Lovin Malta in collaboration with Catena Media, the Health Promotion and Disease Prevention Directorate and the Ministry for Health have recently launched a five-part #Pride ‘Revealing Sex Ed’ series focusing on sex and sexual health.
The second episode of the series focuses on HIV; the rumours, the myths and what measures individuals can take to prevent the acquisition of HIV. The video is in itself a good tool providing essential and basic information about HIV. it is also a conversation starter even on a public health level. At this point in time, it is important to get rid of any misinformation which still blightes any conversation on HIV. Misinformation and misrepresentation of facts leads to stigma and value judgements which are not only not desirable but can provide to be fatalistic in public health; Stigmatising people living with HIV can and does in fact as a deterrent for those who would like or need to get tested for the virus.
Since the discovery of the virus 35 years ago, treatment and prevention methods have improved dramatically. As rightly put in the video, HIV is no longer a “death sentence”, but a chronic infection that can be kept under control with daily treatment. And even though the treatment provides the individual living with HIV a good quality of life and prevents any forward transmission of the virus, there is still a lot of work to be done on both a scientific and social level. Finding a cure (sterilizing/functional) is providing to be more difficult than originally thought and eradicating the stigma around HIV, one could say, is even more problematic.
Research to find a cure for HIV infection and improve the current treatment and prevention methods is ongoing all around the world, resulting in continuous flow of new data and knowledge which is then transposed into sexual health strategies. That is why it is very important that one should always check the accuracy and reliability of their information and their sources. Also continue questioning the current available tools and implementations to follow the latest improvements and make sure they are available in our own regions.
In this blog post, we would like to give more detail on the subjects covered in the video, make some clarifications, corrections and ask questions that need to be covered. But before we start, it is important to repeat the definitions that were given in the video:
Post-Exposure Prophylaxis (PEP) is an important preventive public health tool which can reduce the risk of acquiring HIV after a potential exposure to the virus. PEP is a 28-day course, consisting of three drugs that are normally used to treat HIV. It needs to be started within the first 72 hours after potential exposure.
Pre-Exposure Prophylaxis (PrEP) is another preventive public health tool for the use of any individual who is not living with HIV. It varies from PEP in that, PrEP is taken before engaging in any sexual activity that might result in an exposure to the virus. Current data shows that PrEP provides over 99% HIV risk reduction with no condom use.
Now, while condoms continue to be the most commonly used and trusted STI prevention and contraceptive method, there are various reasons why people may decide, or for other reasons beyond their control find themselves not using condoms. Although we continue to recommend and advice to use protection, scaling down the protection tools only to condoms may cause stigmatization of people who choose not to use condoms.
Such paternalistic approach towards sexual health may and effectively can put off people from coming forward for testing in case they have not been using condoms. In fact it can a contributory factor that leads to further stigma. That is why it is important to always have an inclusive approach and inform people of ALL the preventive tools available to them.
Sexual behaviour is classified into 3 main groups namely high risk, middle risk and low risk. The information in the video regarding the transmission of the virus through bodily fluids that may contain HIV within them is accurate. There is however a small clarification that needs to be made. Oral sex is NOT classified as a high risk behaviour. On the contrary, it is classified as low risk.
Although PEP has been available in Malta since 2013, there has been little to no work to improve the implementation of this preventative tool or increase the access for people who might need it.
Even though, PEP plays a very important role in public health when it comes to preventing acquisition of HIV, in Malta, it comes with a hefty price tag of 600 Euros for the 28-day course which does not even satisfy the who recommendations on PEP provision and causes undesirable side effects. Charging such an exorbitant sum goes against any principle of public health.
PEP is ONLY available from the hospital pharmacy
For more detailed information on PEP you can read: https://prepingmalta.wixsite.com/website/single-post/2018/08/02/Have-you-recently-been-exposed-to-HIV
It is worth mentioning that last year PrEP has been added to the World Health Organisation (WHO) ‘essential’ medicines list. It is a list deemed ‘essential’ as part of a well-functioning health system. That is, the drugs that every person should have access to, should they need it, no matter where they are.” (https://www.avert.org/news/prep-now-included-who-essential-medicines-list).
Sadly Malta hasn’t caught up with the news yet.
Although in the video it is said that PrEP is available in Malta, it is in fact not provided by the healthcare system and, to the knowledge of this website, neither in any local pharmacies. Only way to access PrEP in Malta is to purchase it from online suppliers.
There are many things that need to be discussed when it comes to implementation of PrEP in Malta but we are listing the most important points below.
Even though it’s mentioned in the video that PrEP is for HIV negative people, it does not put enough emphasis on the need for people to get an HIV test before starting the medication. Assuming one’s a HIV’s status is certainly not enough a confirmation to get on PrEP. In other words, get tested.
Before starting PrEP one must also get tested for hepatitis B and also get a kidney function test. Before deciding to get on PrEP ask the clinicians at the GU clinic to run the necessary tests for you.
PrEP does not simply lower the chances of infection. PrEP is over 99% effective. This does not mean that you have 1% chance of getting HIV but rather, your risk of contracting HIV is 99% lower than it would be if you weren’t on PrEP.
Reference is only made to the daily regimen which might not suit many people’s lives and lifestyles. And whilst it is the daily regimen that is recommended, other regimens have provided to be as effective, namely the “on-demand” is as effective as the daily regimen. (https://www.poz.com/article/new-hiv-infections-new-french-study-ondemand-prep)
PrEP is not just for gay men. PrEP is also effective in women and transwomen. Any educational material on PrEP should also at the very least mention that it is also for women.
PrEP is also a public health cost effective measure. When compared to the cost of treatment and follow up tests that is provided by the healthcare system for a lifetime HIV treatment PrEP is cost efficient. This enables governments to save on their healthcare budget while preventing new HIV infections. It’s a win win situation, really!
For the most recent developments on HIV you may also find of interest: