Speech by Dr Amy Khor at the 10th Singapore AIDS Conference, 3 Dec

Mr Steve Kraus, Director, Regional Support Team for Asia and the Pacific, UNAIDS,
Co-Chairs of the 10^th Singapore AIDS Conference,
Distinguished guests,
Ladies and gentlemen, 

Good morning.

1.        It is my pleasure to join you today at the 10^th Singapore AIDS Conference. We are now into the fourth decade of the HIV/AIDS pandemic, and this biannual conference is an excellent opportunity for us to take stock of our progress in addressing this public health challenge. 

HIV Situation in Singapore

2.        We are fortunate that in Singapore, the prevalence of HIV remains low amongst the general population at 0.2%. We have also seen the levelling off of the number of newly diagnosed HIV infections in Singapore, at around 450 cases per year.

3.        To date, we have not had any cases of HIV transmission from blood transfusion or blood donation, and we also have very few cases arising from intravenous drug use – on average less than 10 a year over the past five years.

4.        Unfortunately, even though we continue to see no cases of mother-to-child transmission in Singapore, this year we picked up two young children who were infected overseas at birth. This illustrates the importance of maintaining vigilance in screening our pregnant patients and treating any infection detected, to prevent transmission.

5.        Sexual activity continues to be the main driver of HIV transmission in Singapore. Our surveys show inconsistent condom use amongst persons who engage in casual sex with multiple sexual partners, and in recent years, we have seen a rising trend in the proportion of infections transmitted among men who have sex with men.

Prevention is Key

6.        This is why we continue to stress the importance of prevention in HIV control. We need to prevent and minimise the number of new infections every year. And we must focus our efforts on those who are most at-risk.

7.         I am pleased to note the strong emphasis on prevention in this year’s conference. This is also the theme of our World AIDS Day Campaign this year, reaching out to the general population with our core ABCD prevention message - Abstinence, Being Faithful, Consistent condom use and Detecting early. Through these efforts, we hope to reinforce the importance of prevention, and educate members of the public on ways to protect against HIV.

8.        There have also been recent developments in the use of anti-HIV medications by uninfected individuals to prevent HIV infection either before exposure (Pre-Exposure Prophylaxis, or PrEP), or after exposure (Post-Exposure Prophylaxis, or PEP). Some studies suggest that this may be a useful supplementary option for individuals who are at high risk of HIV infection. PrEP and PEP are available in Singapore. For instance, PrEP is now available at Tan Tock Seng Hospital, the National University Hospital and some private clinics here. The DSC Clinic at Kelantan Lane also plan to offer PrEP. Individuals who wish to use PrEP/ PEP may consult their doctor on their suitability to be prescribed the drugs. However, it is important to remember that PrEP and PEP are not 100% effective and do not protect against other Sexually Transmitted Infections (STIs). Hence they should not be the first or only option. Neither should PrEP nor PEP lead to complacency in the use of protection. We must remember that there is no substitute for safe and responsible behavior in protecting ourselves and our loved ones from infection.

Early Testing

9.        This brings me to the letter “D” in our prevention campaign – early Detection. We encourage those at-risk of HIV infection to test early, so that any infection can be detected and treated early. Early treatment will help to suppress viruses in the body, and minimise the risk of onward transmission.

10.        In Singapore, we have made HIV testing widely available and readily accessible to members of the public. Today, anyone can get screened for HIV at a polyclinic or GP clinic and receive results within 20 minutes. Anonymous HIV testing is also available for individuals who would like to be tested but prefer not to be identified.

11.        We have seen an expansion in anonymous testing numbers over the years, from 9,000 in 2011 to over 15,000 in 2015. However, despite the increase in testing numbers, we still consistently see over 40% of all new cases being diagnosed with late-stage HIV infection, signifying a delay in early detection. This is a problem, because late diagnosis is associated with poorer clinical outcomes and greater opportunities for HIV transmission. 

Treatment

12.        When detected early, advances in the management of HIV infection have transformed it from a fatal disease to a chronic infection. An infected individual receiving good treatment and care can live almost as long as a person without HIV. Treatment also suppresses the level of virus in the body, often to the extent that the individual is no longer infectious. We therefore need to strengthen the linkage between testing, early detection and access to HIV treatment and care. Cost should not deter persons diagnosed with HIV from accessing treatment.

13.        The Government has helped with treatment cost by allowing Medisave to be used for HIV drugs (up to $550 a month), and by providing a means-tested subsidy for HIV treatment to lower to middle-income patients at public hospitals and institutions. As of March this year, there were more than 8,000 claims from this subsidy scheme, with an average assistance of about $400 per claim. As a final safety net, Medifund helps to cover the cost of treatment for the neediest patients. Taken together, these schemes ensure that those who require treatment are able to access it.

Continuum of Care

14.        From early detection, to starting treatment and remaining on treatment, we can see the importance of all these components in ensuring good outcomes for every person living with HIV, as well as for HIV control as a whole in our population. In this regard, UNAIDS’ 90-90-90 target provides a useful framework for countries to track and evaluate their progress in improving the continuum of care for affected persons. The aim is for 90 percent of all persons living with HIV to know their status, 90 percent of people diagnosed with HIV infection to be on sustained antiretroviral therapy, and of these, 90 percent to have viral suppression. Associate Professor Vernon Lee will elaborate more on the cascade of HIV care in Singapore in his presentation later, but allow me to briefly share Singapore’s progress compared to the 90-90-90 target .

15.        In Singapore, we estimate that about 69% of people living with HIV know their status. This shows that our efforts to encourage early and regular testing amongst those at-risk have made inroads, but it also highlights that we still have some way to go in destigmatising HIV infection and getting more people at-risk to come forward to get tested. With regards to treatment, about 77% of those diagnosed with HIV here are on sustained treatment, and about 82% of those on treatment have suppressed viral loads. These results are encouraging, because they show that we have managed to treat and suppress HIV infection in a significant proportion of patients. We must continue to improve our outcomes moving forward.

16.        On this note, I would like to commend the Organising Committee for the excellent scientific programme that will include presentations and discussions addressing advances in HIV prevention, treatment and control.

17.        I would also like to thank all of you for your hard work and partnership in HIV prevention and care. Your collective efforts have made a positive difference to those living with HIV, and I look forward to your continued support in the years ahead.

18.        I wish you all a fruitful conference, and a meaningful World AIDS Day. 

Thank you.