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"HIV/AIDS prevalence among MSM
Singapore, Straits Times 2006"
By Ong Soh Chin
DESPITE our best intentions, more Singaporeans are being infected with
HIV/Aids every year. And most of them are young, single men.
Here are the facts: In 2003, a total of 242 people were diagnosed with
HIV/Aids, exceeding the 2001 high of 237 new infections. Last year, there
were 317 cases. From January to October this year, there were already 286
new cases.
Of course, compared with other countries, we are not that badly off. But
when it comes to a fatal disease with no cure, there is no room for
complacency.
According to the Ministry of Health, of the 149 Singaporeans detected to be
HIV-infected in the first six months of this year, about 94 per cent were
male. About half of all new cases were patients between 30 and 49 years of
age. And 60 per cent were single.
A total of 22 teenagers have been diagnosed with HIV since the start of the
epidemic here in 1985.
Figures are also rising for other sexually transmitted infections among the
young. In 2001, 256 teens aged between 10 and 19 sought help for sexually
transmitted infections. Last year, the number rose to 678.
For a conservative society which often errs on the side of righteous denial,
this cannot be seen as anything other than a reality check.
If prevention is really better than cure, and in this case, there is no cure
yet, then surely the best way to stop the spread of HIV/Aids is to arm our
young people with the right tools.
When Dr Balaji Sadasivan and his newly formed anti-Aids task force come
together, hopefully, they will decide it is time to forgo coyness and take
'morality' and moral judgments out of the equation.
While our national squeamishness with sex extends across the board, it is
particularly pronounced when it comes to two groups: youths and gay people.
Arming our young
SAYS Ms Joanna Wong, marketing and communications director of MTV Networks
SEA: 'Short of finding a cure for Aids, the best way to fight the disease is
by educating the young. Once people are older, it is harder to change
mindsets.'
Clearly, education is key. But just as clearly, the effective messages are
not getting through, despite good intentions.
While private-sector organisations like MTV are doing their part to spread
the safe-sex message to youths, what they do is only supplemental. The
outreach has to be on a national level for it to be really effective.
In 2002, the Ministry of Education introduced the Growing Years Series,
which addresses sexuality and targets students from upper primary to junior
college levels. Of the universally acknowledged ABC scheme in HIV/Aids
education, where 'A' stands for abstinence, 'B' for being faithful and 'C'
for pro- per condom use, it emphasises abstinence.
But the renewed calls for school curricula to embrace a more realistic form
of sex education, in the form of teaching proper condom use, should not go
unheeded - not unless we want to continue sending our children out into the
world equipped only with abstract pipe dreams as coping tools.
Understandably, some parents may be upset at their children being taught
'how to have sex' in school, even if it is safe sex.
So perhaps one way to get around this awkward impasse is to have an opt-out
scheme where parents can choose to take their children out of such
programmes if they object. This approach will have another effect - it may
nudge parents into assuming responsibility for their children's sexual
safety.
In other words, hopefully, parents who have to actively take their children
out of a school safe-sex programme will realise they have to be the sole
purveyors of proper sex education for them.
The gay community
CORRECT education must also apply to another high-risk group - the gay
community.
While early perceptions of the disease as a purely homo- sexual one have
long been debunked, male homosexuals still have a higher risk of being in-
fected than other groups, said Dr Balaji in an interview with The Straits
Times on Dec 1.
Of the new cases this year, heterosexual transmission accounted for 59 per
cent of infections, homosexual transmission 26 per cent and bisexual
transmission 4 per cent.
If Dr Balaji is right, then we face a conundrum here because homosexual sex
is a crime in Singapore, making it difficult to target education efforts at
the gay community without being seen as 'endorsing' a law-breaking activity.
So, on the one hand, we have spent a lot of time and resources on the
relatively ineffectual abstinence school of thought when it comes to our
young. On the other, we have extended little, if not zero, public outreach
to the gay community.
In March last year, Dr Balaji linked the sharp rise in new Aids cases to
Nation, the popular annual gay party held every National Day on Sentosa.
In 2004, the group Action for Aids (AFA) set up a booth at Nation. It had
prepared safe-sex postcards and condoms for distribution to the estimated
8,000 people who attended the event.
