Malta has the highest rate of new HIV diagnoses among EU countries and continues to report an increase, while two-thirds are showing declines, according to the latest report on HIV/AIDS surveillance, based on 2020 figures.
With a rate of 15.9 per 100,000 population, Malta was way above the 3.7 EU average, according to the new report, published jointly by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation Regional Office for Europe to mark World Aids Day.
It showed a 24 per cent drop in the rate of newly diagnosed HIV cases between 2019 and 2020 – largely due to reduced HIV testing last year as a result of COVID restrictions and disruptions to services.
The situation was considered worrying, given that, over the last decade, new HIV infections have been increasing in the WHO European Region, and it suggested the number of people living with undiagnosed HIV was on the rise again.
“While we have seen a decline in cases in 2020, it is likely that a substantial proportion of that is due to fewer cases detected early, given that HIV testing services were reduced or unavailable during a portion of 2020 due to COVID-19 measures,” the report said.
Even though Malta had the highest rate of new HIV diagnoses in the region – 81 cases – with the figure more than doubling since 2011, it still did not have an updated sexual health policy, free access to pre-exposure prophylaxis (medicine to prevent getting HIV), and sufficient access to testing, said Mark Josef Rapa, a lecturer in Bioethics at the University of Manchester and founder of PrEPing Malta.
Reacting to the findings, he also highlighted the issue of “inconsistent reporting on modes of transmission” for Malta, which, he said, created all sorts of problems in particular when building campaigns.
The route of transmission varied across the region, with sex between men being the most common mode in the EU, accounting for 38.8 per cent of all new HIV diagnoses in 2020, while heterosexual transmission and injecting drug use were the main reported transmission modes in the eastern part of the European region.
But Malta and Lithuania did not report any data on transmission modes for 2020, the report states.
As regards diagnoses rates, Malta was followed by Latvia, Cyprus and Estonia, with the lowest in Slovenia and Austria, the report shows.
The highest rates of newly diagnosed HIV infections per 100,000 population (more than 15.0) in 2020 were observed in Russia (40.8), followed by Ukraine (37.5), Kazakhstan (18.5), Moldova (16.7) and Belarus (15.1).
The rate of new AIDS diagnoses varied widely among the countries, with the highest reported in Ukraine, while Malta and San Marino reported zero cases.
Asked if in Malta’s case, given it had the highest rate of diagnoses, testing was not necessarily lacking, Rapa said that “while it could not be discounted, we do not know the extent the effect of reduced HIV testing has on new diagnoses”.
While reduced testing would lead to fewer diagnoses, other factors have contributed to a drop in new cases, he said.
Countries that have introduced PrEP have, over the years, been reporting a dramatic decrease in HIV cases, continued Rapa, who is also a member of the European AIDS Treatment Group.
“Ironically, last year, even with reduced testing compared to previous years, Malta still managed to report an increase in the number of cases,” he said.
The report also showed the proportion of 2020 diagnoses that had previously been diagnosed in another country was higher than the EU average in Malta at 16 per cent.
Of the 6,979 new HIV diagnoses in the 15 countries with information on previous diagnoses, 16 per cent were previous positives.
HIV infection continues to affect the health and well-being of millions in the WHO European Region.
Over the last three decades, over 2.2 million people have been diagnosed with HIV.
Despite the potential under-diagnosis and under-reporting in 2020, 104,765 new HIV infections were diagnosed in 46 of the 53 countries in the European Region.
Since the HIV virus was first identified back in 1984, it has claimed more than 35 million lives worldwide.
“We can do more, and we can do better, but this demands a proactive approach from our government to introduce an updated sexual health policy, make PrEP available for free and increase resources to our clinicians,” Rapa appealed.
Last June, Times of Malta reported that sexually transmitted infections in the country rose by about a third as COVID restrictions eased.
The spike also coincided with an increase in patients being handled by the GU clinic as the state hospital’s operations returned to normal.