Ariadne Massa and Christian Peregin
UNHCR planning targeted HIV/AIDS project for Malta
Human contact... Immigrants at the Marsa open centre. Photo: Chris Sant Fournier.
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.
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Joe Xuereb
Mar 22nd 2009, 09:48
Some have very cleverly suggested that not 'sleeping around' safeguards one from HIV and other infections. Really? One can give advice but enforcing it is another matter. A wife for instance can get all smug and advice her husband not to stray, because....... And he of course will retort, don't worry darling, I love only you. So far so good. Problem is, short of chaining oneself to a partner so that one is witness to their every breath, the reality is one just does not know what the other half is doing at least some of the time. And it only takes a second to get infected, etc. So, advising somebody not to sleep around is a safety net of sorts. Because the net has some rather large, irreparable holes in it. Irreparable because there are things beyond our control.
I see this as sound advice from personal experience working, in a wider sense, with people afflicted by HIV. It is called counselling and getting to grips with reality.
Dr Savior Tortell Pisani
Mar 22nd 2009, 02:35
So testing an *illegal* immigrant for deadly disease is considered unacceptable and unethical, whereas exposing Maltese citizens to the (very) possible fatal risk of incurable infectious disease... No, that is perfectly acceptable!!
This is crazy and very short sighted reasoning, not to mention irresponsible. THIS is outright unethical. When discussing ethics one has to balance the consequences and the effect inflicted on the persons involved. One the one hand there is the right of privacy of the immigrant disease carrier and on the other hand you have the right for LIFE itself of the innocent Maltese citizen.
I question: Which is the more important?
Unfortunately, ethics is never black or white. One man's right is another man's loss. So you have to be very careful before being too dogmatic on human rights.
I would go one step further to say that all people with life threatening infectious disease should be obliged to register their condition and get tattooed or electronically RFID tagged in a way that enables, healthy people to take an informed decision before choosing to have sexual encounters or share needles with these people.
Carima Magdi
Mar 13th 2009, 20:44
Mr Xuereb I have nothing against homosexuality. Read my comment again maybe the second time will illuminate that tiny mind of yours. If not, let me explain once again... I meant that in Africa a majority of people do not accept homosexuality and most of the time homosexual people hide that they are homosexual. Issa Fhimt?!! As usual Mr Xuereb thinks he is always right.
Joe Xuereb
Mar 13th 2009, 15:49
cont./ Carima, you can go to Africa. Plenty more Mr. Magdis there. Of course you'll say you are Maltese and have family here, etc.etc. Fair enough. But in that case, I am afraid you are going to have to shut up and put up. Don't forget now - homosexuality is a very fluid aspect of human sexuality and not a million miles from most people's lives. Far from it (quoting Evarist Saliba). Far from it.
PS You go on and on about compulsory health awareness lessons 'and not just a one day seminar'. I tell you what should be compulsory Carima. A thorny subject that is not taught as a separate subject. It is called Thinking. As in reasoned thinking, Lateral thinking and so on. Now this should be compulsory. Then people will take off doing their own research, informing themselves without being frightened of innovations, and making decisions that are worth something. Think about it. It is high time people found out the truth for themselves. Because waiting for this to come from some elected guru - it just is not going to happen. All one needs to do is look at track records.
Joe Xuereb
Mar 13th 2009, 15:38
@ Carima Magdi (nee` Bugeja? Buhagiar? something-like-that). First Aid lessons would indeed be useful. A bit superfluous though. I do not know if you have children and if yes, whether to go to a Faith school. Maltese children in Catholic schools are taught that sex outside marriage is a no-no and all religions I believe have this guilt-inculcating obsession with matters sexual. So, once they stick to the whatever religion teaching, they are safe from sexually transmitted diseases. Like not.
Your list of viral transmission is somewhat short. Aid lessons where not very thorough so you sense of security is false indeed.
As for your take on Mr. Saliba's take on homosexuality, may I remind you that I and mine have fought for our freedoms and we are not ready to relinquish all that so you may sleep easy. If you prefer your homosexuals hidden and 'out of sight, out of mind', go where this is permitted. Homosexuals are here, and here to stay. You are free to go. If your son/s or daughter/s turn out gay, leave them here. If your husband turns out to be gay - happens! - you can leave him too. cont./
Joe Xuereb
Mar 13th 2009, 15:22
@ Evarist Saliba.
