The MSM HIV/STI Prevention Programme
First Published – 13 Mar 2004
Please disseminate the information below (especially about the HIV/STI situation) to your customers, members, and friends.
These matters were discussed at a Stakeholders’ meeting on 13 March 2004, attended by
– 3 CDC/TTSH staff,
– 2 DSC Clinic staff,
– 3 sauna owners/managers,
– 2 MSM internet portal representatives,
– 5 representatives from MSM groups/organizations,
– 1 AFA representative
We hope you can help to alert the community to the seriousness of the situation and encourage the adoption of relevant risk reduction measures.
CAUSE FOR CONCERN
There is a general concern that a continued rise in HIV infection among MSM in Singapore will lead to the authorities closing down MSM establishments (bathhouses in particular, as has been done in the US) and clamping down on MSM activities in general in an effort to control the spread of HIV infection.
Rather than allow the authorities to deal with the situation as they see fit, the community, especially its stakeholders and gatekeepers, should take appropriate measures to effectively deal with the spread of HIV and STI among MSM.
The following are some of the warning signals:
Significant rise in the number of officially reported HIV infections among Singaporean MSM:
| 2000 | 2001 | 2002 | 2003 | |
| No. of MSM | 28 | 42 | 42 | 54 |
| % MSM | 12.4 | 16.1 | 17.9 | 22.3 |
– 1 in 4 males diagnosed in 2003 were MSM
– more cases of newly-infected MSM being diagnosed (rather than those with later-stage HIV infection/AIDS) – an indication that there is a significant amount of unsafe sex currently going on increasing proportion of younger MSM (below 25) being diagnosed with HIV infection, and they seem more nonchalant about being HIV+
– more MSM have been infected in Singapore rather than overseas (fewer are reporting overseas sexual encounters as compared to before) – suggesting that HIV prevalence in Singapore is increasing some of those testing HIV+ did not know how to use a condom correctly
– projections are that the actual number of HIV+ MSM is likely to be 3 times the reported figure (437 in total so far, including deaths)
Alarming rise in number of MSM diagnosed as HIV+ at the AFA Anonymous HIV Testing Centre:
| 2000 | 2001 | 2002 | 2003 | |
| % MSM among those tested | 22.0 | 20.0 | 24.4 | 28.0 |
| No. of HIV+ MSM | 7 | 6 | 10 | 25 |
| % MSM among HIV+ | 46.7 | 31.6 | 66.7 | 67.6 |
More cases of STI seen among MSM at the DSC Clinic (a few are married/divorced/widowed):
| 2001 | 2002 | 2003 | |
| Genital/Anal Warts | 20 | 29 | 45 |
| Gonorrhoea | 22 | 33 | 42 |
| Syphilis | 14 | 21 | 38 |
| NGU | 19 | 17 | 27 |
| ALL STI | 83 | 105 | 163 |
– increase in most age groups from 2001 to 2002 to 2003 (most infections in 20 – 39 age group)
– large number of MSM reported having had anal sex without condoms, as well as oral sex without condoms (compared to those who reported protected anal and oral sex)
– 79.2% of those who had anal sex with regular partners did not use condoms vs. 68.8% of those who had anal sex with casual partners
– figures represent the tip of the iceberg as STI are not notifiable, so those seeking screening/treatment in other clinics are not captured here.
A survey of 1,291 MSM in Singapore conducted by AFA from Nov 02 to Feb 03 also provided a few insights:
– most MSM (41.4%) had 2-5 sexual partners in the previous 3 months, 20.9% had more than 5 partners
– the internet was the most common way of acquiring sexual partners (60.6%), followed by meeting partners at gay saunas (47.8%)
– 29.4% had unprotected receptive anal sex, 28.7% had unprotected insertive anal sex with ‘boyfriends’
– 14.8% had unprotected receptive anal sex, 16.9% had unprotected insertive anal sex with casual partners
– 21.3% had had sex while drunk, 4% after consuming recreational drugs, and 8% after consuming both alcohol and drugs: the last group was more likely to have had unsafe sex
– 40.4% had never been for an HIV test – most of them were unaware about anonymous HIV testing being available
Feedback has been that:
– saunas offer condoms to clients (with different levels of access to condoms in different saunas), but a few do not offer water-based lubricant (citing cost and difficulty finding lube distributors)
– saunas, especially those that do not have condoms freely and readily available (e.g. when clients may have to ask for condoms from the counter), are more likely to be venues for unsafe sex
– unsafe sex may occur both in cubicles as well as in the dark rooms of saunas
– one club has a condom vending machine
– orgies organised in people’s homes, especially those involving recreational drugs, are more likely to involve unsafe sex
– some MSM, especially younger MSM, may be embarrassed about buying or asking for condoms
– some MSM live more for the moment and are not concerned about life-threatening infections, they are quite content to live until their 40s or 50s
– some saunas have had clients stocking up on their condoms or wasting them.
WHAT AFA HAS DONE IN LAST 18 MONTHS:
– survey to investigate knowledge, attitudes, and behaviour
– development and distribution of safer sex postcards (and condoms) in MSM establishments and at events
– setting up of an LGBT resource centre
– running of safer sex workshops
– training of volunteers to handle outreach on the internet (chatrooms, bulletin boards)
– a pilot project offering anonymous HIV testing and testing demonstrations in the saunas
SUGGESTED ADDITIONAL MEASURES
Internet
– developing e-banners, advertisements and messages for the websites, chatrooms , MSM establishments
– developing eye-catching posters for MSM establishments
– developing audio-visual commercials/videos for MSM establishments
– having display stands available for safer sex material
– making condoms available for sale or free distribution in clubs/bars
MSM Saunas
– making condoms and water-based lubricant more accessible in all the saunas
– having handy wrist-pouches for sauna customers to carry condoms and locker keys around
– developing attractive eye-catching posters and stickers for all sauna cubicles
– preparing a set of guidelines (“best practices”) for saunas
General Outreach
– developing smaller (credit card-sized) cards for distribution
– developing more comprehensive material, including booklets, on STI, testing, encouraging protected oral sex, etc.
– using personal testimonies/anecdotes of HIV+ MSM in safer sex material
– Have condom use demonstrations to ensure people use condoms correctly
– organising concerted and coordinated campaign(s) to alert the community to the rising figures for HIV/STI
– continuing with testing ‘road shows’ in MSM establishments and for MSM groups – demonstrating anonymous & rapid HIV testing
– setting up an MSM Youth Outreach project