen Codere, information manager at Health Protection Scotland, said: "We are seeing more reported HIV cases in Scotland than at any other time in the history of the virus. Until 2001, we saw around 160 cases a year. Since then, the rates have risen quite a bit. The indications are that we will eclipse the previous high mark this year. The pool of HIV-infected persons in Scotland is higher now than at any time, and continues to rise."

Though there was a cautious welcome for the two-fold increase in HIV testing that partly explains the rise in detected infections, many in the care sector believe the figures indicate a failure in prevention as Scots become "blasé" about safe sex.

Ron Christie, a manager at the Tayside HIV support group Body Positive, said: "The message has been lost over time. We have become blasé because it never quite became the epidemic we once thought it would be. It's dropped off the agenda. But in Dundee we've seen the biggest rise this year since the early 1980s, and the stigma is still there as much as ever."

AIDS-related deaths among those infected with HIV have fallen by a factor of ten since the introduction of effective combination drug therapies in the mid-1990s, allowing most living with the virus to maintain reasonably good health over a near-normal lifespan, without having to swallow fistfuls of pills each day.

Yet David Johnson, director at Waverley Care, an Edinburgh-based HIV charity providing a wide range of services, fears meeting the costs of the anti-retroviral drugs will become increasingly difficult. "We're building up some major costs in terms of treating people," he said.

"A lifetime of treatment can cost £300,000 for each person. My big fear is that we are going to reach a point where it will not be possible to offer people treatment and pay for all the services we currently enjoy, if the rate of new cases doesn't go down.

"We need to work much harder on prevention. The complacency is really worrying. As a nation we're not very relaxed taking about sex. We need to change the culture and we all have a role to play."

HIV Scotland estimate that assisting the 400 newly diagnosed patients each year could cost more than £200 million, requiring a renewed commitment by government to halt the rise. Kilpatrick said: "Provision is patchy is some areas. There needs now to be an increased boost in the level of funding, because we need extra resources on the ground. But prevention is much more cost effective than treatment in the long-term."

A Terrence Higgins Trust Scotland report sent to every MSP, and seen by the Sunday Herald, outlines 20 things the Scottish government can do to tackle the HIV outbreak. It urges the new administration to set targets on reducing undiagnosed HIV from 32% to 25%, and recommends that HIV home-testing kits, currently banned in the UK, are legalised and properly regulated.

TerrENce Higgins Trust Scotland also wants a major anti-stigma drive on along the lines of the "See Me" campaign, widely praised for leading to a better understanding of mental health, and a huge improvement in the delivery of sex education.

"We appear not to be getting the safe sex message across," said Susan MacDonald, director of Terrence Higgins Trust Scotland. "Sex education is patchy. There's no compulsion for schools to undertake proper education of this kind. There should be a clear, standard, age-sensitive courses that allows young people to make really informed choices about sex, to get the message across early rather than later."

A new report by Health Protection Scotland outlines the trends in the rise of HIV among high-risk groups, confirming that Glasgow now accounts for more new cases than Edinburgh.

More strikingly, 60% of all reported HIV cases since 2002 are among those coming into Scotland who have contracted the virus outside the country, mainly from sub-Saharan Africa and eastern Europe.

Acknowledging the sensitivity of the issue, Jonathan Creil, manager at Waverley Care, insisted that Scotland was not being targeted by asylum seekers looking to benefit from medical care.

"The number of people who've contracted HIV abroad is a bit of a political hot potato. We've dealt with many people who've experienced harsh winters while they're here working or studying. Their immunity plummets and only then do they realise they need tested and have the virus.

"There are very, very few people who come here knowingly to receive treatment."

Kilpatrick added: "One of the good things about Scotland is that it has had a very open and humanitarian attitude to population movement. It does mean that Scotland experiences a ripple effect from the epidemic in high prevalence areas like sub-Saharan Africa."

The other group affected disproportionately by the new wave of HIV infections is gay men. Of those infected within Scotland last year, 75% were homosexual men, and the rate has risen to 80% this year.

Yesterday saw the re-launch of "HIV: The Comeback Tour" to mark World Aids Day, a multi-agency collaboration to raise HIV awareness among the gay community and disrupt any misapprehension that the success of anti-viral treatments has diluted the threat of serious illness.

Creil, who works with those struggling to live with the chronic condition at Milestone hospice, believes misconceptions about a miracle cure have led to complacency.

"We provide a lot of care and support to people who, despite the treatment, often become extremely sick. There are people doing very well, but they still require a stay in hospital a few days a year. I don't think people quite grasp that living with HIV is not an easy thing to do."

Other awareness-raising events taking place yesterday included the World Aids Day Youth Conference in Paisley, organised by Oxfam Scotland. Emma Laverie, Scottish Youth Parliament development officer, said: "It's time to talk frankly about HIV and Aids in Scotland. Infection rates are on the rise in this country and young people are especially at risk."

Meanwhile, some 50,000 people gathered at a Nelson Mandela Aids concert in Johannesburg to watch performers such as Peter Gabriel and Annie Lennox.