Fact Checker
Updated: 18 December 2020
It is now widely known and understood fact that when it comes to sexual health, Malta has been missing its targets. Less than 2% of the population gets tested annually, and that 2% includes repeat visitors. Potentially, the actual population getting tested is closer to 1%. COVID-19 has introduced a new barrier. As the authorities started to prepare the country for the pandemic, one of the most immediate decisions made was to effectively shutter down the only Genitourinary clinic in Malta, leaving a small window open for emergency tests only. All sexually active people lost the ability to get any form of sexual health services in the country. Even with such limited servicing, HIV rates continued to climb, with the new diagnoses by November 2020 reaching 72, including one AIDS diagnosis.
Shockingly, this disregard and loss of focus has meant that December 2020 has been characterised by shortage of HIV medication that left several people living with HIV without their life-saving medication.
Against this background we have started to notice that in the months leading to this crisis, misleading or factually incorrect statements related to HIV were being made, including statements in parliament. This is what we found out.
Statement 1 - Partial lockdown rules led to a drop in STI rates
Rating:
False
Reason: A May 2020 article by the Times of Malta stated that ‘as a result [of the partial lockdown], the numbers of cases at the clinic have dropped to very low levels.’
There are two reasons why this statement is incorrect:
When the Partial Lockdown measures were announced, the GU Clinic circulated a notice to inform the public that PCR testing was suspended. In an email to Lovin Malta, the GU Clinic also confirmed that routine appointments were not being accepted. It is unsurprising therefore, that the number of the cases had dropped when the number of appointments had floored. An article by Dr Mark Josef Rapa published on The Malta Independent shows that in the first six months of the year, for both Chlamydia and Gonorrhoea, tests were down by over 50 per cent and for HIV and Syphilis by around 32 per cent.
It is true that the number of diagnoses for some STIs had decreased, but the number of HIV diagnoses had actually increased, and the increase was dramatic. In his article, Dr Rapa reports that ‘between January and April 2020 alone, there were 23 new HIV cases, 10 more than the same period last year’. As at December 2020, the number of new diagnoses stood at 72, including one AIDS case.
Statement 2 - The number of people diagnosed with HIV between January 2015 and April 2020 was 326
Rating:
False, but likely due to poor record keeping
Reason: In a reply to a Parliamentary Question by Hon. Claudette Buttigieg, Hon. Chris Fearne, Deputy Prime Minister and Minister for Health stated that the number of people diagnosed with HIV between January 2015 and April 2020 was 326.
However, a Request for Participation issued by the Central Procurement and Supplies Unit of the Ministry for Health, for the provision of Service for treatment of HIV-positive patients, indicated that as at 29th January 2019, the number of HIV patients on treatment in Malta amounted to 362. Using simple arithmetic, one would think that the number of new HIV diagnoses between 30th January 2019 and 30 April 2020 amounted to 36 (362 between Jan-15 and Apr-20 less 326 as at Jan-2019)
We however know that the number of HIV diagnoses in 2019 was 73. We also know that the number of people diagnosed with HIV in the first six months of the year was 23. That leaves us with 60 more diagnoses than expected.
We do not think that there is an intention to mislead. Nevertheless, poor record-keeping and failure to correct records once an error is identified, impacts the way in which NGOs, and possibly public health authorities themselves dedicate their resources.
Statement 3 - PEPSE (Post-Exposure Prophylaxis after Sexual Encounter) is available for free at Mater Dei Pharmacy
Rating:
False
Reason: This will have to be a longish one. PEPSE is a combination of drugs, that if taken within 72 hours of an encounter, can stop seroconversion (a person’s HIV status changing from negative to positive). Let us start with facts. The drug is available at Mater Dei, but at a cost for EUR600. That cost is waived only for rape victims and healthcare workers who suspect they could have encountered HIV in their line of work. Anyone else needs to pay for the medication, including amongst others persons whose condom tears, and those who discover that their partner has been unfaithful.
