The Malta Independent on Sunday
Climate change and immigration having impact on infectious disease levels in Malta
The persistent and unpredictable nature of infectious disease emergence, climate change and global population migration represents a continual challenge, according to a public health study.
Celebrating 20 years of the Malta Association of Public Health Medicine (MAPHM), a number of its members – who are experts in their respective fields – have produced a study regarding the main public health issues facing Malta and the added value of a vibrant public health community that has shaped the development of health systems in Malta during this period.
The study was divided into a number of chapters, ranging from infectious diseases to tobacco and nutrition, with the aim of shining a light on the successes, failures and ongoing challenges for health in Malta.
In their editorial, the authors explain that they sincerely hope their research will inspire policy-makers, fellow health professionals and civil society to come together and work towards addressing the remaining and emerging health challenges whilst retaining all that has worked well in order to ensure that everyone in Malta – regardless of age, gender or socio-economic status – are able to enjoy good health and wellbeing throughout their life.
The Infectious Diseases chapter of the study goes into further detail, noting that in recent years it can be said that there are no borders when it comes to infectious diseases, due to the increase in global travel and the mass migration of people and the large number of people considered as displaced. This has led to the introduction of new diseases in countries that previously had no experience of them, as well as the re-emergence of diseases that had been considered controlled.
HIV and AIDS
The assessment explains that Human Immunodeficiency Virus (HIV) was first introduced in Malta in 1984, as far as can be established, and in a few returned HIV-positive homosexual men, previously domiciled and infected abroad.
This led to a National Advisory Committee on Aids being established in December 1986, with initial cases of HIV/AIDS being followed up at Boffa Hospital by dermatologists. Further down the line – in 1995 – patients began being reviewed by Infectious Disease clinicians.
HIV and AIDS became a notifiable disease in Malta in 2004 and the reliable data that has been collected since then shows that there has been an increase in the number of HIV cases, especially since 2012, always with a predominance in males. In the early years, heterosexual transmission was the most common mode of transmission, but since 2013 there has been a steady increase in the number of men who have sex with men (MSM) being diagnosed.
The greatest increase in numbers over the past few years has been seen in the foreign population (both EU and non-EU) compared to Maltese nationals. The situation in Malta compares with the situation in general in the European Region.
For the future, it was noted that of primary importance is the promotion of sexual health awareness, especially among risk groups, and increasing human resources and finances at the needed clinics.
The study also suggested that programmes for men who have sex with men should be further developed and strengthened, whilst noting that HIV cases among migrants are a reality, as is evidence of post-migration HIV acquisition. It also suggests that prevention services need to take this into consideration and adequate harm-reduction measures must continue to prevent HIV among people who inject drugs.
Sexually Transmitted Infections (STI)
In Malta, the cases of chlamydia, gonorrhoea and syphilis reflect the situation in Europe, with increasing numbers being identified over the past decade.
With improved diagnostics and surveillance, and increasing attendance at the GU clinic as more people are aware of the services offered, more cases are being diagnosed.
The main cause of such an increase is due to the low level of condom use, multiple partners and risky sexual practices.
The Genito-Urinary (GU) clinic is seeing and treating an increasing number of patients each year, but it needs to expand and augment its services in order to meet the demand fuelled by the increasing rate of STIs locally.
As in the situation regarding HIV/AIDS, the suggestion to help resolve this is education, which needs to be targeted towards other health professionals, risk groups and the general population, particularly with the setting-up of a service that offers contraceptive advice, family planning, counselling on STI issues, advice on PrEP and PEP, as well as the monitoring of individuals on such medication.
Effective surveillance the cornerstone
The study notes that Malta has had an increased influx of migrants from across the globe, affecting the local scenario regarding the incidence and prevalence of infectious diseases, and it goes on to say that they are a significant burden on public health and the economic stability of societies all over the world.
And, despite significant advances – especially during the past two decades – infectious diseases continue to kill several million people each year.
The study suggests effective surveillance as the cornerstone for the prevention and control of communicable diseases, and timely and accurate information for the accurate monitoring of local trends – all of which would require a national electronic database that is linked to key stake holders.