On 9 March 2005, Senior Minister of State for Health, Balaji Sadasivan,
spoke in Parliament during the debate regarding the Health Ministry's
budget. He outlined some of the issues that he was working on, among which
was the rising rate of HIV infection in Singapore.
He told the House that in 2004, there
were 311 new cases of HIV-positives. Compared to the 242 new cases found
in 2003, there was a year-on-year increase of 28%. No one can deny that
this is quite a leap and cause for concern.
He added that in 2004, 90% of new cases
were male, "with 1/3 being gays."
He went on to qualify these figures by
saying that "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." In other words, these
figures are only indicative of the situation in Singapore, not a complete
picture.
Unfortunately, he then clouded the
picture further by speculating that "gays
from high prevalence societies" were coming to "fraternize with local gay men, seeding
the infection in the local community." The source of this speculation
was an un-named epidemiologist who whispered into his ear that this could
be linked to the Nation party organised annually (so far) by Fridae.com.
Even though Balaji added that this was
only a hypothesis and more research was needed, the damage was done.
Why his comment is
counter-productive
There are many possible hypotheses for
HIV transmission, and given the multi-factorial nature of most epidemics,
almost surely more than one hypothesis can be found to have some truth.
Yet the minister focussed on just one
hypothesis, without providing any data to support why he thought it more
likely than others, without even naming the epidemiologist who first
suggested the idea to him thereby permitting the public to assess his
credentials.
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The damaging effect of focussing only on
this hypothesis is four-fold:
- Immediately, one should be able to see
that what connection there might be can only be indirect. If there is
truth to the hypothesis, what exactly about these parties brought on
transmission? By not being specific about the mechanism and other more
precise factors, the minister left everybody with the vague notion
that "gay parties" is a pestilence and reinforced the stigma
associated with "gay".
- It de-emphasises other factors, such
as the reach and effectiveness of the safe-sex message. It takes the
spotlight away from the government's own failure to do its part. For
decades, the government has been extremely reluctant to address gay
men and gay sex in realistic ways, for fear of breaching its
moralistic stance of not condoning, not promoting homosexuality. It
has refused funding for campaigns that spoke of anything other than
the abstinence message (which is well known to be quite useless). It
has continued to criminalise homosexual sex, and continued to send out
homophobic signals (e.g. through censorship policies and the refusal
to register People Like Us), thus alienating itself from the gay
community. It should hardly be surprised that its public health
messages are ignored as a result of this chasm of distrust. Focussing
on "gay parties" merely removes the spotlight from these
other factors, thus avoiding corrective action in these areas.
- It moves the focus away from local
transmission to foreigners as a source of infection. This is dangerous
as it lulls everyone into complacency about the risk of unprotected
sex among locals.
- By making such a headline-grabbing
hypothesis about "gay parties", it moves the focus away from
heterosexual transmission. It lulls heterosexuals into thinking that
since they are not gay, they are not at risk.
To be fair, the minister did spend at
least equal time talking about heterosexual transmission of HIV [1], but what he said there had much less
sound-bite advantage. See also the next article Party AIDS: what the
newspapers said.
Focus needed on drug use, not gay
parties
There are some disturbing
findings from a San Francisco study (see boxes at right) that links drug
use at circuit parties with risky sexual behaviour. But circuit parties
don't have to be associated with drug use. Another
report [4] revealed that drug use at European
circuit parties is much lower.
From this http://www.lifeormeth.com/circuitparties
site,
Enlightened Americans visiting the
uplifting, house music-filled and still largely crystal-free London club
scene often remark, "Why can't our clubs be like yours?"
It is a well-known fact that being high
on drugs clouds one's judgment and leads to more risk-taking behaviour,
and this may be the direct link, not the parties themselves. If so, then
the remedy must be in controlling drug use and educating people about how
stupid drug-taking is, not a shotgun approach of blaming parties, gay or
otherwise.
If we shy away from specifically
addressing drug use, even if there are no parties around, people will
still mix drugs and sex. The non-governmental Action for AIDS is
well aware that there is a developing trend of organising private house
parties with such themes, (as for the Health Ministry, I doubt if they
even want to know anything about subcultures).
The minister's comment about gay parties
and foreigners thus stops too far short of what is needed, and is likely
therefore to make people think that banning gay parties is all that is
required to solve the problem.
