The legal framework governing HIV in Singapore is set out in the Infectious Disease Act, which relates to the quarantine and prevention of infectious diseases, originally enacted in 1976 and amended in January 2016. It encompasses five areas of concern regarding people living with HIV in Singapore: counseling requirements, sexual activity, blood donation, protection of identity, and disclosure of status.
The Director of Medical Services may require a person diagnosed with HIV to undergo counseling at a government-recommended healthcare institution, whereby the patient is expected to comply with precautions and safety measures specified during the learning session.
Sexual intercourse (defined as vaginal, anal, oral penile penetration, and the act of cunnilingus on females) is prohibited if a person is aware of his or her HIV-positive status, unless the sexual partner is informed of the risk of contracting HIV prior to the encounter, and has voluntarily agreed to accept this risk. If a person is not aware of his or her HIV status, but has reason to believe that there has been significant exposure risk, the same rule of disclosure applies, otherwise he or she would need an HIV-negative test prior to the sexual act, or should take reasonable precautions to reduce risk of transmission. One of these three requirements must be fulfilled.
People living with HIV are not allowed to donate blood at any blood bank in Singapore, nor participate in any activity that is likely to transmit or spread AIDS or HIV infection to another person.
The duty of confidentiality is limited to persons in performance or exercise of his/her functions or duties under this Act i.e., medical practitioners, health care workers, government authorities in the enforcing control of infectious diseases in Singapore. Disclosure of another person’s HIV-reactive status while performing such functions is considered an offense, except in the following cases:
- when the person with HIV has consented to disclosure of his or her status
- when the person is providing information to a police officer concerning commission of or the intention of any other person to commit offence punishable under the Penal Code
- when ordered to do so by a court
- when providing information to the healthcare worker in charge of treatment or counseling
- when a blood, organ, semen, or breast milk bank has received donations from the person with HIV
- for anonymous statistical and epidemiologic reports
- to the sexual assault victims
- to the Controller of Immigration for the purposes of the Immigration Act
- to the next-of-kin, upon death of person with HIV
- to person/s deemed applicable by the Director of Health Services, in the interest of public health
- upon authorization by the Minister of Health for the purposes of public health or public safety
The Director of Health Services has the authority to disclose any information related to a person whom he reasonably believes to be infected with HIV to a healthcare worker or a first responder who has a risk of exposure. In relation to this, a medical practitioner may disclose information about the person to the spouse, former spouse, or other sexual contacts. This disclosure should be done if medically appropriate, upon determination of a significant transmission risk, and after counseling the person with HIV regarding the need to disclose and the intent to notify potentially exposed people if he himself would not do so. If the healthcare professional is unable to inform the person living with HIV regarding the need to disclose to contacts, the Director may waive such requirements if he deems it medically appropriate and that there exists a significant risk of transmission.
The respective fines and prison terms for respective offences under the Infectious Disease Act are stated below. (Table 1)
|FINE NOT EXCEEDING ($) AND/OR||PRISON TERM NOT EXCEEDING|
|Counseling, precautions, safety measures||10,000||2 years|
|Sexual activity||50,000||10 years|
|Blood donation||50,000||10 years|
|Protection of identity||10,000||3 months|
|Disclosure to contacts||10,000||3 months|
|Table 1. Penalties for Offences under the Infectious Disease Act|
When someone undergoes HIV testing in Singapore, all doctors and laboratory staff are required to inform the ministry of a confirmed case within 72 hours of diagnosis.
Anonymous testing clinics are exempted from this mandate as they do not require provision of personal identifying data or contact details. Instead, a receipt with a number is assigned to the test which allows the person being tested to receive the test results.
No personal particulars are recorded, even with positive results of the HIV tests. However, during treatment, patient registration with the Ministry of Health is mandatory, and contact tracing may be done by the health officials.
Anonymous testing is done at the following sites approved by the Ministry of Health:
- Action For AIDS Anonymous Test Site
- Anteh Dispensary
- Cambridge Clinic
- Doctor Jay Medical Centre
- Dr Soh Family Clinic
- Dr Tan & Partners
- M Lam Clinic
- Doctors Clinic & Surgery
- Kensington Family Clinic
- Q&M Medical & Aesthetic Clinic (Tampines Central) Pte. Ltd.
Laws also apply to foreigners living and working in Singapore. Being HIV positive will classify a foreigner as a prohibited immigrant. The ban on HIV-positive foreigners entering on short-term visit passes was lifted on 1 April 2016. Tourists or short term visitors are not required to undergo an HIV test. HIV testing is usually required for applying for a work pass, long term visit pass, employment pass, or permanent residence. Those who are found to be HIV-positive will not be granted passes.
- Infectious Diseases Act. Singapore Government. Available at http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=8e9f623a-e528-418d-94b6-ad6b09bf3486;page=0;query=DocId%3A5e69eb8c-5499-4f83-b096-9747cd9f1fa8%20Depth%3A0%20Status%3Ainforce;rec=0#pr22-he. Accessed 12 October 2016.
- Notification of Infectious Diseases (Exemption). Regulations 2015 Arrangement of Regulations. Available at http://statutes.agc.gov.sg/aol/download/0/0/pdf/binaryFile/pdfFile.pdf?CompId:b5fe9508-6982-4665-aff2-df2803f5969b. Accessed 12 October 2016.
- Anonymous Testing. Health Promotion Board. Available at https://www.hpb.gov.sg/HOPPortal/health-article/6368. Accessed 12 October 2016.
- Work passes and permits. Ministry of Manpower. Available at http://www.mom.gov.sg/passes-and-permits/work-permit-for-foreign-worker/sector-specific-rules/medical-examination. Accessed 12 October 2016.
- Lim YH. Ban on entry into Singapore eased for foreigners with HIV. Available at http://www.straitstimes.com/singapore/ban-on-entry-into-singapore-eased-for-foreigners-with-hiv. Accessed 12 October 2016.