With that in mind, in a parliamentary question to Hon Chris Fearne, Hon Claudette Buttigieg asked whether it was true that patients who do not afford the drug are turned away, to which Hon Fearne replied that ‘the Health Department dispenses all medications irrespective of the patient’s financial means’ - essentially a half-truth.
This triggered a series of Parliamentary Questions by Hon Buttigieg, replacing the term ‘PEP’ (Post-Exposure Prophylaxis) with ‘PEPSE” (Post-Exposure Prophylaxis after Sexual Encounter). The drugs are identical, but the need for the drug is different. The first is the generic name, whereas the second establishes with more clarity why the medicaiton is needed.
The first question was whether payment was requested by pharmacy at Mater Dei, even if the patient had a prescription from the GU Clinic. To this question, Hon Fearne replies that PEP (not PEPSE) is dispensed for free where a patient is entitled to it, but then the price varies according to the medication needed. Having consulted pharmacy at Mater Dei, we can confirm that no one is eligible to free PEP following a sexual encounter. Anticipating a possible counterargument, rape is a violent physical act, not a sexual encounter.
To follow-up questions on what happens when a patient is unable to pay for the treatment, and whether it is true that seroconversion can take place if time is wasted trying to fund this payment Hon Fearne refers Hon Buttigieg to previously answered questions. In the case of the latter, Hon Fearne is referring to a question about PEP, when Hon Buttigieg’s question was about PEPSE. Hon Fearne also confirmed that no records of the number of individuals who requested PEPSE but were unable to fund it are kept.
As a human rights NGO, we are disappointed that these important questions are answered with half-truths, or worse, with incorrect statements. It is clear what the subject of Hon Buttigieg’s question is, namely the price of the treatment and the consequences of not affording that treatment. We are convinced that Hon Fearne appreciates that what is at stake here is people’s lives, not the possibility to score political points in Parliament.
Statement 4 - The formulary will be updated soon to include new HIV treatment.
Rating:
Unknown but Likely True
Reason: In a parliamentary question, Hon Claudette Buttigieg asked Hon Minister Chris Fearne whether he could give an update on the February 2019 Request for Participation issued by the Central Procurement and Supplies Unit of the Ministry for Health, for the provision of Service for treatment of HIV-positive patients. Hon Fearne stated in his reply that the process is close to conclusion and explained that this was a complex process which assessed offers made by four separate companies.
Whilst hoping that the above is true, we would like to provide some context. In most European countries, HIV patients are required to take one tablet per day in order to treat HIV. The main benefit of taking one tablet, rather than multiple tablets several times during the day is reflected in what is known as ‘drug adherence’. This is the ability of a person to effectively take the treatment every day, and exactly as prescribed. Once this is achieved, the number of copies of virus in every millilitre of blood is so low, that it becomes undetectable and untransmittable (Undetectable = Untransmittable). Effectively, persons who are HIV positive and on effective treatment, cannot transmit the virus to their partners.
Meanwhile, treatment in Malta is so outdated, that several patients in Malta are required to take four, or more, pills a day, with several side-effects compared to more modern treatment which is common elsewhere in Europe. Combivir, one of the most common treatments in Malta, is no longer recommended by the European AIDS Clinical Society as first-line therapy, yet most of HIV patients are still relying on the drug. The situation is bad enough that when a Spanish foreign national sought the assistance of HIV Malta after he became stuck in Malta during the COVID-19 pandemic, he was advised by his HIV specialist that it would be better to suspend therapy and wait for his treatment to arrive in Malta by courier, rather than rely on the treatment dispensed to Maltese patients.
Eventually, in December 2020 it transpired that the medication had become so severely outdated that it was becoming scarce. This came to a point where for several consecutive days, starting on 9 December, several patients were left without their life-saving medication. This too was followed up by other misstatements and mixed messages which compounded the crisis.
It is worth providing a timeline that illustrates the progress (or lack thereof) made in terms of this longstanding matter:
9th October 2017 - In his budget speech, the Minister for Finance states that "We will be updating our HIV treatment while launching a new programme for the treatment of Hepatitis C that should see the number of cases of Hepatitis C falling during the next five years.". Following this statement nothing happens for a number of years.