Instead, we're stuck arguing about
gay parties
When people saw the causative gap between
gay parties and infection, they started writing emails to the minister,
telling him he was wrong to focus on that. Ryan Wong did just that on 11
March 2005, with a copy sent to People Like Us.
He wrote:
Pinpointing a single event as the key factor in a general trend, without sufficient research, is simplistic and unscientific. Even if we were
to take the claim as true, can an entire year's worth of HIV infections realistically stem from just a matter of a few days? A
claim that holds no water should not be brandished easily in parliament!
He pointed out data from Action for AIDS'
website
Secondly, based on data from Action for Aids' Anonymous HIV Testing and Counselling Centre, HIV prevalence, or infection rates, among MSM clients only went up from 3.5% in 2003 to 4.3% in 2004, having accounted for the 68% increase in number of MSM clients screened.
(Raw data of HIV infection is meaningless until it is analysed against total number of patients/clients screened) This hardly shows a sharp rise, bar the official reported figures from MOH being wildly different from anonymous data from
AfA.
To this, Balaji replied,
3.5% TO 4.3% is a year on year increase in prevalence rate of 22%. In 2003, 1 in 28 MSM is HIV+. In 2004, It is 1 in 23 MSM is HIV+. 2005?
(To his credit, Balaji seems to reply
to virtually every email sent to him!)
Balaji read from emails such as Wong's a
tendency to deny the existence of the problem. He tries hard to convince
people that the threat is real and growing. Alas, in so doing, he began to
draw conclusions from very poorly controlled data, which then compounded
the disbelief.
You see, the data is from an anonymous
testing site. The base is not a controlled sample of the general
population, but a self-selecting sample of people who choose to walk in to
the testing site. There can be a million questions about what the data
represents, for example:
- Are heterosexuals as likely to walk
into the testing site as homosexuals? If not, won't we be
disproportionately picking up more cases from homosexuals?
- We know that the two most vulnerable
groups are MSMs (Men who have sex with men -- and many of them do not
identify as gay) and heterosexual males who go abroad for casual sex.
Often the latter category are non-English-speaking working-class men.
How many of them even come for testing? How many of them even know
about anonymous testing?
- In trying to compute rates of
infection, in trying to compare rates of one group with another, there
must be some consistency in the sample bases. A simple factoid must
give us pause: there was a 68% increase in the number of MSMs screened
in 2004 compared to 2003. Thus, there appears to be a surge in
awareness, and in gay men's faith in AfA's pledge of confidentiality.
With a huge increase in testing of MSMs, of course we will find lots
of new cases, but are these new infections, or old infections newly
discovered?
Yet, the minister, in his reply to Ryan
Wong, calculates rates of infection from such data, and compares the rates
from one year to the next.
We shouldn't fault the minister for his
earnestness in trying to get people to understand that there is a problem,
but he hurts his own cause (and ours) if he uses such faulty data and
logically-challenged computations in trying to make his case. People then
invest lots of effort arguing over the numbers rather than address the
real issue, and gay men get another excuse to say the government is
motivated by underlying homophobia when they see a minister make a claim
that isn't supported by the facts.
Let's cut to the chase
Decades of official antipathy to the gay
and lesbian minority is now coming home to roost. Here is a minister that,
we can assume, means well. Here is a problem that no reasonable person can
deny exists and is growing.
Yet at this juncture, when an urgent task
awaits us, governmental bodies have neither reliable data nor any insight
into the clubbing subcultures, as a result of years of neglect and
exclusion.
On the other side, there is such a high
level of suspicion among gay people of the government's motives, that
every statement from the government is read as another underhand attempt
to discriminate against and stigmatise gays and lesbians.
People Like Us, in their recent
statement, noted that the government won't be able even to begin to
address the HIV problem, unless it first sweeps away its disrepute among
gay people. A good demonstration of sincerity would be decriminalisation. 
© Yawning Bread
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| Drug use is a better predictor
of unsafe sexual practices than attendance at circuit parties
A study by
Colfax et al, published in the 1 December 2001 issue of the
Journal of Acquired Immune Deficiency Syndromes [2] found that
increased drug use at circuit parties was linked to risky sexual
behaviour, rather than attendance at parties itself.
