Bill Clinton

as well as the concerns over the side effects and toxicity levels ART leaves in the patient. Data from a study in Brazil also confirmed that putting Dolutegravir in the first line regimen (the preferred, recommended treatment) significantly increases the chances of virological suppression compared to other treatment regimens that do not include Dolutegravir.

As to a possible cure for HIV, data from the ‘River Study’ has put to test the ‘kick and kill’ strategy where an agent is used to ‘kick’ the virus in the reservoir while a vaccine is used to ‘kill’ the awoken virus. Even though the results were disappointing, the study provided further insight into the HIV reservoir. Studies and analysis are currently underway to further understand why the study failed.

Decriminalisation of sex work

Possibly one of the most vociferous groups in the conference was that of sex workers, who demanded entire decriminalisation of sex work across the globe. Sex workers are 10 times more likely to become infected with HIV. Legislation which criminalises the sex client and not the sex worker, so called ‘end demand laws’, was originally thought to drive a higher demand for essential services, including HIV prevention and treatment. However, two studies on Canada and France’s ‘end demand laws’, presented at the conference, showed a decrease in the demand for essential services. “If ‘end demand’ laws create new barriers to HIV prevention and care, that is a very significant concern,” Linda-Gail Bekker, President of the International AIDS Society and International Chair of AIDS 2018, said. This provokes careful reconsideration of the ‘end demand laws’ and further investigation of the impact they have on access to health care services.

A group of sex workers also interrupted former US president Bill Clinton’s keynote speech on the last day of the conference, demanding that he exert what political pressure he could to decriminalise sex work. They also joined other protests held at several intervals during the conference demanding that the next AIDS conference is not held in Trump’s America. Laws on sex work and drug users, together with the constant undermining of rights of transgender people, would prove to be problematic for those who would need to obtain a visa to attend the conference.

Bringing the conference home

In a plenary session, Minister for European Affairs and Equality Helena Dalli spoke about the recent introduction of gay marriage and the Gender Recognition Act, which allows transgender people to change the gender on their identification documents without the need to undergo gender reassignment surgery. She also mentioned the government’s positive actions to provide a gender reassignment clinic. Even though not mentioned in the press release issued by Dalli’s ministry, in her concluding address, the Minister referred to HIV-related issues pertaining to Malta.

When asked to provide dates for the government’s action plan to provide Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) on the NHS and better treatment for those living with HIV in Malta, no concrete answers were forthcoming. When pressured, an accompanying ministry official stated that the changes mentioned are part of an action plan the government has and which it will implement over the next three years.

What policymakers must recognise is that the use of political rhetoric hardly ever works in health-related matters, especially in the field of HIV. People living with HIV and those affected by it (those at a high risk of contracting HIV) demand not only accurate answers but also immediate implementation of effective strategies which could see their quality of life improve.

The results from separate investigations conducted by myself and a colleague of mine earlier this year on what medication is prescribed to people living with HIV in Malta and what services they are offered, show that some people are still being prescribed a concoction of pills. Some have reported taking up to six pills a day. To add insult to injury, these medications fall entirely outside international guidelines on ART; they are not even recommended to be prescribed in developing countries. Not only did the medication have to be collected from the pharmacy at Mater Dei Hospital rather than a pharmacy of the patient’s choice, but there were also occasions where stock of certain medication was running low, so patients had to go back to the pharmacy to get more medication. Psychological support was reportedly not available.

As things stand, the cost of PEP, a 28-day treatment which can prevent HIV settling in the body as long as it is started within 72 hours of exposure, sets you back about €550. Even though PEP is considered to be a powerful preventative tool for HIV, it seems that making it accessible to the general public who might need it is not a priority.

The engagement of politicians with key populations is a prerequisite for any effective policies. Former President Bill Clinton, Elton John and Prince Harry, Duke of Sussex, were unanimous in stating that this is not the right time to cut down on funding in HIV and Public Health at large. They have also encouraged activists to keep lobbying and fighting for support from their politicians and international organisations. HIV is an infection which affects all parts of the world and it is only through global cooperation that the number of new infections can be reduced, with effective treatment and virological tests made available in all parts of the world.