Philip Carabot: Sex workers simply do not trust the system.

Prostitution should be legalised and made as safe as possible with compulsory regular health checks, like the German model, according to Malta’s top sexual health expert.

“I have found it very difficult over the years to attract sex workers to the clinic. They simply do not trust the system, because they are an illegal profession,” GU clinic consultant Philip Carabot said.

Dr Carabot was speaking to The Sunday Times of Malta following a report on sexual health published by the European Centre for Disease Prevention and Control, which profiled EU and European Economic Area (EEA) member states. Unlike several other countries, Malta does not have a national prevention programme for HIV and sexually transmitted infections (STIs) which targets three specific, vulnerable groups: men having sex with men, migrants and sex workers.

Moreover, Malta is one of only four EU/EEA countries to explicitly criminalise sex work.

The report notes that the legality of sex work affects sex workers’ vulnerability to HIV/STIs and other sexual and reproductive health hazards.

Criminalisation was found to result in reluctance among sex workers to access healthcare and support services.

Dr Carabot stressed the importance of targeting the three vulnerable groups.

We have failed several generations with our head in the sand attitude

“Unfortunately, our idea of sexual health promotion is to lump everybody in the same pigeon-hole, and repeat the mantra of the ABC [abstinence, be faithful, use a condom] ad nauseam. This does not work and is a waste of time. Each group has its own needs and expectations, and they are very different.”

Malta also lacks a national strategy to prevent teenage pregnancy. Interestingly, Malta was the only country where no data was available on the percentage of 15-year-olds engaging in sexual intercourse and whether or not they used condoms.

Dr Carabot believes that young teens should be one of the major target groups.

“We have become very blasé about our teen mums. It has crept on us and because of our inaction it has become a social norm.

“We should have nipped it in the bud, but because of our endemic reluctance to be proactive, rather than the usual crisis management, the situation is what it is today.

‘Nation has become blasé over teen mums’

“The age of consent does not determine when people start having sex. Shouldn’t we consider changing it to 16?”

Contrary to several other countries, Malta has never carried a campaign promoting condom and contraceptive use.

Does he believe that this should be undertaken in Malta?

“Unfortunately, some still like to delude themselves that we are still living in a Catholic utopia where nobody has sex outside marriage and all we need to tell young people is to abstain and all will be well.

“We have failed several generations with our head in the sand attitude. Condom campaigns are essential but should not be exclusive of other messages, always tailored to individual target groups.”

While Malta has a national antenatal screening programme for HIV and a publically funded HPV vaccination programme, it lacks national screening programmes for chlamydia and cervical cancer.

As a result, screening was being done on girls as young as 13 and every six months for no apparent reason.

“Worse still, the smear test is very frequently used as a screen for STIs which is, of course, nonsense.”

According to the statistics, Malta did not have an alarmingly high incidence of STIs.

However, Dr Carabot noted that GU clinic statistics should not be misrepresented as national statistics because they only represent a unique group of patients which attend one clinic run by one doctor.

“My feeling is that the actual incidence of at least certain infections is actually much higher then we think – syphilis and gonorrhoea in particular. There is a substantial sub-group which practises completely anonymous sex and with multiple partners.

“I shudder to think of the number of people with syphilis and gonorrhoea happily, and possibly unknowingly, infecting other people every weekend in our ‘entertainment establishments’!

“We have been advocating the need for national prevalence studies for several years now, but so far nothing has happened. Without basic information, we cannot even begin to plan any rational sexual health strategy. Otherwise we restrict ourselves to the occasional leaflet or poster which as well-intentioned as it might be, is of very limited, if any, long term value.”