''Let me make myself very clear. I am not advocating a liberal approach promoting total sexual freedom. Far from it'. Your words Sir. Far from it? Very near to home in fact. You have that bit right. Evarist, so you reckon that, if there is a suggestion of segration of the sexes, why not segregate homosexuals (anatomically men) from real(?) heterosexual men. What you are saying is, for equality's sake, women and homosexuals should be grouped together and separated from heterosexual males. At a stroke you are saying that heteromale sexuality is so fragile that anything on two legs will tempt them. And more seriously, you might as well have spelt it out that in your view, a homosexual is some sort of surrugate female. As I said, the very thought of any sexuality terrifies you. In 2009. Get to know
Muscat.Pat
Mar 13th 2009, 08:48
When I went to the USA I had to aply for a VISA. On the Visa module I had to declare whether I suffer from HIV. Inevitably I would have been refused entry to the USA if I had contacted HIV. This the USA, the symbol of freedom and democracy as seen in the Free World. Why is it NORMAL to be refused entry in the US and ABNORMAL in Malta? Are,nt we entitled, together with our kids a better future? Maltese have rights too and it is teir government's duty to defend them. Full Stop!
Joe Xuereb
Mar 13th 2009, 07:27
cont./ I do not like anecdotal evidence as it gets emotive and serves no purpose. That said, I cannot believe that this HIV-stricken individual wanting treatment in Europe was an isolated case. Other takes on this health matter:
1) It has been widely reported that many believe that bedding a virgin will dispel the virus. This is a cultural thng. As is the refusal to use any protection.
2) It is a well-known fact that the poor, the desperate resort to a pastime that costs nothing, ie having children. For the sake of our argument, having sex as a right regardless of how, or when, or where or with whom. It is a cultural thing, not entirely unknown even in 'civilised Europe.
3) Many of these people will never have had access to any civic services in their country. A clinic? What's that? Therefore, a clinic will either be shunned or merely used as a Day Centre. After all the nurses look very nice (don't forget, from their perspective).
There are other issues but these will suffice.
So, to recap. Aspiration to be an economic migrant? I think not. I think they've a better chance of being a liability.
Joe Xuereb
Mar 13th 2009, 07:04
Reading this article has confirmed to me what I suspected/knew all along.
Let me for argument's sake not use emotive language like illegal immigrants, etc. Let me say these are people seeking asylum/refuge in Europe. It is claimed that many are economic migrants. By which I understand, migrating to another country to improve your lot. This is normally done by working (ie contributing to the host country) and integrating thus reaping the benefits of the host society. That is how it works. Since forever.
Nowit is obvious from the article that any number of asylum seekers do not have what it takes to be a regular migrant because:
1) There is a language problem.
2) There is a lack of skills necessary for work.
3) There are the cultural differences possibly insurmountable.
Regarding health issues. I have been approached by perfectly legal African friends to advise on how to help an HIV-stricken friend of theirs in Africa to come to UK for treatment. I suggested the usual asylum-seeking channel. The matter was dropped. What could I do? I cannot resolve the ills of the planet even if I chose to. This is an anecdote I can vouchsafe for. Cont./
Joe Xuereb
Mar 13th 2009, 00:53
It is extremely naive to believe that the HIV virus is transmitted solely through sexual contact.
I disagree with the notion that testing forHIV should not be done in order to respect human rights. The necessity for testing is more easily grasped if the matter is seen from the 'patient's point of view. Meaning, if an illegal immigrant - and one must not lose sight of the fact that this is what many of the people are - is HIV positive and aware of it, would such a patient request testing so that he can get treatment, the alternative being for him not to be tested to safeguard his privacy but getting no treatment . On the other hand, if an individual is HIV positive and unaware of it, would he prefer to be tested, be diagnosed positive and start treatment rather than safeguarding his privacy while his HIV positive status is doing the damage that it does if undiagnosed and undetected. It seems to me that overriding the privacy hurdle would benefit both the patient and the people he comes in contact with, Keeping in mind that transmission of this virus is not only via sexual contact.
Carima Magdi
Mar 13th 2009, 00:29
@Mr Chris Mifsud
Sorry but are you going to have any sexual contact with these immigrants? Are you going to have any blood transfusion or use an already used needle by the immigrants?
No?!! Mela you can sleep well tonight. HIV or AIDS are only transmitted this way.
Here in Malta we need more education regarding some health diseases, so one will know how to prevent them from an early age. We should have like First Aid classes and Health Awareness in our secondary schools. They should be compulsory like other subjects not a one day seminar.
