‘Government doesn’t like to talk about sex,’ HIV activist says

An HIV activist and lawyer has accused the government of lacking initiative to talk about sex and sexual health in general.

Mark Joseph Rapa is a law graduate from the University of Malta whose doctoral thesis focused on criminal law on HIV transmission, and is now a teaching assistant at the University of Manchester.

“The lack of sexual education is why the stigma on HIV still persists. You cannot acquire HIV by sharing the same bed with someone who lives with HIV, or by drinking from the same glass they do, or by hugging them or kissing them. These are misconceptions which unfortunately still persist,” Rapa says as an individual who has taken issue with recent guidelines published by the education ministry.

The guidelines on sex education by the Directorate for Quality and Standards in Education suggest that HIV be discussed from a sexually transmitted infection perspective, in terms of prevention.

Rapa, however, insists that people have been choosing not to use condoms for a long time. “This is another reason to upscale our testing and treating services,” Rapa says as he contends that Malta is years behind on keeping up with today’s sexual tendencies.

“Stigma on HIV arises from misinformation or lack of information at schools. Sexual health and relationships should be included in the national curricula. This would equip the students with the necessary knowledge to make an informed decision on the behaviours they engage in,” he said.

Rapa is the founder of prEPing Malta – a reference to the once-daily prEP pill, a pre-exposure prophylaxis which Rapa says prevents acquisition of HIV with over 99% effectiveness.

“Introducing prEP makes sense both from a public health and financial perspective, so I don’t understand the government’s delay,” Rapa said, especially when considering that studies by the World Health Organisation suggested that reported cases of HIV increased by 50% in Malta last year.

This statistic, Rapa argued, might indicate the increase of people being tested at the Genitourinary (GU) clinic at Mater Dei. In 2017, the GU clinic carried out a total of 5,864 consultations, of which only 107 were people aged under 18. The most common conditions identified were genital warts, chlamydia and herpes. 45 cases of HIV were identified. The clinic has recently introduced free rapid testing and self-tests for the public from pharmacies.

Rapa says that preventing HIV is not a case of dictating abstention from sex or scaring youngsters into using contraceptives. “People have a right to conduct their life in the way they deem best for themselves. It’s not up to us to dictate what they should or should not do in the privacy of their own homes,” he says, adding that it was a question of government deciding which information would be of relevance to its audience and how best to deliver it.

The HIV activist said that people are still haunted by the dark images of 1980s campaigns. Since then, the lives of people with HIV have improved considerably and they can live long and healthy lives without ever contracting AIDS.

“Sadly, in Malta, we are still prescribing old drugs which have adverse effects on both the physical and mental health of the patients. In any state-funded healthcare service, there will always be competing claims on what medication one ought to include in the national formulary. Questions on the quality of life of patients and scarcity of resources need to be addressed. Introducing newer HIV treatments would not only improve the quality of life of people living with HIV but would also see a reduction in treating complications as a result of lifelong use of toxic medications,” Rapa says.

Even the law, Rapa argues, is questionable. Maltese law ascribes criminal responsibility to people transmitting the virus even when they are not aware of being infected.

“Which persons are reasonably expected to know that they might be living with HIV? Many would say: men who have sex with men, but globally more than 50% of the people living with the virus are women. Those who have multiple partners? One need not have had multiple partners to acquire HIV.”

He adds that currently there is a strong international movement to remove HIV criminalisation laws, which Rapa says contribute to unjust prosecutions and convictions.

“We must keep in mind that in prosecuting a person who was unaware of his infection, you are putting two victims before the courts because even the defendant is a victim here,” Rapa says. “We do not have the science to prove beyond a reasonable doubt that person A transmitted the virus to person B.”