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Unprotected sex behind record rise in HIV cases

World AIDS Day has come and gone with barely a whisper, yet Malta is this year facing a record surge in new HIV cases.

A record high of 60 people became infected with the HIV virus, according to the latest figures.

A record high of 60 people became infected with the HIV virus, according to the latest figures.

Fourteen new cases of HIV have surfaced in just two months – shooting up the total for this year to a record high of 60 people who became infected with the virus, according to the latest figures.

Casual unprotected sex is behind this record surge – 17 more cases than all of 2014 – and medics are concerned that this coupled with the fact that the fear factor associated with HIV is no longer present could lead to more people becoming infected.

The British Medical Journal has just reported that since 2005 the rates of new diagnoses have more than doubled in Malta, Bulgaria, the Czech Republic, Hungary and Slovakia. In 2005, Malta had just 15 cases of HIV.

We must get away from the idea that the human body and sex is somehow shameful and sinful from the word go

Surveillance data released by the European Centre for Disease Prevention and Control and the World Health Organisation’s regional office for Europe showed that 142,197 people were newly diagnosed with HIV last year; the highest recorded since reporting began in the 1980s.

According to the BMJ, in the EU, as in Malta, sexual transmission between men was still the most common mode of contracting the virus.

However, Mater Dei Hospital’s infection specialist Charles Mallia Azzopardi is keen to stress that although the majority of infected patients in Malta are gay men, mainly aged between 30 and 50, HIV “is not a problem of gays but of unprotected sex”.

Against this backdrop, World AIDS Day, marked globally on December 1, came and went without much fanfare or prominent public campaigns. Are these still relevant?

“I do believe they work, but they need to be very well planned and sustained. The input of experts in human behaviour is crucial,” Dr Mallia Azzopardi said.

“I risk sounding too conservative but I strongly believe we need to go back to basics and start to really deal with the root of our problems.

“A very significant proportion of behavioural problems can be traced to childhood, so a strong family unit in its diverse forms, which seeks to impart sound values must be one of our main goals.

“Therefore, our main duty as a society is to impart sound values during our children’s formative years. Missing this we will just be firefighting.”

Genitourinary consultant Philip Carabot agrees: “I believe that education, done properly and started early and consistently throughout life, is the key.”

Just this week Professor John Ashton, president of the UK’s Faculty of Public Health, urged parents to start talking to their children about sex from as young as three.

In an interview with The Sunday Times of London, he warned that if parents evaded questions about girls’ and boys’ different anatomy children would grow up believing the subject was taboo and eventually need sex and relationship advice when they reached adolescence.

Dr Mallia Azzopardi said: “The cradle of one’s education is the family, not schools, although these have a very complementary role to play.”

It was important, he added, for authorities to take a very good look at family units, and plot the way forward.

“We can simply shift responsibilities on to schools and government, but I feel the earlier we start with educating our children in all aspects of life, including sex education, the better,” he said.

Dr Carabot concurs with Prof. Ashton’s advice, but would not be drawn into saying what the appropriate age was to start having conversations about sex.

“I wouldn’t like to comment for the simple reason that this would serve as an excuse to derail the whole discussion, and instead get bogged down in the minutiae and miss the wood for the trees... as we are wont to do in Malta,” he said.

“What I will say is that we must get away from the idea that the human body and sex is somehow shameful and sinful from the word go.”

Dr Carabot – who until last year headed the GU Clinic and was an untiring sexual health campaigner – did not mince words and said the efforts being employed in this field were clearly failing.

“While I don’t doubt the good intentions and efforts of many, for the last 15 years – since records started being kept – there has been a consistent increase in all STIs, unplanned pregnancies, condom non-use in 70 per cent of all patients attending the GU Clinic, as well as 45 per cent admitting to casual sex.

“All this should tell us very clearly that whatever sex education and health promotion efforts are in place are simply not working. We need to get out of our comfort zone and have a radical rethink of the whole subject.”

Dr Carabot referred to the recent proposal to lower the age of consent.

He said that while this sounded very modern and liberal, unless it was preceded by a much more solid sex education programme, “then we are asking for even more trouble”.

When asked what could be done to address the growing number of new HIV cases, Health Parliamentary Secretary Chris Fearne said the HIV/AIDS think-tank would be presenting a draft HIV strategy in the first quarter of 2016.

Touching on the subject of sexual education, he said parents had a crucial role to play in a child’s sex education.

Our main duty as a society is to impart sound values during our children’s formative years. Missing this we’ll just be firefighting

The Health Department, Mr Fearne said, was currently carrying out a study with parents to map out their knowledge, attitudes and skills to help develop initiatives to support parents in this area.

