Silent killer still at large

First Published – 08 Dec 2008

Health @ AsiaOne

Silent killer still at large
Have attitudes towards the HIV situation in Singapore changed for the better?
Sat, Nov 29, 2008
The Straits Times

You could call it a silent epidemic. On Nov 8, Senior Minister of State for Foreign Affairs, Dr Balaji Sadasivan, announced that voluntary HIV testing would be offered to all patients above 21 admitted to public hospitals.
The announcement comes as part of a plan to identify more HIV-positive patients at an earlier stage in their condition.
Speaking at the 6th Aids Conference, he cited results from an anonymous survey conducted by the Ministry of Health (MOH) last year that found one in 350 patients discharged from hospitals to be HIV positive but undiagnosed.
“This is not something our hospitals can be proud of,” he said.
He added that the stigma associated with the condition must first be eradicated to get more people to take up
HIV testing.
Fueli2ng this concern over HIV are MOH statistics on the 423 Singapore residents who were newly reported to be HIV positive last year, one-eigth of whom were aged between 20 and 29.

Of this group, only 13 per cent were detected through voluntary screening. The majority (73 per cent) were discovered through HIV testing during the course of some other medical care.
As of the end of last year, 3,483 Singaporeans were reported to be infected with HIV, of which 1,144 have died.
The human immunodeficiency virus, or HIV, infects the cells of the human immune system and destroys or impairs their function.
In its early stages, those with HIV may not show any symptoms.
Aids, or acquired immunodeficiency syndrome, is HIV in its final stages, when sufferers can succumb to the slightest infection.
Through highly active antiretroviral therapy (HAART), those with HIV can use a combination of antiretroviral drugs to delay the onset of Aids.
With proper management of their condition, HIV patients can enjoy lifespans comparable to that of the general population.
Dr Arlene Chua, a visiting consultant with the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital,said that the fear of discrimination can play a large part in people choosing not to have themselves HIV tested.
She cited the lack of anti-discriminatory laws as one reason some patients may choose to seek treatment anonymously overseas.
Another is the lack of subsidies for antiretroviral drugs.
Compared to the generic brand drugs available in Thailand which cost $100 to $200 a month, patients here pay between $800 and $1,000 a month for their medication.
Dr Chua said the combination of these factors explain why some local HIV patients may lack confidence about having their identities and their rights safeguarded over here. While she believes in the importance of knowing one’s HIV status, she said that focusing on testing alone may not be enough.
“If people have trust, they will want to know their HIV status and will want to be tested,” she said.
Ms Ho Lai Peng, principal medical social worker with the CDC who has been counselling HIV and Aids patients since 1995, shared Dr Chua’s sentiments.
She said that 80 to 90 per cent of the patients she sees do not tell their employers about their status for fear of losing their jobs.
Some are even hesitant about telling their friends and family members.
While she tries not to influence her patients’ decisions, she does encourage those who are close to their families to open up.
Patients with strong family support, she said, tend to fare a lot better in managing their condition.
Currently, the CDC manages around 80 per cent of HIV and Aids patients in Singapore.
Through various support programmes, about 50 of its patients are receiving monthly subsidies of about $350 to help pay for medication.
Ms Ho said that one way to make medication more affordable would be to have HIV classified as a chronic disease, thus making patients eligible for subsidised medication.
Despite all the awareness campaigns over the years, she said that the stigma HIV patients face still persists.
In an anonymous online survey of around 400 to 500 students aged 17 to 18, which she conducted a few months ago, about 30 per cent of respondents said they would not work with a person who is HIV-positive.
Another 30 per cent said they were unsure if they would be comfortable with the idea.
“Every year we do educational programmes but it has not translated into changes in attitude or behaviour,” Ms Ho said.
Meanwhile Action for Aids (AFA), a stalwart in the battle against HIV, has been operating an anonymous testing and counselling centre at the Department of Sexually Transmitted Infections Control clinic in Kelantan Lane since 1991.
Between 1999 and 2007, an AFA report said that 125 out of the 6903 tested were found to be HIV positive.
Now in its 20th year, the non-governmental organisation has continually worked towards providing social support for patients and their families, spreading awareness of the conditions to vulnerable groups and has conducted research on HIV and Aids in Singapore.
Dr Roy Chan, AFA’s director, said that the organisation will continue to target high risk groups such as men who seek sex workers and men who have sex with men (MSMs) in their prevention efforts.
He said that while the recent rise in case numbers is not astronomical, it is still of concern. Messages promoting safe sex practices, like the use of condoms, for instance, need to be delivered in an open manner and should be customised to suit the target audience, he added.
Dr Chan cited efforts by public bodies to promote condom use among brothel-based sex workers here as one
example of successful targeted work.
The AFA too has its own outreach programme aimed at providing materials and information on HIV to freelance sex workers.
Other more public messages said Dr Chan, were not as forthright and tended to promote abstinence rather than an open dialogue about sex.
“It’s not a glib remark to say that globalisation and the Internet have encouraged younger people to be more sexual,” he said.
“We can’t stick to messages of abstinence and expect them to be followed.”
On the issue of discrimination, Dr Chan agreed that not much headway has been made.
“I think Singaporeans tend to stigmatise those who do not fit the mould of normal behaviour,” he said.
While putting a “face” to HIV campaigns in Singapore would definitely get people talking, no one has been willing to take on the role in recent times, he added.
It has been 10 years since former flight attendant Paddy Chew revealed publicly that he had Aids, thus putting a human face to the disease. He died in 1999. Since then, no one else has dared come out in the open about the condition.
While Dr Chan is not optimistic about attitudes changing anytime soon, he said: “There’s always hope. Every
day that we continue our work, we get more volunteers and people on our side.”

According to statistics from the Ministry of Health (MOH), 2007 saw 423 new reported HIV or human immunodeficiency virus cases, an 18 per cent increase from the 357 new cases reported in 2006.
At the end of 2007, there had been 3,483 reported cases. Of these, 1,144 had died and 804 were suffering from Aids-related illnesses.
The remaining 1,535 were reported carriers who showed no symptoms.

Some other facts from the 2007 report:
9 cases reported here were of young people between the ages of 10 and 19.
13 per cent of the new cases were detected through voluntary screening.
57 per cent of all cases reported were aged between 30 and 49.
73 per cent were detected from HIV tests carried out during some other form of medical care.
93 per cent of the new cases reported in Singapore were men.
95 per cent were infected through sex, nearly two-thirds (64 per cent) through heterosexual sex.
Facts from WHO
3.6 million Aids sufferers in South-east Asia, according to World Health Organisation (WHO). This ranks it as
the second most HIV endemic region next to sub-Saharan Africa.
33 million people are living with HIV and two million people died of Aids in 2007, according to WHO estimates.

This article was first published in Mind Your Body, The Straits Times on November 27, 2008.