However, says Dr Stuart Koe, the chief executive officer of Fridae.com,
which organised the event, the police stopped AFA from giving out its
materials on the grounds that the postcards and condoms were tantamount to
advocating gay sex, which they said was illegal. They threatened to shut
down the party if AFA did not close its booth immediately.
Nation has since stopped, as has its Christmas instalment, Snow Ball.
Last year and this year, Nation was held in Phuket as a result of the ban in
Singapore. Fridae.com , in collaboration with the Centre for Disease Control
(CDC) Bangkok (the Asian headquarters of the United States' CDC), set up a
24-hour voluntary counselling and testing service for HIV at these two
Nation events. More than 100 people were tested.
As Dr Balaji has correctly noted, Singapore is at the epicentre of an Aids
epidemic, with figures rising in the region. Singaporean men, straight or
gay, travel often and easily to neighbouring countries, putting themselves
at risk when they have unsafe sexual encounters.
So, in truth, stopping gay parties here may not have stopped the infections.
What has happened as a result of the ban, however, is that one avenue for
outreach and education to the community here has been closed and the gay
community has been further stigmatised.
Dr Balaji himself noted that, ideally, the disease should be treated like
any other, with the aim of stopping transmission. But because of stigma and
privacy issues, this has been difficult, not only in Singapore but
worldwide. 'Because all these exceptions were made, HIV was not controlled,'
he said.
He is right. And he is perhaps right in his belief that once normal
public-health principles are exercised, the spread of HIV/Aids can be
controlled. But in reality, this may be difficult, because no matter how one
slices it, HIV/Aids is a unique beast.
It is contagious, it has no cure and it is linked inextricably to homosexual
activity, something which a traditional society cannot comfortably embrace.
To be absolutely brutal, from a health policy point of view, one could even
conclude that keeping infected people alive only increases the chances of
them passing on the virus to others.
Tackle closed minds
EVEN semantics betray society's prejudice. MTV's Ms Wong says: 'The Chinese
name for Aids - ai zhi ping - connotes a disease caused by love and sex.
That perception is always there, regardless of the fact that a baby can get
this 'love disease' from a blood transfusion.'
Since the first HIV case in Singapore was detected in 1985, only one person
has dared to come out as HIV-positive. The late Paddy Chew went public with
his condition in 1998 and eventually died in 1999.
As long as our minds stay closed, even our statistics may be flawed. While
26 per cent of this year's infected are homo- sexuals, that figure only
applies to those who actually admit that they are gay. A closeted gay man
who has contracted HIV through sex with men might say he got the infection
through heterosexual sex instead. Or maybe, the figures just simply show
that more straight men are having unsafe sex than gay men. Who really knows?
When asked about his wish list for the new task force, Dr Koe says that it
should adopt all the CDC guidelines for tackling HIV/Aids and not just one
or two initiatives. It should also include on its committee MSM (or men who
have sex with men but do not necessarily identify themselves as gay) as well
as people living with HIV/Aids.
He adds that there have been numerous studies showing how timely treatment
can not only lead to long and productive lives, but also a cost savings for
the health-care system as people fall sick less. In addition, treatment also
lowers the rate of HIV transmission.
Many of our neighbours, such as Malaysia and Hong Kong, have subsidised HIV
treatment for their communities.
The World Health Organisation and the United Nations have endorsed
guidelines that will lead to universal treatment and care of HIV/Aids for
those who need it by 2010, and Singapore is one of the signatories.
But ultimately, the biggest challenge we face now is closed minds.
Dr Koe says that apart from the stigma, 'there are other factors, such as
the lack of access to care, support and treatment in Singapore that serve as
strong disincentives to being tested in Singapore.
'This means that there is a very large underground epidemic that our
Government can only estimate but will never know until Singaporeans feel
that the pluses outweigh the minuses of getting HIV-tested on home ground.'
sohchin@sph.com.sg
The renewed calls for school curricula to embrace a more realistic form of
sex education, in the form of teaching proper condom use, should not go
unheeded - not unless we want to continue sending our children out into the
world equipped only with abstract pipe dreams as coping tools.
Copyright � 2006 Singapore Press Holdings. All rights reserved. Privacy
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