| December 2004
Condom letters in the Straits Times source: Forum page of the Straits Times 24 Nov and 1 Dec 2004
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24 November 2004Published in the Straits Times Forum Plugging use of
condom not the way to go
The nature of sex among MSM, usually casual and often involving multiple partners, is without a doubt high-risk sex. HIV rates in this group have gone up in recent years, and alarmingly so in the past one year, almost doubling that of the previous year. It is interesting to note that HIV rates began to spike in recent times after the authorities relaxed the rules on gay clubs and bars, and gay events were even allowed to be organised in public places like Sentosa. Let us look at some countries where such behaviour is endorsed. The Public Health Agency of Canada recently reported that 'the HIV/Aids epidemic has had a tremendous impact on MSM... As of June 30, 2002, the Centre for Infectious Disease Prevention and Control reported a cumulative total of 18,336 Aids cases. Of the 16,669 adult male Aids cases, 77.6 per cent were attributed to MSM and an additional 5 per cent to the combined group, MSM and injecting drug users'. Canada is not alone. According to a report by the American CDC in 2001, 'studies of sexually transmitted diseases and sexual behaviours suggest a resurgent HIV epidemic among men who have sex with men'. Can aggressive promotion of condom use, rather than the message of abstinence or faithfulness, be the answer? The facts do not support that either. A report by America's National Institute for Health in 2001 put the efficacy of the condom in preventing HIV infection at 85 per cent, and that only if it is used correctly and consistently all the time. It had not been shown to be effective in preventing the transmission of sexually transmitted diseases (STDs) like herpes simplex, syphilis and human papilloma virus, the virus that causes genital warts and is a risk factor in the development of cervical cancer. While condoms may
reduce the risk of infection, they can never eliminate it. The fact
remains: the greater the practice of casual sex, the higher the risk. In Singapore, the drive by AFA to promote condom use, especially in places like bars and lounges where its proper use is often compromised by the influence of alcohol and drugs, is more likely than not to contribute to the spread of sexually transmitted infections, including HIV. Finally, it is a disservice on the part of Dr Koe to suggest that those who engage in homosexual sex are quite incapable of abstaining from casual sex. This is akin to telling smokers that it is impossible for them to quit. While the road to a genuinely healthy lifestyle of abstinence or faithfulness can admittedly be difficult for many, respect for their dignity as human beings, and for their health, demands that we never give up on them. We should instead continue to provide them with correct information, options and support to choose the path that is truly safe. Dr Lee Hew Mun * * * * * |
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1 December 2004 Harm-reduction, not abstinence, way to go I HAVE been following The Straits Times' coverage of the Aids situation in Singapore with interest, particularly Dr Lee Hew Mun's letter, 'Plugging use of condoms not the way to go' (ST, Nov 24). What Dr Lee states is fundamentally true; if gay men stopped having casual sex, we will see a decrease in HIV infections among them. He goes on to link the increase in HIV infections to a loosening of rules surrounding the organising of a number of events and businesses targeted at gay people. The increase can also be linked statistically with a number of other events in Singapore's recent social history. Perhaps the higher figure is associated with the lack of eggs in people's diet because of the recent bird flu. Perhaps it can be linked to the simple fact that more people are getting tested. This is not to say that the situation is not problematic or that as a country our response to it should be casual. Indeed, quite the opposite, the increasing number of infections in the United States and Canada has been attributed, not to aggressive promotion of condom use, as Dr Lee suggests, but rather to a relaxed attitude towards the presence of disease, people with Aids are increasingly invisible, newer drug therapies are making the disease less immediately fatal and life expectancy is going up. The problem here is that people do not think Aids is such a huge problem anymore, even though it is. Back to the question of abstinence promotion as a prevention model: is promoting abstinence the way to go? While it is true that every person that we are able to persuade to abstain from sex entirely will be living with a much reduced risk of contracting any sexually transmitted infection, how do we deal with the hundreds of others that are not persuaded? As an Aids education outreach worker, I know the reality is very much more complicated. What Dr Lee says is true, aggressive promotion of condom use exclusively is not the way to go. It does not serve those who are willing to abstain or maintain one faithful partner, it also does not serve those who refuse to use condoms, and they do exist. Nor does it serve those who simply need more information on safer sex. The way to go is a harm-reduction model, where education can meet people at what they are prepared to do. It isn't such a foreign model to Singapore. Think about the 'Ask for less salt' stickers displayed at hawker centres. There, too, we see people managing the risk associated with their pleasures and desires. People need to be likewise empowered in making their sexual choices. Eugene Tan Siah
Yew * * * * *
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1 December 2004 Condoms may have cut Uganda's HIV rates DR LEE Hew Mun in his letter, 'Plugging use of condom not the way to go' (ST, Nov 24), claims that 'aggressive promotion of condom use in most parts of Africa has proven useless in stemming rising HIV rates. 'Only one country there has bucked the trend - Uganda, where the authorities emphasised the importance of abstinence and faithfulness, and discouraged casual sex, whether homosexual or heterosexual. This policy has resulted in a more than 50 per cent reduction in HIV prevalence in the past 10 years.' This information is at odds with what is stated on the UNAIDS website. According to UNAIDS, the following are two facts pertaining to the HIV situation in Uganda:
In other words, the level of abstinence among Ugandans had not changed significantly, while the use of condoms had risen dramatically. It is debatable to deduce that the emphasis on abstinence is the major factor in the decrease in HIV infections in Uganda. Furthermore, it was stated by UNAIDS that 'studies consistently show that in every population above the age of sexual debut, there are many people who are unable or unwilling to practise abstinence, monogamy and non-penetrative sex'. UNAIDS also states that 'more data is now emerging that demonstrates the effectiveness of condoms in preventing HIV transmission in generalised epidemics'. As stressed by UNAIDS, HIV prevention should be a multi-prong ABC effort that emphasises Abstinence, Being safe (by being faithful and limiting the number of sexual partners one has) and Consistent and Correct use of condoms. If Singapore is serious about its HIV-prevention efforts, it should base its strategy on sound scientific data and evidence. A 'strategy' that stresses only abstinence and being faithful is misguided, unrealistic and dangerous. Harvey Neo Choong Tiong
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Footnotes
Addenda None
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