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     FrontPage Edition: Mon 5 Dec 2005

Impact of HIV epidemic on men, women & children in Singapore



Speech by By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health at Forum on Gender Issues and HIV/AIDS in Southeast Asia: "Trends and Challenges for the 21st Century"

An Excerpt

HIV and Children
In Singapore, since 1985, there have been 25 reported cases of children who acquired the HIV infection from their HIV-positive mothers. HIV infection in babies can now be prevented with early screening of pregnant mothers and treatment of those found HIV infected.
It is sad to note that before 2005, less than 30% of pregnant mothers were screened for HIV. However, since HIV testing was made a standard of care during pregnancy at the end of 2004, for the first nine months of this year, about 14,000 women or 98-99% of women seen for pregnancy at the public hospitals and polyclinics were screened for HIV.
In the private sector, the screening rates are similarly high. So far,11 women were detected with HIV. All have been treated with antiretroviral therapy. Of those who went on to deliver, their babies have so far tested negative for HIV. With antenatal screening, we can eliminate HIV infection in children....
HIV in Men
HIV infection in Singapore is predominantly a male disease with about 90% of new infections occurring in men. There are two high risk groups - gay men and men who have casual sex outside Singapore.
HIV and Gay Men
Although the prevalence of HIV infection among gays in Singapore is many times higher than that of the rest of the adult Singapore population, HIV is less prevalent in the local gay population than in gay populations in many other countries.
In Singapore, 30% of HIV infection occurs in gay men. In the US it is around 68%. In the UK, among those who contracted the HIV infection within the United Kingdom, about 60% were gay. In Singapore, our data suggests that 1 in 25 gay men is positive. In Thailand, 1 in 4 gay men is positive.
The public health challenge for gay men in Singapore is to make sure that gays here do not go down the deadly path taken by their colleagues in Thailand.
Working with gay activists and NGOs
My Ministry has regularly met with gay activists and others with knowledge about the social life of gay men and discussed our AIDS prevention measures with them. Their input has been valuable. We will continue to consult with them and take in their feedback when developing AIDS prevention programs directed at gays.
We realize that AIDS education material will have to be customized for this high risk group. We will work with NGOs like Action for AIDS (AFA) to develop these customized prevention programs. For next year, we have budgeted about a quarter million dollars for this effort.
HIV Self Test Kits
The FDA approved oral fluid based rapid HIV test kit is now available in Singapore. It is a non-invasive, convenient and quick method of testing for HIV without the need for blood taking. The result is known within 20 minutes. In many ways it is like the pregnancy self test kits.
As a pilot project, we are introducing these HIV self test kits at locations where gays tend to socialize. This will empower gay men to know their own HIV status. I believe that once people know their HIV status is positive, they will take precautions to ensure they do not infect others.
HIV and heterosexual men
The second and larger risk group among men is those who visit sex workers abroad. Our HIV prevention program for sex workers in Singapore has been effective and last year no sex worker tested positive for HIV.
However, these men have casual sex with sex workers outside Singapore and so they are at risk. We hope to reach this group of men at their workplace through our recently launched AIDS Business Alliance. This is an alliance between the Ministry businesses and the unions and it is chaired by Dr Wang Kai Yuen, the Member of Parliament for Bukit Timah.
Through the AIDS business alliance, we are bringing to the workplace an AIDS education program that will educate workers on AIDS prevention and fight discrimination against HIV positive workers by teaching workers how to work with their HIV positive coworkers.
HIV and Women
Although less then 10% of new infections occur in women, they are a vulnerable group. It is often women with little or no income who are most at risk. Marriage and the women's own fidelity are not enough to protect them against HIV infection. Most have been infected despite staying faithful to their partner.
Not only are women more susceptible to HIV infection than men, they also bear much of the social burden of this devastating disease. When the infected men fall ill, it is usually the women, who have to care for the sick, manage the households, meet the financial needs and suffer the stigma. When she falls ill, there is no one to look after the children and if she dies, the children become orphans. They are known as AIDS orphans. There are 18 million AIDS orphans in the world. We are starting to have our own AIDS orphans.
These women and children need help. KK Hospital will be setting up a "HIV women and children fund" to help these women and children The public can help by donating to this fund. The cheques can be made to KK Women's and Children's Hospital. We will also protect the identity of these women and children to ensure that they can lead normal lives.
HIV prevention in married women
HIV infection in married women can only be prevented if their husbands behaved differently.
I am told that, very often, the husbands had not intended to infect their wives and were not aware of their HIV positive status. If these men had known of their positive HIV status, they might have acted differently.
MOH is working with GP clinics to make instant anonymous HIV testing available through the use of self testing kits. A person who has exposed himself to the risk of HIV infection will be able to test himself.
The doctor will advise the person on how to self test and the result of the test will be known only to the person being tested. By making HIV testing widely available, we hope fewer women will become infected by their spouses.
Informing spouses
Previously, some wives were not aware of their spouse's HIV status and so they were at risk of the HIV infection. Since July this year, we have informed the wife when the infected husband had not informed her of his positive HIV status.
Over the last 5 months, 41 women have been informed by hand-delivered letters that their partner is infected and that they should go to CDC for testing.
Many of the initiatives I have discussed were launched recently. We will need more time to evaluate their effectiveness. In 2004, there were 311 new cases of HIV infection.
For the first 10 months of this year, there were 198 cases. We project the total number this year to be around 250 cases. In effect, this year we will have achieved a 20% decrease in the number of new cases. This is encouraging but there is much more that we need to do.

Full Text of Speech

Source: News Release 5 Dec 2005

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