Today is World AIDS Day, the international day where we show support to people living with HIV, remember those who lost their lives to AIDS - an immunodeficiency disorder brought on from untreated HIV - and keep raising awareness about better treatment and prevention strategies.
While the number of new diagnoses in several countries in the EU/EEA region is falling, Malta keeps reporting an increase in the number of cases. With 80 new cases in 2019, Malta has the highest rate of HIV diagnoses in 30 EU/EEC countries. What’s more, 30% or more of the new diagnoses were in people under 30 (ECDC HIV/AIDS Surveillance in Europe 2020).
The situation is as bleak this year. From January to mid-November, the Infectious Disease Prevention and Control Unit (IDCU) reported 72 new HIV cases and one AIDS case (59 males, 13 females and one trans person). 39 of these cases were diagnosed in the first half of the year alone when we saw a 32% decrease in the number of HIV tests at the GU Clinic compared to the same period last year and a partial lockdown in March and April. Taking into account the decrease in tests, the numbers could have been higher.
These numbers are increasingly worrying at a time when effective prevention strategies are readily available for governments to use or implement. In England, Public Health England (PHE) attributes the continued decline in new HIV diagnoses in 2019 to an increase in combination prevention: a fall of 18% from 2018 and 47% from 2014 across all genders and sexualities; and a fall of 10% from 2018, 34% from 2014, and 80% from 2011 in gay and bisexual men.
In the lead-up to World Aids Day, the GU clinic, Health Promotion and Disease Prevention, and ARC have been conducting an HIV Rapid Test & Consultation week. Individuals were offered an HIV rapid test and had the opportunity to discuss PrEP with GU clinicians. A similar event was held last September. The number of people who attended and got tested is encouraging, but all of us can do more to reduce the number of HIV infections.
A combination strategy includes “the use of condoms, pre-exposure prophylaxis (PrEP), frequent HIV testing in a wide range of settings, and starting ART as soon as possible after diagnosis” (PHE 2020). Malta could do better on all fronts, and it’s not for the clinicians’ lack of trying. The clinicians at the GU clinic and those working at IDCU are doing their best with the resources they have. The number of samples that GU clinicians can send to the medical laboratories at Mater Dei remains capped as labs have been repurposed to focus on testing for Covid-19. However, a Point of Care Testing (POCT) device allows clinicians to run the samples inside the clinic itself, bypassing the need for the laboratories at Mater Dei Hospital
There are two pertinent questions which have for long been left unanswered: why is the government still postponing the introduction of PrEP on the national formulary, and what is holding public health officials back from supporting ‘Undetectable equals Untransmittable’ (U=U)?
PrEP is a treatment taken by HIV negative people which substantially reduces the risk of acquiring HIV by over 99%. It can be purchased from pharmacies for €57 upon presentation of a prescription which you can obtain from the GU clinic. Not everyone at high risk of acquiring HIV can pay for the treatment, especially in these unprecedented times where jobs are at stake.
U=U refers to when HIV can no longer be detected in the blood at high enough a level to be passed on to another. This can be achieved when a person living with HIV is on effective treatment. The earlier a person living with HIV is diagnosed, the earlier they can be offered treatment reducing the chances of passing on the virus. Improved testing is essential even in these times when our focus is on Covid-19.
ECDC Director Dr Andrea Ammon writes: "Despite the focus on Covid-19 right now, we must not lose sight of other public health issues like HIV." She speaks of earlier diagnosis of HIV as "an urgent priority" which can only be achieved by "diversifying our HIV testing strategies".
HIV is not Santa. It does not care if you have been naughty or nice. It is a virus that does not discriminate. Covid-19 has taught us the importance of solidarity and social responsibility towards one another. Both the government and high-risk groups, in particular, can do more. Let's talk openly about our sexual health and encourage others to do the same. Start the conversion with your friends and show your support towards people living with HIV. It could save lives.
Dr Mark Josef Rapa is a lawyer who has specialised in Healthcare Ethics and Law. He is the founder of PrEPingMalta and a member of the European AIDS Treatment Group.