Last year, 422 people were diagnosed as HIV-positive in
Singapore, an 18 percent increase over the figure for 2006. As you can see
from this graph, annual new infections have more than doubled in ten
years; in fact, the increase is accelerating.
Almost all HIV infections occurred through sexual transmission, as this
This next table shows how men continue to outnumber women by
striking, however, is the fact that in 2007, nine teenagers (6 boys and 3
girls) were found infected with HIV.
Most Singaporeans do not conceive of Singapore as a hotspot for
disease; perhaps we too often buy into the notion that we're a clean and
But when it comes to HIV, we are a moderate hot spot.
situation is not as bad as in Thailand, Myanmar, Cambodia and Vietnam, but
in three of these countries, things are actually improving. As UNAIDS said
in its most recent report, "the epidemics in Myanmar, Thailand and, most
profoundly, Cambodia, all show declines in HIV
Singapore and Vietnam are the opposite, experiencing increases.
Singapore looks even worse if we compare it to countries with similar
wealth and effective governmental reach.
Hong Kong reported 414 new cases in 2007, an 11 percent increase over
2006, figures that are marginally lower than ours. But Hong Kong has
nearly twice as many people as Singapore. 
Australia (population about 20 million) saw 960 new infections in
2006 , about 2-and-a-half times our 2006
figure. But it has 5 times our population.
In Taiwan, "the 2,942 new HIV infection cases in 2006 represented
a drop of 457 cases from the 3,399 cases in 2005, reversing a twenty-year
growth trend," according to the BiotechEast website .
Its figure of 2,942 is about 9 times our 2006 figure, when the island has
about 6 times our population. So overall, Taiwan's trend is worse.
However, about 60 percent of new infections in Taiwan come from injecting drug use, only about 40 percent comes from sex. Thus, in terms
of sexual transmission, Singapore's figures are much worse.
What are we doing about it?
Same old, same old.
There is still a great reluctance to
bring sex out of the shadows, hence high-profile campaigns to normalise
the use of condoms are not allowed. On the other hand, Christian crazies
are permitted to write to the newspapers scaring everybody away from
condoms, with the false statistic that it has a 10 percent failure rate,
when the truth is that studies have shown the failure rate to be
negligible. See box at right.
Some of these letter writers claim to be
doctors, and I have often wondered how long we have to wait before the
Singapore Medical Association takes an interest in such unprofessional
conduct by one or more of its own and considers disciplinary action.
There is still no safer sex campaign
targetted at gay men with any meaningful message. In fact, the Health
Ministry has an unwritten rule not to be associated with any campaign
targetted at the gay community, perhaps because it is afraid of Wong Kan
Seng's Home Ministry scolding them for "promoting
homosexuality", which as you know, is still illegal in Singapore.
For heterosexuals who enjoy sex, there is
no meaningful campaign either. What campaign there is, is always done in a
furtive manner, like handing people a leaflet or condom very quietly,
which only reinforces the unspeakability and stigma of
"promiscuity". As the past 25 years' worth of literature tells
us, cloaking the subject with shame is a serious barrier to effective
This poster would be far
too explicit to be allowed in public view in Singapore. The
people in power think that (a) it would offend the public with its near
obscenity and (b) it would encourage people to have casual sex.
What is left? Abstinence campaigns, which
study after study has shown is no strategy at all when it comes to
fighting Aids. See salmon-coloured box below. Worse: the abstinence campaigns are mostly left to Christian
fundamentalists, who in the course of it cocoon the entire subject of sex
with guilt and disapproval.
But what's wrong with abstinence? Surely
you can't get infected if you abstain from sex? That's true. For you. What
I mean is that telling other people to abstain doesn't work, because people will
not listen to you, especially if people sense that you're preaching a
religion at the same time. Abstinence is not a strategy.
* * * * *
Constrained as the government is by its ultra-conservative aversion to openly talking about sex, condoms and
homosexuality, it reaches for its usual toolkit Ė punitive measures.
In announcing the 2007 data, the Ministry
of Health also stressed that,
It is an offence under the Infectious
Diseases Act for persons who know that they are infected with HIV not to
inform their sex partners of their HIV status before sexual intercourse.
