Fate of GU clinic patients up in air, stakeholders say they are shut out

Stakeholders have told this newspaper they are concerned about the fate of the genitourinary (GU) clinic and its patients, after monumental changes to the way the sexual health clinic was run saw patients outsourced to different health care centres.

HIV activist Mark Josef Rapa told MaltaToday, a sexual health activist who raised awareness over medication for HIV patients, said the closure of the GU clinics had left patients and clients of the service without a clear reference point.

The GU clinic sees both patients with and without symptoms, ranging from those seeking a check-up to others concerned about sexual health cases and related symptoms. But from March, the health authorities will be implementing a system where patients – both with or without symptoms – will have to present to other general health centres in Mosta, Floriana and Paola. Only complicated cases will continue to be seen at the GU clinic.

“Initial confusion gave the impression the GU clinic would be closing down – however, it will remain open,” Rapa said – albeit in a decentralised state. “They are shifting some of the services to primary health care,” Rapa, who identifies as non-binary, said.

“The issue is that stakeholders are not aware of which cases the GU clinic are going to see. In the cases of rape or those who need pre-exposure prophylaxis (PrEP), we still do not know where they will be seen. Whether it is the GU clinic or health centres, this is our main concern; we do not know what will remain in the remit of the GU clinic,” they said.

Rapa said another concern is that the change is only weeks away. “When it comes to training GPs, it is not something that can be done overnight. While testing patients is not a difficult task, it goes beyond this. Sexual health is still very much a taboo in Malta. These people need to be trained in sensitivity.”

Rapa said there was an issue on training, who will be carrying the training of the GPs in health centres, and how sensitised will they be to the cases treated by the GU clinic. “If someone from the LGBTQI+ community or a woman were to walk into the GU clinic, they know that those persons are trained and that they will find persons who understand. The concern is, will those people be receiving the same level of care and understanding at health centres?”

Rapa said that the GU clinic does not just test and send people on their way. “They talk to the patients, they take a sexual history, they track the sexual behaviour of the patients. Then they come together with the patient to try and find a way forward. In some cases, they recommend using more condoms. And in other cases, there is a chance to talk about PrEp – which I don’t see happening at health centres.”

Rapa said that while it is true that the GU clinic has a long waiting list, the answer to solving that problem was not decentralising the system in a matter of weeks. Rapa said there is also the issue of medical results. “In the GU clinic, a patient is a particular number, and the clinician can go into the system and access the person’s history, which includes contacts in the past. Will health centres have access to this database?”

Rapa said that if health centres have access to this, it would raise important confidentiality and privacy issues. “What protection is there for this data?” Rapa questioned.

“Then, there is the issue of who is going to be giving patients results. If a person is HIV positive, there is an entire system in place. They ask the person for a sexual partner history because there is such a thing as partner notification. So, either the patient or the clinician will inform the partners and suggest they get tested. Will this remain in the remit of the GU clinic or primary health care?”

The decentralisation approach

Rapa says decentralisation can be the right approach if the GU clinic is not willing to extend its hours of operation after its current 1pm closure. But in that case, the primary goal would only be an extension of opening hours. “The first thing you do is improve a system. So the concerns of the GU staff are still valid and should be taken into consideration,” they said.

Moving GU clinic patients to primary health care does make sense for asymptomatic patients, giving them practicality with three different places, and convenience.

“In theory, it would speed up the process of people who get tested. But we cannot increase the quantity at the expense of the quality.

“I think community testing is a brilliant idea, but it needs to be done properly. If I go for a sexual health screening, I need to know that my information is safeguarded. In Malta, we have an issue that the practicalities don’t work because everyone does as they like. If the answers I have asked are answered and clear, then we can start a conversation,” they said.

Rapa complained that too many unanswered questions had left him suspicious of what the health authorities would achieve. “What is ridiculous and shows what a rushed job this is, it’s that there was no pilot project. No one changes a system like this without first conducting a pilot project.”