Revamped sexual health strategy is finally birthed

Proposals from Malta's long-awaited sexual health strategy, revealed last week, include the free distribution of condoms and the addition of emergency contraception to the national formulary.

This marks the first update to the country's sexual health strategy in over 14 years. For the last decade, Malta's sexual health policies were based on studies from 2010, which had already been considered outdated by stakeholders.

During the launch, Health Minister Jo Etienne Abela emphasised the government's commitment to promoting sexual health in a progressive and inclusive way, focusing on education, prevention, and services that reflect the realities of modern society.

“As we move forward, it is essential to consider evolving social norms and changing times, while ensuring our efforts align with the legal framework of our country,” Abela said.

The strategy is now open for public consultation before it is finalised.

MaltaToday has reviewed the Sexual Health Strategy 2025-2030. These are the key points:

Targeting vulnerable groups

1.     Sex between men: The strategy includes targeted campaigns for Men who have Sex with Men (MSM), promoting prevention, early diagnosis, treatment, condom use, and raising awareness of PEP and PrEP, alongside a nationwide free condom distribution scheme.

2.     Sex workers: It also proposes the creation of a multidisciplinary clinic for sex workers, offering a holistic, patient-centred approach that addresses medical, psychosocial, and substance abuse needs, in collaboration with government and NGOs.

3.     Migrants: The strategy also focuses on migrants, a group that NGOs such as Aditus Malta had previously raised concerns about being neglected. It aims to address and overcome barriers to sexual health care by offering culturally and linguistically appropriate services, while collaborating with NGOs to enhance access and support.

4.     Sexual assault: Additionally, the strategy seeks to strengthen multidisciplinary responses to sexual assault, focusing on victim-centred care, sensitive interviews, and proper forensic specimen handling, as well as enhancing training for healthcare providers and reducing barriers to reporting, especially for vulnerable groups.

5.     Gender-affirming genital surgeries: It also includes plans to explore agreements with expert centres for gender-affirming genital surgeries (bottom surgeries) in line with international best practices.

Contraception

6.     Emergency contraception: The strategy proposes adding the emergency contraception pill to the national formulary to improve access, alongside clear pathways for contraceptive advice. Investigative exercises carried out by MaltaToday over the years have highlighted ongoing barriers to access, particularly due to conscientious objection, which allows pharmacists to refuse to dispense the pill if it conflicts with their moral or religious beliefs.

7.     Free contraceptives: The strategy also includes providing free barrier contraceptives, such as condoms, to all individuals aged 16 and over. It proposes funding modern contraceptives (e.g., IUDs, implants, oral contraceptives) and surgical options, starting with vulnerable groups.

8.     Minors seeking services: It is also stated that it was also essential to balance sexual health needs and parental rights when minors seek SRHR services, through inter-ministerial legal and policy discussions.

9.     Free menstrual products: Moreover, following the success of a pilot project, the strategy proposes that the provision of free menstrual products in schools should continue, alongside ongoing efforts to educate children and youth about menstrual health and body positivity.

Expanding GU services

10.   Integrated GU services: The strategy also calls for the continued integration of GU services across primary, secondary, and tertiary care, expanding them into secondary care hubs and community clinics. This includes increasing trained staff, laboratory capacity, and IT systems, as well as providing psychosocial support and exploring virtual consultations to improve access.

11.   HIV: HIV testing will be expanded, alongside the provision of free pre-exposure prophylaxis (PrEP) for high-risk populations, with a focus on raising awareness and reducing stigma.
Additionally, the regulation of medical devices, such as HIV self-tests and condoms, will be strengthened to ensure their reliability and provide necessary support.

12.   HPV: Regarding HPV, the strategy states that the promotion of HPV vaccination should be expanded to include all genders, and offered to key populations at risk.
It was also recommended that cervical cancer screening should shift from liquid-based cytology to primary HPV testing for all women and people with a cervix, and HPV screening should be implemented for men who have sex with men (MSM) in line with clinical guidelines.

More education for children and youth

13.   Sexual education: The strategy also proposes the formation of a permanent working group, involving representatives from the Health and Education Ministries, along with stakeholders from state, church, and independent schools, to ensure that comprehensive, evidence-based sexuality education is delivered to all primary and secondary students in Malta and Gozo.

Reactions from stakeholders  

Reacting to the strategy, Checkpoint Malta welcomed the government's announcement to provide free PrEP and PEP but called for these services to be made universally available to all who need them.

The organisation said these medications should be provided regardless of gender identity, sexual orientation, or immigration status, in order for the initiative to be truly effective in reducing HIV transmission in Malta.

The NGO also urged the government to implement opt-out HIV testing for all hospital admissions and individuals requiring blood tests, to help scale up HIV testing and enable early diagnosis.

MGRM echoed this call, emphasising that incorporating opt-out HIV testing in hospitals and during routine blood tests is crucial for early diagnosis and effective prevention. They also commended the move to provide free PrEP and PEP, describing it as "significant progress in public health and HIV prevention."

Meanwhile, the Women's Rights Foundation responded with mixed feelings, commenting: “Finally! In a country with a near-total ban on abortion, this should have been done long ago. As it stands, it is more than eight years overdue, but we suppose it’s better late than never. We now await its implementation.”