When the Infectious Diseases (Amendment)
Act 2008 comes into force, a person who has reason to believe that he has,
or has been exposed to a significant risk of contracting, HIV/AIDS must
take reasonable precautions to protect his sexual partner, such as by
using condoms, even if he is ignorant of his HIV positive status.
Alternatively, he can go for a HIV test to confirm that he is
HIV-negative. Otherwise, he must inform his partner of the risk of
contracting HIV from him, leaving the partner to voluntarily accept the
risk, if he or she so wishes.
In simple terms, it will be an offence to
have unprotected sex with someone if you are not sure that you're free
from the virus.
This law is not without justification.
You should use your common sense and not put other people at risk, if you
have reason to believe that there is risk. However, in practice, there
will be problems:
- What in the minds of ordinary people (as
opposed to legal experts who draft laws) would constitute "reason to
- Wouldn't people still feel that they'll
never be caught? "It won't happen to me" is a very common
- In order to ensure they're not traceable,
wouldn't the law then nudge people towards anonymous, casual sex?
Basically, punitive actions cannot have
much effect in matters of intimate private behaviour, and to expect a law
like this to make much difference is unrealistic. Yet our government seems
to prefer the punitive route, perhaps because it's the path of least
resistance. There are well-trodden paths in halting the epidemic, with
good results in other countries, except that the sex-phobia and moralism
of this government will not allow us to take these paths.
Instead, it is using punitive action as a
substitute for doing nothing else. I'll wager that the infection rate
will continue to rise.
© Yawning Bread
failure rate" is false
Check out this website,
which unlike so many others, is not associated with the fanatic
anti-sex religious rightwing:
It tells you that "Condom
failure rate" as an expression is "often imprecisely
used to refer to a percentage of women who become pregnant over
the course of a year in which they reported using condoms as
their primary method of birth control, even if they didnít use
condoms every time they had sex."
"10% failure rate"
means simply that one in ten of these women, who had sex
numerous times through an entire year, sometimes with condom,
sometimes not, found themselves pregnant.
What sort of statistic is that?
In contrast, studies with
couples, one of whom was HIV-positive and the other HIV-negative
found that condoms protected the HIV-negative partner very
effectively. "Among those who used condoms consistently,
there were 0, 1.1, and 1.0 seroconversion per 100-person
years" in the three studies respectively.
That is, if 100 HIV-negative
partners had sex with their HIV-positive partners many times
over a course of one year, on average, only 1 among that 100
would be found to have been exposed to the virus.
If we assume that those 100
partners had sex twice a week, or 100 times a year, then there
would have been 10,000 intercourse events. On average, only 1
such event resulted in the transfer of the virus to the partner.
That, surely, is not what you would call a 10 percent failure
rate, is it?
The caveat is that you need to
use the condom correctly. That's the easy part actually. People
can be taught that, and through practice get very good at it,
even in the dark.
The only thing is that to teach
it, we need to be relaxed about talking about sex, demonstrating
how it's done, and also be uninhibited about buying and handling
Singapore seems to be determined
to do the opposite. By glorifying abstinence, we cast sex into
shame and embarrassment. So if people don't know how to use a
condom properly, whose fault is it?
|Do abstinence programs work?
paper by Douglas Kirby for the National Campaign to Prevent
Teen Pregnancy examines critically claims made by Robert Rector
of the Heritage Foundation that "abstinence education
programs for youth have been proven to be effective in reducing
early sexual activity". The Heritage report identified ten
studies it said demonstrated that abstinence-only programs can
reduce sexual activity among youth.
Kirby cautioned that in this area
of research, many studies "are not based on generally
accepted standards of good research, and therefore little can be
learned from these studies about the impact of these programs on
When he subjected the ten studies
cited by Heritage to vetting for their design, he found serious
deficiencies. In conclusion, Kirby wrote: "Of the ten
studies identified by the Heritage Foundation paper as providing
proof that their respective programs reduced early sexual
activity, nine of them failed to provide credible evidence ...
that they delayed the initiation of sex or reduced the frequency
"One of the studies suggests
that the program, Not Me, Not Now, may have delayed the
initiation of sex among youth 15 and younger, but not among
those 17 and younger."