An elderly Maltese woman steps off the bus and walks to her son’s workplace. She is given a prescription for HIV medication and is then waved off. This is the second time she is making this journey. 

Antiretroviral medication in Malta can only be found at Mater Dei Hospital’s pharmacy, and her son has experienced three shortages to date. On these occasions, Frank* returns home with a supply of pills that will last a weekend or at most two weeks, rather than the regular two-month dose. 

This means asking for more time off work or calling his mother to help him out.

The HIV positive community in Malta is on a six-pill regimen, criticised as ‘archaic’ in comparison to other countries in Europe where a daily pill does the job. 

The drugs need to be taken at 12-hour intervals to suppress the virus, so carting medication around becomes a necessity. 

If the pills are not taken on time, the virus is at risk of mutating, which could render the treatment ineffective. 

This month another recurrence of shortages sparked frustration among the HIV community. The Health Ministry confirmed the limited supply of antiretroviral medication but did not answer questions asked by Times of Malta regarding the occurrence.

“It is totally irresponsible and illogical behaviour and practice to make access to medication difficult,” said Mark Josef Rapa, Teaching and Research Assistant for the Healthcare Ethics and Law at the University of Manchester. HIV transmission increases when there is a lack of access to medication, he added.

HIV cases in Malta increased last year, the GU clinic said. The total number of HIV diagnoses was 73, of whom three patients were tested positive for AIDS. 

Out of the overall figure, 19 were Maltese and the remaining foreigners. 

Furthermore, 16 were known cases – already diagnosed in other countries and receiving treatment. Once they registered with the Maltese health care system, they were re-tested, and their case was reflected in national statistics, Valeska Padovese, head of the sexual health clinic confirmed.

It would totally change my health and my quality of life

“Considering these figures there is still an increase of cases, but most are among foreigners and I do not think we can do much to control this data, apart from increasing awareness, testing uptake and promoting pre-exposure prophylaxis,” she said.

Treatment, however, is an important part of the equation for keeping the disease at bay, and Dr Padovese agrees that the HIV clinic should be run on a daily basis rather than solely on a Thursday for half a day. 

Upgrading the six-pill regimen to the daily dose would also be effective at lowering HIV cases, explained Dr Rapa, who is the founder of www.prepingmalta.com and a member of the European AIDS treatment Group. 

“Newer medication come with less side effects, which in turn leads to higher adherence. Higher adherence to medication is necessary to keep the viral load down, and a with a low viral load the higher are the chances for the virus to become undetectable. A person with undetectable HIV cannot transmit the virus to another person.”

In addition, the current medication wreaks havoc on the body. 

Even though the side-effects aren’t as strong as they used to be when Frank first went on the medication, he still goes through very rough phases. 

“Most of my symptoms are gastric, ranging from cramps to diarrhoea or constipation... but your life still needs to go on… you still have to get out of bed and go to work,” Frank confides. 

Since the six-pill regimen involves high toxicity levels, long-term effects could include adverse effects to kidney functions and bone density, Dr Rapa said.

While HIV is no longer a death sentence, a person diagnosed with the virus in Malta still faces numerous challenges. 

Stigma persists and dating can be hard, Frank said. Taking out a mortgage can also be an issue, as life insurance providers refuse to offer their services to HIV positive persons. 

But it is the more consistent availability of medication and a change to the daily dose, that the HIV community currently have high on the agenda at the moment. 

“It would totally change my health and my quality of life,” Frank concedes.

*Name has been changed