The AIDS Epidemic

In November, I had forecast that the rate of increase of AIDS was such, that in 2004, we will cross the 300 mark in terms of new cases diagnosed. The final tally is in. Sadly, the total number of new cases for 2004 was 311. In 2003, the number of new cases was 242. This means there was a year-on-year increase of 28%. Currently 90% of these newly diagnosed patients are males, with 1/3 being gays. We had a low prevalence rate of HIV in the past, even in the gay community. We do not know the reasons for the sharp increase of HIV in the gay community. An epidemiologist has suggested that this may be linked to the annual predominantly gay party in Sentosa - the Nation Party -which allowed gays from high prevalence societies to fraternize with local gay men, seeding the infection in the local community. However, this is a hypothesis and more research needs to done. The reported new cases are only the tip of the ice-berg. In total, we have more than 2,000 HIV/AIDS patients. But for every AIDS patient we have diagnosed, there are possibly 2 to 4 undiagnosed patients with HIV in Singapore. That means there could be, anywhere between 4,000 to 8,000, undiagnosed HIV patients in Singapore. Last month, there was an alarming report from the US. The AIDS virus has mutated and the new virus is drug-resistant and kills quickly. Even those who are already HIV-positive can get infected by this strain.

Some Measures being Studied

We therefore have to make testing simpler for people at risk. MOH is currently studying the introduction of over-the-counter HIV test kits. These test kits are easy to use because they test the saliva. This will allow those at risk to test themselves. If those with HIV are diagnosed early, they could receive treatment early and hence minimise the development of complications.

Recently we made testing of HIV in pregnant mothers an opt-out option. This increased the overall screening rate from 37% to 77%. As a result of screening, in the last two months we have saved at least one child from getting infected. MOH is studying proposals to make testing of pregnant mothers compulsory so that we can achieve 100% screening.

Legislation on AIDS

Besides gays, the other major risk group are heterosexual men who have casual sex. In many cases, this puts the wife, at risk. Sir, in countries where the AIDS epidemic is full-blown, the majority of AIDS patients are women. This is because it is easier for the infection to move from man to woman than from woman to man. Currently, only 10% of AIDS patients in Singapore are women.

Sir, if we do not act to protect women, many women will get infected and we too will have a situation where women form the majority of AIDS patients. Do we want this to happen? There is a need to balance the right to confidentiality of the AIDS patient with the right to protect those at risk. The current legislation appears to be tilted in favour of the patient and exposes the spouse to the risk of catching AIDS. It also prevents the healthcare system from performing its public health duties. This is one reason why the AIDS epidemic is not coming under control. We need to treat AIDS like any other public health problem. We must give public health workers the tools needed to screen for the infection and contact-trace the infection.