UNHCR planning targeted HIV/AIDS project for Malta

Screening all illegal immigrants for HIV is impractical and unethical, although education and an effort to overcome cultural and language barriers can go a long way in reducing the rate of infection, experts believe.

Charmaine Gauci, director at the Health Promotion and Disease Prevention Department, says forcing immigrants to take HIV tests goes against basic human rights principles and does nothing to prevent the introduction or spread of the disease.

"It is useless and unethical to screen without offering treatment and follow up. You cannot offer screening to a group of people coming from certain countries and not offer it to those coming from other countries when they also have high transmission rates of HIV," Dr Gauci says, reacting to an article in The Sunday Times, which showed half of the HIV patients in Malta were African immigrants.

The article explained that, while screening was not expensive, treating an HIV-positive patient costs €500 a month. Christopher Barbara, Malta's only virologist, had pointed out the risk that when patients did not comply with the strict treatment regime, resistant strains of the disease could develop.

Labour social affairs spokesman Michael Farrugia had later said illegal immigrants should be tested for HIV on arrival and if found to have the disease they should treated accordingly, with support from the EU.

Dr Gauci disagrees with this suggestion and stresses that education is the key to preventing and containing the spread of all sexually-transmitted diseases, including HIV.

"It must be emphasised that the risk of developing a sexually-transmitted disease, including HIV, is greatly reduced if one has a long-term, monogamous relationship or if protection is used in non-monogamous relationships."

She explains that human resources for giving treatment are very limited: "Cases are all followed up and efforts made to trace those who don't turn up for the treatment. However, there are problems in tracing some of these cases and in communicating with them."

The issue to screen immigrants for HIV, tuberculosis and hepatitis arose in the UK four years ago but the HIV checks were later slammed by the British Labour Party as "untested, uncosted and chaotic", although it had a five-year plan for tuberculosis.

A medical journal, BMJ, tackled the subject highlighting ethical issues such as discrimination, notions of confidentiality, stigma and the role of clinicians as both patient advocates and protectors of public health.

It questioned whether such a policy should be applied to all populations from countries that have a high prevalence. It pointed out the free movement of people within the EU and said the future eastern border could be with countries that had the most rapidly escalating epidemics of HIV in the world, notably Russia, Belarus and Ukraine.

It asked how such a policy would address migrants who remained undocumented and whether the fear of the consequences meant the undocumented population challenged public health to a greater degree.

UNHCR's representative in Malta, Neil Falzon also believes automatic screening cannot be allowed due to sensitive ethical and human rights issues involved, such as the right to privacy.

"I do not think this is a solution as it is not a solution to screen any other person entering Malta - legally or illegally - for these issues," he says.

He insists on the need for more effective prevention campaigns targeting people in open and closed centres and focusing not just on HIV but also on other sexual health issues, such as reproductive health and family planning.

He adds that attention should be paid to structural issues to ensure men and women are not accommodated in the same detention centre together.

Dr Falzon points out that the authorities are already providing an excellent service but this has to be complemented by cultural mediators and interpreters to help explain the importance of accepting and complying with treatment.

He also suggests reaching out to people living in the community who do not approach health services either due to lack of information, fear or stigmatisation.

"UNHCR is at the moment planning a targeted HIV/AIDS project for Malta and we are consulting all competent authorities and organisations, including the Home Affairs Ministry, the Public Health Department and relevant NGOs," he adds.

Genitourinary Clinic head Philip Carabot agrees that finding a solution is very difficult and something authorities had to stop and think about seriously.

"Screening is a two-edged sword: you have to test with a view to treat, you cannot just test for statistical purposes," he says, questioning whether Malta can even afford to embark on such a project.

Speaking from experience, Dr Carabot says he gets immigrants referred to his clinic and the vast majority cannot speak English; communication is close to impossible, which causes problems.

"Invariably, they come without an interpreter and even when they do the interpreter needs an interpreter. There are also cultural differences that we need to be tackling through education," he adds.

He explains that last year, there were 1,970 new patients who attended the GU Clinic; of these 287 were foreigners, including 53 immigrants. None tested positive for HIV.

"They have their own personal problems and we're not doing them justice," he stresses, adding that, irrespective of race or gender, people should not be sleeping around and if they cannot be good they should be careful.