Key sentences from the abstract
of the study:
Context: HIV risk behavior among urban gay/bisexual men has recently increased.
High-risk sexual activity and drug use may be particularly high during circuit party
(CP) weekends, during which gay/bisexual men congregate for social activities and
dancing.
Objectives: To compare prevalence of risk behaviors during CP weekends with those
during non-CP weekends.
Design: Cross-sectional study.
Participants: 295 gay/bisexual men from the San Francisco Bay Area.
Main Outcome Measures: Drug use and sexual risk behavior during a San Francisco CP
weekend, a CP weekend held in another geographic area (distant weekends), and two
non-CP weekends.
Results: Unprotected anal sex with partners of unknown or opposite HIV serostatus was most prevalent during distant CP weekends,
reported by 21% of HIV-positive and 9% of HIV-negative participants. In multivariate
analysis, predictors of unprotected anal sex with opposite or unknown HIV serostatus
partners included being HIV-positive, and weekend use of crystal
methamphetamines, sildenafil, and amyl nitrites..
Conclusions: Prevalence of high-risk activity during these weekends suggests
significant potential for HIV transmission in this population. Public health programs
in communities hosting CPs should aim to reduce rates of drug use and sexual risk
behavior among CP participants, especially HIV-positive men.
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| A more-layman-friendly summary
[3] of the findings could be found in the rense.com website.
here is what it says:
Gay Men Said To Take AIDS Risks At 'Circuit Parties'
By Merritt McKinney 12-27-1
NEW YORK (Reuters Health) - Gay men are more likely to use recreational drugs and
have risky sex when they attend weekend dance events called "circuit parties'' far
from home, study results indicate.
The findings suggest a need for special HIV prevention strategies that are targeted
toward men who attend circuit parties, according to the study's authors.
"Circuit parties are an important and often positive influence on the gay
community,'' Dr. Grant N. Colfax of the San Francisco Department of Public Health,
told Reuters Health.
"The point of the article was not to demonize them,'' according to Colfax, the lead
author of the study published in the December 1st issue of the Journal of Acquired
Immune Deficiency Syndromes.
He noted that after taking into account drug use, attendance at circuit parties
itself was not linked to high-risk sexual behavior.
But, Colfax said, "a substantial proportion of circuit-party participants report
high-risk HIV-transmitting behaviors, often in relation to substance abuse.''
He and his colleagues surveyed nearly 300 gay and bisexual men in the San Francisco
area. The men answered questions about their drug use and sexual activity during the
weekend of a circuit party in San Francisco, an out-of-town circuit party weekend,
and two weekends spent in San Francisco without attending a circuit party.
Most of the men reported using at least one recreational drug when attending an
out-of-town circuit party, Colfax and his colleagues report, with 80% taking Ecstasy,
66% taking ketamine, 43% crystal methamphetamines, 29% the so-called ''liquid
Ecstasy'' GHB, 14% taking the impotence drug Viagra, and 12% taking amyl nitrates,
also known as "poppers.''
At San Francisco circuit parties, however, the men used certain drugs, including
ketamine and crystal meth, less frequently than when out of town. And they were
significantly less likely to use drugs -- with the exception of
alcohol -- during weekends in San Francisco when they went to a dance club instead of a circuit party.
On weekends when men did not go out to a club or a party, most did not use any drugs,
the researchers found.
As was the case for drug use, risky sex was most common at out-of-town circuit
parties, where 21% of HIV-positive men and 9% of HIV-negative men had anal sex
without a condom with a partner whose HIV status was unknown or different from their
own.
Colfax's team suggests several possible reasons why men are more likely to have risky
sex at out-of-town circuit parties. Increased drug use may contribute, as may the
anonymity possible at an out-of-town party. In addition, the availability of new
sexual partners at an out-of-town party, as well as an absence of regular partners,
may lead some men to have unsafe sex, the authors report.
"There needs to be a greater focus within the public health community on the high
prevalence of club drug use in relation to high-risk sexual behavior,'' according to
Colfax.
And since Viagra was frequently used by men at circuit parties, "physicians should
provide safer sex messages'' whenever prescribing the drug, he noted.
SOURCE: Journal of Acquired Immune Deficiency Syndromes 2001;28:373-379.
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With thanks to Clarence Singham
for links and information about
these studies |