22nd February 2019 – A long awaited Request for Participation (RFP) is launched. The RFP drew concerns from activists who pointed out that the RFP was poorly drafted, and was not aligned with EACS European Guidelines for the treatment of HIV-positive adults in Europe. Furthermore, there was some concern around reference in the RFP for the successful bidder to provide ‘continuous monitoring, follow-ups and education to support adherence’ which is usually the remit of the Infectious Diseases Unit. If transferred to a private company, government would be essentially privatising HIV care, which would set a very dangerous precedent. The RFP also did not include any information on preventive care, which Dr Rapa calls ‘a missed opportunity’,
4 April 2019 – In a facebook post, Hon Chris Fearne called Malta ‘l-aqwa fl-Ewropa’ (the very best in Europe) in terms of percentage of people who are on HIV treatment, making no reference to the new medication
23 July 2019 - First news about a looming shortage of HIV medication emerges.
14 October 2019 – HIV Malta issued a statement to note with disappointment that the 2020 Budget did not allocate any new budgetary contribution towards new HIV treatment
23 February 2020 – Reacting to a report by the European Centre for Disease Prevention and Disease Control, Prof. Charmaine Gauci stated that ‘more work was needed to contain this disease’. Prof. Gauci went on to state that government is working on a strategy to further strengthen [its] work on HIV’.
2 March 2020 – Hon Rosianne Cutajar is quoted in an article by LovinMalta as having said that that following talks with the Ministry of Health, she could confirm that the new treatment would be ‘on the market in the coming months’.
10 June 2020 – Following a series of Parliamentary Questions related to HIV Medications, MGRM and HIV Malta stated that government was once again dragging its feet in this urgent matter.
6 August 2020 - In a meeting with the Minister for Health, the Minister confirmed that new medication was expected to start replacing the current regimen by the end of 2020.
11 December 2020 - The Malta LGBTIQ Rights Movement announces that it was receiving reports of people who are being told that their HIV medication is out of stock. NGOs resort to appealing to persons who had extra medication to share with those who did not have any.
14 December 2020 - A Press Release issued by the Ministry for Health, admits that there is a shortage, and that new medication will be rolled out in a matter of days. HIV Consultants express alarm at a rushed transition that could be detrimental to their patient’s health. In the same day, the shortage is attributed to COVID-19 and Brexit. NGOs express scepticism, seeing how this saga had been ongoing since 2017 giving the authorities ample time to make preparations.
18 December 2020 - In the midst of the shortage crisis, a clinician confirms that a “handful” of people living with HIV have received new medication. The clinician expresses concerns about a rushed transition that does not give HIV specialists the opportunity to discuss this change with their patients.
Statement 5 - Government is working on a National Strategy on Sexual Health including HIV
Rating:
Unknown but Likely True
Government is working on a National Strategy on HIV
In his reply to a parliamentary question by Hon Claudette Buttigieg, Hon Chris Fearne stated that a National Strategy on HIV was being prepared, which also included the use of preventative treatment. We believe this statement to be correct, as it was also referenced by Prof. Charmaine Gauci in a statement made to the press in February 2020.
It is worth mentioning that as one of two NGOs in Malta who have a strategy on HIV and is in direct contact with people living with HIV on a day-to-day basis, we are completely in the dark with respect to this National Strategy. When asked, Checkpoint Malta also confirmed that they are not privy of this National Strategy. Dr Mark Josef Rapa, a long-time HIV activist in Malta is also not part of this National Strategy.
There is a chance that this matter will come up in the coming weeks in meetings scheduled with the Health Minister, however until then, MGRM and HIV Malta are unable to comment on the contents of this strategy. We remain baffled by this approach because our priority is the wellbeing of the plHIV community just like it should be for local authorities, yet to a certain extent, we feel that the Ministry feels we are somewhat of an obstacle.
