The clinic in 56 Dean Street, London has reported a decrease of 90 per cent in HIV diagnoses; from 60 to 70 a month two years ago down to three cases last October. London has in fact become the third city, along with Amsterdam and Melbourne, to reach the 90/90/90 target set by the United Nations of getting 90 per cent of people with HIV diagnosed, 90 per cent of those on treatment and 90 per cent of those virally suppressed and therefore non-infectious. New York City has also just reached an all-time low level of new cases. This did not happen by chance, but by accepting recent developments in science.

The development of Pre-exposure prophylaxis (PrEP) - a single tablet which if taken every day or even just when needed reduces the risk of acquiring HIV by 99 per cent - was key to the reduction in numbers, together with a holistic approach to sexual health that includes frequent testing and immediate treatment of people who test HIV positive. People fear that those on PrEP will start engaging in condomless sex and so acquire more sexually transmitted infections (STIs). Research, once again, is already a step ahead: If we follow the Centres for Disease and Prevention Control PrEP guidelines which recommend biannual STI testing, we would actually see a 42 per cent decrease in gonorrhoea and a 40 per cent reduction in chlamydia in men who have sex with men,

At last weekend's first-ever PrEP in Europe Summit, the consensus was that PrEP works and we have a moral duty to ensure that those at high risk have access to the drug. Legally, the right to health can be interpreted to extend to the right to preventative health care. Globally, governments are shifting their health budgets to preventative care, because prevention is better and cheaper than cure. The cost of providing PrEP for a year or two is cheaper than the lifetime cost of treating a person living with HIV; PrEP users use less drugs than those living with HIV over a lifetime.  

Another wonderful development of science is what has become known as the "U=U" (Undetectable equals Untransmittable) campaign. People living with HIV who are on effective treatment and have had their viral load (the number of copies of the virus in their body) suppressed for six months, cannot transmit the virus to other people.

Unfortunately, here in Malta the treatment of HIV is far from desirable. The medication provided is far from what is recommended in the EACS guidelines; a one-tablet-a-day regimen is still not on offer. Many people still have to endure the burden of taking up to six tablets a day. This drug burden can lead to lesser adherence and less chance of reaching an undetectable viral load.

With the rates of new HIV diagnosis on the increase we do not have a single day to waste. Like other major urban areas, we can be a success story and end HIV. We must focus our energies on getting more people tested; the earlier they know their status and are provided with effective medication, the fewer forward transmissions. PrEP is also an effective tool and our clinicians and policy-makers need to look into how to introduce it.

We have the tools to end the HIV epidemic. The rest depends on each one of us: We must start talking about sexual health. People of all ages, gender and races engage in sexual activities and most of the time we underestimate the risks we take. It is in the interest of both the country and its citizens to have an open discussion in our classrooms on sexual health; parents also ought to have these discussions at home with their children. Irrespective of one's opinion on sex and age of consent and one's religious beliefs, young people engage in sexual relations. It is therefore imperative to provide them with all the necessary information so they can make informed decisions about what practices they engage in. Keeping mum is no longer a tenable option. This only leads to further stigma, and puts the sexual well-being of every one of us in danger even more.

A comprehensive sexual health education, access to preventative treatment and encouraging more people to be tested are key to not only end HIV but to take control over our bodies and be more responsible for our own actions. Shaming people living with HIV or even suggesting outing them is not in any way in the interest of public health - conversation and testing are.

We should not fight people living with HIV, we should fight the virus. Science has given us all the tools we need.

You can book a sexual health screening at the GU clinic (Mater Dei Hospital) by calling 2122 7981.

 

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Dr Rapa is a lawyer who has specialised in healthcare ethics and law. He is also a member of the European AIDS treatment Group (EATG) and EATG Training Academy Step-up programme Alumni 2017