As Mr Cassar said the UNHCR is The United Nations High Commissioner for Refugees which is found world wide. These help over 31.7 million refugees and we grumble for a thousand we have.
@ Mr Evarist Saliba
If you knew anything about the African culture you would surely know that any homosexual has to stay in hiding. Most of the times they are not accepted by their people. Therefore Mr Neil Falzon knew well what he was saying.
Good day to all
A Vella
Mar 12th 2009, 21:46
Unethical to screen immigrants?! isn t it illegal to enter a country without documents too? Neil Falzon really does keep in mind the immigrant's endless rights! what a pity that something that he describes unethical could very easily help avoid the spread of life threatining diseases in our otherwise safe country.
Alfred Farrugia
Mar 12th 2009, 17:29
Why do we carry the International Certificate of Vaccination as approved by the World Health Organization when we travel abroad?
Are illegal immigrants presenting such updated certificates when they arrive here?
Is fingerprinting ethical? The EU’s Eurodac system and the regulation to compare the fingerprints of asylum seekers and illegal immigrants for the effective application of the Dublin Convention are not considered unethical by the EU!
http://europa.eu/scadplus/leg/en/lvb/l33081.htm
This sensitive and serious public health issue deserves to be addressed properly for the benefit of the immigrants themselves as well as for the Maltese population.
I was screened at the airports in Indonesia, Malaysia and Singapore when measures were being taken to combat the Avian Influenza A (H5N1) virus, or bird flu. Were my human rights being tampered with then? I thought that those measures were taken for my own benefit!
http://wwwn.cdc.gov/travel/contentAvianFluPassengerChecks.aspx
Let us not bring up any excuses and take the appropriate measures for all concerned.
lgalea
Mar 12th 2009, 16:58
louise vella
Agree 100%
Evarist Saliba
Good observations
Screening should be FORCED if necessary to protect Maltese citizens from the exotic african diseases spreading in Malta as evidenced by the agreement reached with Libya for our doctors to go and train on african diseases.
Andrew Cassar
Mar 12th 2009, 16:28
@ g. scerri
Yes, a hospital like Lazzareth would be against human rights if you kept someone in there for no valid reason. Forced quarantine is only useful if a very contagious disease is a danger to the population (E.g. Bird flu, SARS, Ebola, Marburg disease, MDRTB etc). Quarantining someone for having a disease that wouldn't even be transmitted if you gave him/her a deep passionate kiss is hardly contagious. And if you did, you have to quarantine everyone who has the disease (Maltese, tourists etc) and not just black patients.
@louise vella
UNHCR cares for refugees anywhere they are in the world, where governments allows them to work. It has nothing to do with health care in africa except where there are refugees.
Denis Catania
Mar 12th 2009, 15:26
@Louise vella well said.
The illegals deserve to be tested and TREATED at all cost, paid for by the EU/ UN. I hope the UNHCR is not putting cost infront of treatment, just because they are Africans.
louise vella
Mar 12th 2009, 15:10
The best thing UNHCR can do is to go and treat as many Africans as possible in Africa. The second best thing is to help Malta to defend itself from invasion by illegal immigrants. The third best thing is to do its work in silence.
By the way, exactly when will the "planning" come into effect? So far it seems a pipe dream.
g. scerri
Mar 12th 2009, 13:42
So the Lazzaretto hospital went against human rights? The policy of quarantine in the recent past was a measure against human rights? Or well all such measures designed to stop the spread of infection?
Evarist Saliba
Mar 12th 2009, 13:38
UNHCR's representative Neil Falzon says that we should "ensure men and women are not accomodated in the same detention centre together."
May I put a deliberately provocative question?
On what grounds should men and women be separated? Presumably on sexual grounds. In that case why should homosexuals not be separated as well? Are some people more equal than others?
Let me make myself very clear. I am not advocating a liberal approach promoting total sexual freedom. Far from it.
d. borg
Mar 12th 2009, 11:03
Some people are always ready to quote human rights for these immigrants. What about the rights of the Maltese people. Not only are we being invaded by these unwelcome visitors but they also bringing with them ailments for which we have no immunity. The govt should take all possible precautions in order to protect us.
Chris Mifsud
Mar 12th 2009, 10:25
"forcing immigrants to take HIV tests goes against basic human rights "
This is riduclous . Of course they should be forced to have the test . Malta is a small country and deadly diseases like HIV and AIDS can spread quickly .