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World Aids Day: Overcoming the STIgma

Medical students Mark Miruzzi and Lara Miruzzi lament that there is no local pressure group supporting HIV/AIDS patients.

The World Health Organisation today marks the 30th anniversary of World AIDS Day with the theme ‘Know Your Status’. Since 1988, World AIDS Day has been a platform to spread awareness and education about AIDS (acquired immune deficiency syndrome) and has also served to urge policymakers to promote healthcare systems which allow better treatment that is accessible to all affected individuals.

Crucially, throughout different societies and cultures, stigma exhibits a tendency to rear its ugly head in the discussion of sexually transmitted diseases, and World AIDS Day aims to combat such stigma so as to promote better healthcare for patients worldwide.

‘AIDS’ refers to a wide spectrum of conditions resulting from HIV (human immunodeficiency virus) infection. HIV is a blood-borne virus typically transmitted via sexual intercourse, shared intra-venous drug abuse paraphernalia and vertical transmission from mother to child during pregnancy or breastfeeding.

In 2017, there were 36.9 million people globally living with HIV. Only 21.7 million were accessing antiretroviral therapy, and this shows that globally, more efforts must be made to increase the accessibility of AIDS medication.

HIV infection causes damage by destroying specific white blood cells which are found in the blood and play an essential directing role in our body’s cellular immunity. These white blood cells are artermed Helper T lymphocytes (CD4+), and orchestrate the cellular and antibody responses against infections. This explains why persons affected by the disease have a below-par immune system that is incapable of withstanding infections by organisms to which the healthy person is immune. 

As applies to many diseases, early detection is the key to more treatment options and enhanced prognosis for the patient.

It is important that the public becomes aware of the early signs and symptoms of AIDS which include fever, headache, nausea, diarrhoea and fatigue. In late-stage infection, patients tend to present symptoms such as rapid weight loss, unexplained fatigue, swollen lymph glands in the armpits, groin or neck, pneumonia and other infections, red-purplish blotches on or under the skin or inside the mouth, nose or eyelids.

There are about 400 people reported to be HIV+ in Malta

Some HIV-positive patients remain asymptomatic for up to a decade before the disease progresses, at which point they are much more susceptible to acquiring dangerous infections and cancers.

Awareness about AIDS and HIV is particularly important in Malta since in 2016, Malta had the third highest rate of new HIV diagnoses, which points both to relatively high incidence and also a good level of screening which is leading to the diagnosis of more cases per year. Sixty new HIV cases were reported in 2018, meaning that by now there are about 400 people reported to be HIV+ in Malta.

The majority of HIV patients in Malta are male, and the main mode of transmission on our island is via sexual contact (mainly MSM: male sex with men) and not intravenous, via blood products or via vertical transmission. This explains why we need more awareness about AIDS in our country since there is an information deficit both in terms of knowledge and awareness of how this disease affects us locally. There is also no pressure group supporting HIV/AIDS patients, so it is important for the LGBTIQ+ community to get more involved in supporting people living with this condition.

The Malta Medical Students Association (MMSA) every year organises World AIDS Day in Valletta for the purpose of public outreaching and decreasing the stigma associated with this disease. In Europe, around one in seven cases remain undiagnosed, and this number could be even higher in Malta since the subject is still considered taboo.

Treatment of HIV includes giving a combination of different medications to combat the virus at different stages of its replication. Patients on highly affective antiretroviral therapy (HAART) have to take a number of tablets a day, and this may result in non-compliance. HIV regimens are available as a single tablet, but these are not yet used in Malta. While HAART does not cure AIDS, it increases life expectancy of AIDS patients and reduces the risk of HIV transmission. This antiviral therapy inhibits replication of the HIV virus to reduce the viral load in the patient’s body, thus stunting the development of the disease and improving the patient’s condition.

A major purpose of World AIDS Day is to bring hope to those patients who suffer from AIDS. After all, HAART leads to a near-average life expectancy and an enhanced quality of life for AIDS patients.

We must remember that prevention is better than cure when it comes to sexually transmitted infections (STIs), so safe sex practices such as condom use must continue to be promoted.

In Malta, HIV testing can be done at the GU (genitourinary) clinic at Mater Dei Hospital, and patients receive healthcare and support from a multidisciplinary team including consultants and HIV nurses. Confidentiality is guaranteed at all instances. 

As a Maltese society, from a medical perspective we must continue to strive to enhance our diagnostic and treatment policies and educate people so as to eliminate stigma, promote public health and decrease the incidence of HIV/AIDS.

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