Issue link: https://maltatoday.uberflip.com/i/1537913
SEXUAL health is a cornerstone of overall well-being, encompassing not only phys- ical safety but also emotional, mental, and social aspects of sexuality. In modern societies, ensuring access to accurate in- formation, preventive tools, and medical treatment is a fundamental responsibility of governments. Unfortunately, in Malta, political prom- ises surrounding sexual health—particu- larly the availability of HIV-prevention medication such as PrEP and PEP—have repeatedly fallen short, putting vulnerable populations at unnecessary risk. Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are proven tools in the fight against HIV. PrEP is a daily pill taken by HIV-negative indi- viduals to prevent infection, while PEP is taken after potential exposure. Numerous clinical studies have confirmed that when used correctly, both medications are high- ly effective in preventing the transmission of HIV. Despite these scientific advancements, Malta has consistently lagged behind its European counterparts in ensuring wide- spread, equitable access to these medi- cations. The major political parties have made commitments during electoral campaigns to expand access to PrEP and PEP. Yet in practice, those promises have amounted to little more than lip service. It is of course the responsibility of the gov- ernment to provide free and complete ac- cess to these medicines, but thus far noth- ing concrete has happened. Access to PrEP in Malta remains limited, fragmented, and, for many, unaffordable. Currently, individuals often rely on pri- vate clinics or import the medication at their own expense, leaving lower-income individuals and at-risk populations with- out viable options. The situation is even more dire when it comes to PEP. Despite its critical role as an emergency interven- tion—meant to be started within 72 hours after potential HIV exposure—availability remains inconsistent. There is no central- ised system ensuring 24/7 access in emer- gency settings, putting lives at risk due to bureaucratic inertia and underfunding. This lack of access is not merely an ad- ministrative oversight; it is a failure of gov- ernance. The health ministry has had ample time to integrate PrEP and PEP into national health services, particularly since these medications have been recognized by the World Health Organization for over a dec- ade. Some months ago, the government published the long overdue national sex- ual health strategy. But, again, beyond the rhetoric and promises, nothing concrete has happened. The consequences of this failure are tan- gible. Malta has seen a steady number of new HIV diagnoses each year, a trend that could be significantly reduced with a ro- bust, publicly-funded prevention strategy. Moreover, the stigma surrounding sexu- al health—particularly within LGBTIQ+ communities—remains a formidable barrier to care, compounded by govern- ment silence and inaction. In recent years, international sexual health advocates have also begun explor- ing the use of DoxyPrEP and DoxyPEP— antibiotic-based regimens that can reduce the risk of certain sexually transmitted infections (STIs), including chlamydia and syphilis. A 2022 study published in the New England Journal of Medicine showed promising results: among men who have sex with men (MSM) and trans- gender women, doxycycline taken within 72 hours of unprotected sex significantly reduced STI incidence. Though DoxyPrEP and DoxyPEP are not without controversy—due to concerns over antibiotic resistance—they represent an emerging frontier in STI prevention that Malta should not ignore. If incorpo- rated responsibly into a broader sexual health strategy, these tools could help re- duce the overall burden of STIs and offer additional protection to those most at risk. The conversation around sexual health must shift from being politically conven- ient to being a public health imperative. It is unacceptable that in 2025, the Labour government still treats preventive sexu- al healthcare as an afterthought. Malta's supposedly liberal government must move from promises to policy. The Nationalist Party has made public its proposals on this matter. Below is an outline of our proposals: 1. Access to PrEP, PEP, and potentially DoxyPrEP/PEP should not be a priv- ilege for the few, but a right guaran- teed for all. 2. Convert the GU clinic into a walk-in facility, extend its operating hours (including weekends) to provide 24/7 access to PEP, and increase the number of healthcare professionals in this area. Open additional com- munity-based clinics. 3. Expand and improve the screen- ing process, especially for high- risk groups, and establish a regular screening schedule with specific timelines while offering PrEP medi- cine for those at risk. 4. Implement a national awareness and prevention campaign tailored for different age groups, genders, and sexual orientations. Address antibi- otic resistance, especially in relation to gonorrhoea, through a dedicated action plan. 5. Introduce more progressive and practical measures that can deliver measurable improvements in service quality and public awareness about sexual health practices. 6. Address mental health issues to re- lated to and effected by sexuality. Issues like compulsive sexual be- haviour and pornography addiction — both recognised by the World Health Organization — should not be ignored. Anything less is not just a missed oppor- tunity—it is a betrayal of public trust and a failure to protect the nation's health. The time for talking is over. What Malta needs now is action. 6 maltatoday | SUNDAY • 27 JULY 2025 OPINION Graziella Attard Previ Sexual health: Broken promises amid a public health crisis PN MP and spokesperson for equality and civil liberties This lack of access is not merely an administrative oversight; it is a failure of governance