The Genitourinary Clinic, founded in 2000 at Sir Paul Boffa Hospital, moved to Mater Dei in 2012 with the aim of detecting and treating sexually transmitted infections and other infections not necessarily acquired via sexual contact. Maria Abela, a nurse who has been working at the GU clinic for seven years, spoke to the Personal and Social Development Association for this article.
The GU Clinic is the only place in Malta which tests for STIs free of charge. Tests carried out privately could amount to a maximum of €300.
Considering the number of people who book for a test at the GU clinic, a proposal has been put forward by the clinic whereby asymptomatic patients – those who are not experiencing any symptoms – can visit Health Centres, while others who are experiencing symptoms visit the GU clinic. This will limit waiting time and ensure efficacy.
The mean age of people who get tested is from 18 to 25, with men getting tested more than women – which mirrors the patterns found across other countries. Despite the clinic receiving patients from around 103 countries, the majority are Maltese.
The most common STIs in Malta are:
• HPV, with 181,997 females aged 15 and older at risk;
• Chlamydia, with 90 people diagnosed during the first quarter of the year, and a total of 344 people during 2018. This is mostly diagnosed in younger people;
• Gonorrhoea, with 44 people diagnosed during the first quarter of the year, and a total of 122 people during 2018; and
• Latent syphilis, with 14 people diagnosed during the first quarter of the year, and a total of 60 people during 2018.
With regard to HIV, 11 new patients were registered during the first quarter of the year, with last year seeing 67 new cases (statistics obtained from hpvcentre.net and the Health Promotion Unit).
If the test results positive for any STI, medicine is dispensed by the GU Clinic and if someone is found to be HIV positive, the patient is referred to the Infectious Diseases Unit at MDH.
Patients aged under 18 who test positive for an STI are given the choice of whether to tell their parents or guardians and will not be contacted by the clinic. Moreover, if an adolescent visits the GU Clinic with an adult, the latter will be asked to exit the room when asked about their sexual history – for people to feel more comfortable when answering the questions.
11 new HIV patients were registered during the first quarter of the year. Last year saw 67 new cases
The GU clinic performs contact tracing by asking their patients who tested positive for an STI for a list of previous partners in order for the clinic to contact them to undergo testing. This prevents the risk of spreading STIs. Despite the high rates of STIs in Malta, 75 per cent of sexually active people still do not make use of condoms. The GU clinic suggests regular testing if an STI is present, since once you get the first one, the risk of acquiring another is fivefold.
There is the tendency among sexually active people to think that it will happen to others but not to them. Moreover, the pressure to conform and issues of identity also lead to sexual experimentation not only in young people but adults as well, where the importance of certain skills, especially assertiveness, was highlighted. This involves the ability to know oneself and be able to make informed decisions in any given situation, including sexual encounters.
Assertiveness, self-esteem, sexual knowledge and sexual identity are a few of the skills which are transmitted to students during PSCD lessons. Values such as respect for oneself and others, maintaining good health and the ABC model (abstinence or delaying initiation, being faithful and using condoms) are also communicated.
During these lessons, sexual and relationship education is tackled, whereby students are equipped with the necessary skills and knowledge for everyday life experiences. The students are encouraged to apply what they have learnt at school. However, open communication and the role of parents or guardians is crucial. It is important for students to feel comfortable speaking with their carers while teachers build upon the knowledge and information that they pass on to their children.
During PSCD lessons, the educators elicit what the students already know to be able to build upon it in an informal setting and a safe environment where they can feel comfortable discussing and asking questions on topics at hand.
It was noted that, at times, resistance from parents or guardians is present both in schools and when visiting the clinic, with parents wanting their children not to participate in lessons at school and resist the use of contraception, even though they might know that their son or daughter is sexually active. This may reflect the lack of communication with their children on sexual matters.
It is also important for both teachers and parents to be well informed in order to provide the correct information and guidance to young people. This information can be obtained from the GU clinic or Health Promotion Unit. The GU clinic is open Monday to Friday from 8am to 2pm and welcomes people of all ages, sex and nationality. In order to get tested at the clinic, one needs to call 2122 7981 or 2545 7494 for an appointment, notifying them whether any symptoms are being experienced.
On the day, when visiting the clinic at MDH outpatients on the second floor, a doctor and a nurse will ask a series of questions about one’s sexual behaviour and history. Needless to say, it is crucial to be honest for your and your partner’s safety.
Confidentiality is ensured by using a separate database from MDH. Therefore, this information will not show on a patient’s medical records. Patients are also given a code number to use instead of their name and the test results are communicated after a week or two on a mobile number provided by the patient.
Young people under the age of 18 can also visit the clinic on their own to undergo screening. This encourages adolescents to get tested without worrying about confidentiality.
The association serves as a support group for PSCD teachers and student teachers.