Sunday, 9 April 2017

MGRM & Gay Malta: Position Paper on HIV Prevention and Treatment Guidelines

Published by the Malta Gay Rights Movement (MGRM) and Gay Malta
April 2017

The information guidelines below have been formulated to provide information to Malta based Lesbian, Gay, Bisexual, Trans, Intersex and Queer (LGBTIQ) sexually active individuals who wish to have access to adequate prevention or treatment for HIV.

In view of the paucity of actions so far, and the slow development of an adequate sexual health policy, the unfortunate and inevitable result is of an increase in sexual health related diseases, including HIV, which disproportionately impinge upon our community with those most at risk being men who have sex with men and trans sex workers. This important issue requires several fronts of action and these guidelines relate both to the access of effective prevention from HIV infection and also to better treatment for those individuals who are HIV positive.

The local community is reminded that a highly effective measure for having safer sex is use of condoms. Effectiveness of condom use however has been shown to be greatly reduced when alcohol and drugs are involved. In addition, oral sex carries risk of transmission especially where oral ejaculation is involved. Oral sex is UNSAFE SEX!

It is very important to stress the need for regular and up to date HIV testing, at least every 6 months, for sexually active individuals at risk of HIV infection. Early confirmation of a positive HIV status is essential in obtaining early and effective treatment, and carries a better chance of leading a healthy life of normal life span. Regular testing can be undertaken at the GU clinic in Mater Dei hospital, private clinics locally and also several health services if one is abroad.

There is also now the opportunity of home self test HIV kits, which are a quick and confidential way of confirming an HIV status. (Any HIV test is always a look-back at the actual status several weeks back, as it takes some time for a positive status to show up in most HIV tests. The look back window is variable, according to the test type). Examples of home test kits can be found on several websites, such as

Post-Exposure Prophylaxis (PEP)

PEP is a way to prevent HIV infection after a possible recent exposure. It involves taking HIV medications as soon as possible (within 3 days) after a single high-risk event to stop HIV from making copies of itself and spreading throughout your body.

PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. The sooner it is started the better the protection from acquiring HIV. If you think you’ve recently been exposed to HIV during sex or through sharing needles contact the GU clinic at Mater Dei straight away (preferably within 24 hours, but maximum 72 hours) to obtain PEP treatment. If the GU clinic is closed then attend the A&E (emergency) department at Mater Dei to obtain PEP. Protocols to issue PEP should be in place. Unfortunately, as per current policy, individuals will have to pay for a course of PEP treatment which costs around €600 Euros.

Pre-Exposure Prophylaxis (PrEP)

High risk individuals are advised to include PrEP in addition to safer practices to reduce risk of acquiring an HIV infection. High risk individuals are gay/straight/bi/trans/queer individuals who have multiple partners or whose partner might present a risk through activity outside the relationship. Couples where one partner is HIV positive should consider PrEP for the negative partner, even if undetectability has been confirmed, as treatment may suddenly fail, putting the negative partner again at risk of infection.

It is very important to state that both PEP and PrEP should ONLY be taken if the individual isHIV negative, as evidenced by an up to date HIV test.

The issue is too detailed to fully cover in these guidelines but the links below to informative websites provide detailed background on the issue.

Preventative treatment called PrEP is available and authorised in Europe for all those who want to take charge of their own circumstances and protect themselves from HIV. PrEP is currently available free or at affordable prices in countries such as the USA, Canada, Australia, South Africa and France, but not in Malta. Detailed information on PrEP can be accessed on the websites below: (background information on PrEP availability around the world) (guidance on how to access PrEP)

As PrEP in Malta is not as yet available on the National Health Service, some in the local community have turned to ordering medicines online, at the cost of about €80/month for the generic product. The original brand is Truvada® and the community should avoid buying cheap products claiming to be Truvada® as it is highly likely that it is a counterfeit. The generic products’ names vary but the ingredients are the same, Tenofovir disoproxil fumarate/emtricitabine.The current situation is unfortunate and undesirable, and such measures are only being proposed given that PrEP is not yet widely available in Malta at free or subsidised cost through the local health service. For those wishing to purchase PrEP online, experience within the local LGBTIQ community suggests use of this website:

Self importation has some risks associated with it. There is no quality protection provided by having drugs evaluated by EU Authorities. Supply time may vary and the postage time could be delayed if customs investigates the package.

Self importation is legal and orders should be kept to 3 month supply for personal use. Having a valid Maltese prescription, completed by a registered medical practitioner will facilitate the process but patients should allow up to eight weeks for delivery. Prescriptions can only be provided by doctors after negative status is confirmed as taking PrEP when already infected will not be effective in controlling infection and risks development of resistance to the treatment.

Those taking PrEP are advised to talk to their doctor as routine tests, such as kidney function will need to be monitored frequently. PrEP users should also undertake regular (every 3 months) HIV tests while taking the preventative medication.

How to take?

Daily, every other day or during times of sexual activity (intermittent). Important to note women need to take it daily for vaginal intercourse. See the link below to see which best suites your circumstance:!how-to-take-prep/mm6t5

If you are HIV Positive

The listed website also provides other treatment options for HIV Positive individuals at own cost and which provide better treatment outcomes. Those HIV Positive individuals receiving treatment in Malta are for now advised to remain on their current treatment, (even though this is considered outdated by international guidelines) if they are tolerating the treatment and able to achieve and maintain undetectable levels.

Communication with authorities to improve standard treatment to internationally acknowledged guidelines and recommendations is ongoing, and is of high importance to the community.

The community is also reminded that such prevention is only against HIV and does not protect against other Sexually Acquired Infections (SAIs) which are on the rise and also of great concern.

Other informative links:

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