The Health Ministry has told The Malta Independent that the transition period between the old HIV medication and the new one can last up to 6 months, however, HIV physicians have not been informed about this or if a transition strategy will be put in place. 

At the end of last week, HIV medications made headlines as three of the outdated HIV medications that were being distributed were out of stock in Malta, leaving patients scrambling to outsource medication from other patients or NGOs. 

On Saturday, the Health Ministry announced that the €3 million investment in this new medication arrived in Malta and would be distributed among patients in the following week. It also said that in light of shortage of the old medication across the EU, the Ministry is doing the best it can to get the new medication. 

While this was great news for Malta after years of waiting for the new medication, it also raised some red flags from HIV physicians, patients and NGOs who feared that the switch from the old and new medication would be too abrupt - considering that the old medication was out of stock in Malta - and a transition strategy was needed. 

The Malta Independent asked the Ministry about these concerns. It informed that the majority of the new treatments have arrived in Malta and that the change-over will take up to 6 months, “so that the clinicians will be able to follow their patients closely.” 

Additionally, it said that the old medication will continue to be sourced until all patients are switched over onto the new treatment, adding that it will be proritising the change-over of treatments with limited availability on the international market. 

‘Our alarm was at the previous press release which contradicts this statement’ – MGRM 

This newsroom informed the Malta Gay Rights Movement (MGRM), one of the NGOs that has been at the forefront in helping HIV patients find medication, about this statement. 

“If the transition is properly prepared and is gradual, we have no objection. Our alarm was at the PR issued by the Health Ministry which contradicts this statement,” spokesperson for the NGO Joe Grima said. 

He noted that if this is a change in strategy then it must be communicated more clearly to staff and patients. 

“We also need to be assured that a proper transition plan that involved consultants and experts in its drafting has been prepared in order to better explain to patients what they should expect to see in the next 6 months.” 

‘We are still waiting for instructions from the health authorities on this matter’ – HIV physician 

The Malta Independent also spoke with an HIV physician in Malta under the condition of anonymity who explained what the situation has been like and the concerns it gave rise to. 

“The medication has been promised on the health agenda for a number of years and when they finally arrived, all this had to happen. While we are grateful and we appreciate that the new medication is coming in, we never had an issue with supply of the old medication.” 

Asked if the reason behind the delay was explained to them, the physician explained that they had not been informed by the authorities about it and are only gathering information from the media. "But whatever the reason is obviously it is not acceptable that you leave people without life-saving medication." 

They explained that there are three main issues with missing treatment. Firstly, it can reduce the effectiveness of the treatment, causing drug resistance and an increase in the levels of the virus in the blood (viral load) which will, in turn, increase the chance of the virus being transmitted. 

The second aspect is psychological as physicians were met with patients who were angry frustrated or guilty for not being able to share their medication with their friends or partner as they did not take the same one. “Of course, we never recommend sharing medications with their friends if they were not assigned the same medication. But sharing medication is better than no medication.” 

Thirdly, there is the issue of disclosure and the fear of stigma. Speaking up about not finding one’s medication in stock indicates that they have the virus and the physician said that while a number of patients were seeking help, surely there were people who do not use social media as much and had to go through this experience alone without consulting their physician or an NGO out of fear of being judged. 

When asked if the new medication is being distributed yet, they said that it has not been done formally but there are a handful of cases where this happened. 

One thing they emphasised is that they have not received any form of guidance on the transition from the old to the new medications and how it will be happening – “we are still waiting for instructions from the health authorities on this matter.” 

The physician explained that when there is a transition, patients typically meet with their healthcare professional to discuss the way medication should be administered as there is an adjustment period where the patient is more prone to make mistakes.  

"Imagine someone who has been taking the old medication for 20 years and then has to adjust from taking 6 tablets a day to just 2 or 1. Thus, patients will need more regular monitoring. This takes a lot of energy and time; it does not happen over the phone or in a five-minute consultation. Even if the new medication is one of the best we have had, it does not mean that it cannot have side effects.” 

The physician said that their plan was to transition the patients gradually and with a priority list, having patients experiencing side effects from the old medication standing at the top of the list. “However, we cannot do it at our own pace as everyone has become a priority since we cannot leave patients without medicine.” 

When asked if they have been informed about the 6-month transition period, they said that they were not aware of it and noted that the transition period still depends on the availability of medication as patients cannot stay without medication.  

“We are hoping that by end of this week or early next week the situation is resolved, whatever the solution will be.” 

Notably, on Wednesday, MaltaToday later revealed that the medication was out of stock as a result of UK cargo delays and that an urgent order was issued from a firm in Portugal. The delivery was expected to arrive on the day this was revealed, but it is now expected to arrive by next week. 

The physician thanked all of the NGOs who have been of great help for patients, including MGRM, Allied Rainbow Community (ARC), and HIV Malta, and encouraged any patients who do not have their medication in stock but have not spoken up yet to communicate with their physician were confidentiality is guaranteed.