“Children will at some point learn about sex in any case. It is much better if they are taught through reliable, factual sources, rather than via invalidated sites on the internet,” Mr Fearne said. Health promotion director Charmaine Gauci said 900 parents of Form 2 students had been selected in a random sample to establish the strengths and deficiencies parents faced when discussing sexual health with their children.

“The results will enable us to provide the backing and support parents need to handle these situations. What we do know from previous interviews is that students want their parents’ guidance.”

Dr Gauci did not rule out targeting parents of much younger children.

“Starting at an early age is important. We’re there to help, but children’s education is also parents’ responsibility and cannot just be left in the hands of the education system.”

HIV – silence is the real disease

Leonard*, 30, who lives with HIV, attempts to chip away at the ignorance still shrouding this misunderstood virus.

Each year December 1 is dedicated to raising awareness on HIV. It is also a date that reminds us to support those fighting the disease, to support research to help find a cure, and to resist the stigma this virus carries.

But the real disease I wish to delve into is not HIV, but the ignorance surrounding this very misunderstood virus. The reason for this continuing stigma is that there is still so little understanding of its complexities and living with HIV.

The misconceptions around HIV started as a result of the media exposure this disease received when it first appeared in the Western world in the mid-1980s.

It appeared in great numbers and was considered an epidemic. At the time, close to nothing was known of the disease and since a large part of those infected were members of the gay community it was labelled the ‘gay cancer’.

It only took a short while for HIV to be recognised as a disease that did not discriminate between race, gender, or orientation.

By the mid-1990s anti-retroviral therapy was discovered, a cocktail of medications prescribed to HIV patients which repressed their virus, bringing viral levels down to undetectable.

Now that we have had at least one generation of gay men who never witnessed AIDS, the sense that we’re all living with HIV is long gone

Today’s suffers can be on as little as one pill a day allowing an HIV patient to live an almost normal life and be of no risk to anyone, as long as they adhere to the medication and do regular check-ups.

This does not mean living with HIV is easy; quite the contrary. Having this disease requires following a healthy lifestyle and permanently adhering to a strict regime of medications and regular tests. Not to mention the psychosocial impact this condition creates, fuelled by an unnecessary amount of stigma it carries.

The media have not helped to fight misconceptions plaguing this condition. Films like the Dallas Buyers Club only served to reinforce the1980s’ perception that this is ‘their’ [gays] problem and belongs to a deprived world of people with a certain social and economic background. Today you only need to search online for organisations with empowering stories by heterosexual women, men, mothers, fathers, girls, boys, trans, bi, or gay, to learn about their journey and life with HIV, to quickly change misconceptions.

Although this is everybody’s disease and we all have a status, be it A+ or A-, as a member of the gay community I would like to bring an issue to the fore.

With higher acceptance of the gay community, marginalisation has begun to form within what was once a tight-knit group. Peter Staley, an HIV survivor and activist since the 1980s, calls this the ‘new HIV war’; that of ‘gay shaming’.

Across the Western world, online dating and social networks have become the norm for both hetero and homosexual people to meet their partners.

Here in Malta, when it comes to the online gay dating scene one commonly finds words ‘I’m clean’ or ‘looking for clean, disease free’ partner. This does not only occur online; I hear these labels commonly used in conversation.

This merely leads to digital stoning when somebody dares come out online, or simply attracts social shunning in public.

Today, I feel, HIV-related stigma is worse than ever. Not in an open, obvious way, where society is in a panic as happened in the mid-1980s and early 1990s, but an internal stigma, where a community shuns its own, which is far more destructive.

There was a time when gay men received communal love and support. Once the gospel of safe sex was firmly entrenched, even sexual shunning was rare. Now that you can take pills and hide it, and now that we have had at least one generation of gay men who never witnessed AIDS, the sense that we’re all living with HIV is long gone.

A culture of safe sex, where you always presumed the person you were sleeping with was HIV positive, has been replaced with a culture of unprotected sex.

Such attitudes lead to a vicious cycle where HIV-related stigma leads to more HIV, while hiding its damage by instilling fear and shame in the newly infected.

Silence is the real disease, as it allows ignorance and misconceptions to prevail and thrive. Being silent about the subject causes us to run the risk of socially marginalising a group of people who are aware of their status and have it under control.

Can anything be done to fight all this?

Yes! Recent history has shown that public health interventions can overcome remarkable levels of social resistance. We have the tools to reduce HIV incidence, through treatment and prevention. We just have to apply them.

* Names have been changed.

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