Study hopes to uncover social factors leading to risky sexual behaviour

The health ministry is launching a study to understand how social determinants of Maltese people could influence risky sexual behaviour and the prevalence of HIV, HCV and syphilis in Malta.

The study will determine the prevalence of the sexually transmitted infections among Maltese nationals and residents, based on their personal characteristics and sexual behaviour, such as gender, age, nationality, region, level of education, sexual preference, contraceptive use, as well as number of sexual partners and history of sexually transmitted infections.

Malta’s genito-urinary (GU) clinic at Mater Dei Hospital has experienced a progressive increase in clinic attendances, with over 6,400 persons attending in 2019, 64% of which were male.

So far it is known that clinic attenders in 2018 mainly hailed from the lower-skilled worker demographic.

Similarly, trends in chlamydia, gonorrhoea and syphilis have shown to be progressively increasing over recent years, indicating an urgent need to curb this rising trend. HIV indicators from the World Health Organisation has shown that in 2019 Malta had one of the highest percentages of new HIV diagnoses as compared to other EU/EEA countries.

And recent local statistics related to STIs have shown that the incidence of new HIV cases in Malta has increased by 50% since the 2007 data.

The health ministry has said that the key populations for HIV infection are men who have sex with men and the migrant population which includes both European and Sub-Saharan African migrants, with migrants from central and Eastern European areas comprising the largest group of new cases of HIV.

However, female transmission through heterosexual contact in middle-aged groups comprise another category of the incidence cases diagnosed at later stages of infection.

Malta has made considerable progress with respect to another STI through the launch of the National Strategy for the Elimination of Hepatitis C Virus in April of 2018, which seeks to eliminate the virus as a public health threat from the Maltese islands by 2025.

“Sexual and reproductive health, in particular the spread of sexually transmitted infections and the incidence of unplanned pregnancies, are greatly influenced by social, economic and behavioural factors. The access to services not only depends on the structural factors including the availability of accessible and acceptable services for the user, but also on the individual’s agency to access sexual health services based upon his/her attitudes in relation to sexual health and the services offered,” the health ministry said in its call for researchers.

The ministry said stigma still acts as a significant barrier for individuals to seek help when they suspect they may have been exposed to an STI, including HIV. “This may hold people back from getting tested, acting as a limiting factor to public health efforts to control the spread of such infections. The individual’s attitude and beliefs are largely dependent on the social determinants, which shape sexual risk behaviour and health service usage attitudes throughout the life course.”

Documented links between poverty and fertility show that women’s level of education and family planning policies influence age at marriage and use of contraception. Poorer women tend to marry at a younger age and have lower rates of contraceptive use, and large families are more likely to experience poverty and less likely to recover from poverty than smaller families.

Although emergency contraception has recently been made available as an over-the-counter medication, this still requires a medical prescription for adolescents between the ages of 16-18 years.

Malta’s first National Sexual Health Survey was conducted in 2012, followed up by a National Sexual Health Policy and Strategy. But since then, Malta has undergone marked legislative and societal change with respect to civil liberties, LGBTIQ rights, lowering of the age of sexual consent.

And a recent influx of migrant workers, both lower and higher skilled, has brought its own context of sexual attitudes and behaviours.

Yet despite being promoted as an LGBTIQ friendly country and becoming known as a ‘party’ island that also draws persons who engage in risky sexual behaviours, no update of the national sexual health policy has ever been carried out.