Her friend -­ let's call her Kathy -­ was just starting to date a new boyfriend, and she had the idea that they should get tested before they, ummm, begin.

So they went to a polyclinic with the intention for getting an HIV test for the both of them.

Things didn't go well. First of all, they were made to wait a long time before they got their turn, and when they saw the doctor on duty, Kathy couldn't quite find the words. She finally used the term "pre-marital check-up".

The doctor then said, oh, if that's what you want, then go an see such and such a nurse over there; she's the one doing pre-marital counseling.

So Kathy and beau waited some more.

When they got to see the nurse, the latter went off on her spiel about congenital diseases like thalassaemia [2] and prescribed a standard set of tests to check for inheritable conditions. If I heard correctly, I think the couple agreed to the tests and gave samples of blood accordingly.

But of course, that was not what they came for, so in order to steer the consultation nearer to the original objective, Kathy started asking about, ummm…. you know… contraception.

"Oh no, you don't want contraception," said the nurse. "You want to have babies."

Clearly, more drastic measures were called for, so Kathy summoned the courage to mention HIV.

"But you're not in the risk groups," the nurse cheerily said. "You two are not homosexual and you're not a sex worker."

"In any case, it costs an extra $25 for an HIV test," she continued, suggesting that it would be foolish to waste money like that.

Thoroughly defeated, Kathy and her boyfriend went away without getting the HIV test done.

Kathy confided in her friend (the one present at the AWARE talk) soon after, who told her to go right back to the polyclinic and ask specifically for the HIV test. But Kathy didn't think it would be possible now; her boyfriend was already reluctant to go the first time, and would not be prepared to wait another 3 hours for a second visit.

* * * * *

The first thing I mentioned in my talk was that people who promote the ABC strategy tend to do it as a moral hierarchy. It tends to go something like this "The best protection is abstinence, if not then be in a faithful relationship. If you can't even do that and insist on sleeping around, then at least use a condom." 

The problem with this kind of message is that it reinforces the idea of sex as dirty and immoral; it stigmatises people who are sexually active outside of marriage. Yet these are the people most in need of safe-sex education; these are the people who most need to be encouraged to come forward for testing. How do we hope to be effective in reaching out when we at the same time slight them for their morals?

The other, and related, point I made in my talk was that if we want people to buy condoms, use condoms, volunteer to be tested, and generally do the right thing even when they have sex, then it is critical that we as a society become less hung up about sex. The more embarrassment people suffer, the harder it is to live up to the aim.

The anecdote that I recorded above illustrates this all too well. Kathy knew what she had to do, but when she got to the polyclinic, she couldn't just say it straight. The only way she way could allude to sex was to use the term "pre-marital", which then sent everyone off on a tangent. As a society, we seem to disapprove of discussing sex except under the rubric of marriage, and this disapproval made it impossible for her to be upfront with her intention at the clinic.

I think it's quite obvious that embarrassment also made it extremely difficult for the boyfriend to go the clinic the first time and impossible to go back a second time. So what has all the social shame (that our policy-makers seem so proud of) achieved?

* * * * *

What was inexcusable was the nurse's dismissal of Kathy's mention of HIV testing. The nurse herself was repeating stereotypes. She did not appear to be aware that of the 280 HIV-positive women Singapore had as at December 2004, 172 (61.4%) were married and 29 more (10.4%) were divorced or separated. They are most unlikely to be homosexual or sex workers, as the nurse indicated as risk groups.

* * * * *

I sent an early draft of this article to Minister of State for Health Balaji Sadasivan. In his reply, he said his ministry will look into the matter raised by Kathy's story, and promised to work to put in place systems that allow people to get tested in an efficient non-embarrassing manner. He acknowledged that people who go to a polyclinic for HIV tests will probably be under some stress and extra effort must be put in to ensure that the entire process is not an unpleasant one.

© Yawning Bread