Speech by Dr Amy Khor, Senior Minister of State for Health, at the 9th Singapore AIDS Conference, 29 Nov 2014

Distinguished guests,

Ladies and Gentlemen,

Good morning.

1.         I am pleased to join you today at the 9^th Singapore AIDS Conference. As Chairperson of the National HIV/AIDS Policy Committee (or NHPC), I am heartened that this biennial conference continues to serve as a platform for those working at the forefront of HIV-related fields to share and discuss the latest research and engagement strategies. It is also an opportunity for us to take stock of our progress to date and chart the way forward in globally managing this preventable disease.

2.         In Singapore, we have much to be thankful for. The HIV prevalence in our general population remains low, at 0.1%. Our blood supply remains safe and we continue to see no cases of HIV transmission from blood transfusion.  With an antenatal screening programme that has been part of our standard care for the past 10 years, we did not see any cases of mother-to-child HIV transmission last year. We also continue to have very few cases of HIV transmission through intravenous drug use.

3.         While these are some reassuring indicators, we must not be complacent. HIV transmission remains a concern for some risk groups. Singapore’s HIV epidemic remains largely driven by sexual transmission. Heterosexual men engaging in casual or commercial sex, and men-who-have-sex-with-men (MSM) are still our two biggest risk groups.

4.         Of the heterosexual males surveyed in 2013, fewer than 3 in 10 who engaged in casual sex reported consistent condom use. Almost 3 in every 10 of those who had casual sex also reported having had sex with a regular partner in the past six months, thereby posing a transmission risk to their partners or wives. Among males, the number of HIV cases through homosexual transmission has increased steadily over the past decade, surpassing heterosexual transmission since 2011. Consistent condom use with casual partners amongst MSM has remained at about 60% since 2010.

5.         Such findings point to how crucial it is for us to engage, educate and empower target groups to be aware of their risks and make informed choices to take charge of their own health.  Coupled with community support and policy initiatives which improve access to testing and treatment, such personal responsibility will remain central to a sustainable and robust HIV/AIDS response in Singapore.   

Prevention & Education

6.         The Health Promotion Board (HPB) promotes the ‘ABCDs’ of HIV prevention amongst these target populations. ‘A’ is for Abstinence , ‘B’ is for Being faithful to one’s partner, ‘C’ is for Consistent and Correct Condom use; and ‘D’ is for early Detection. While these principles broadly apply to everyone, we have emphasised some aspects for certain population segments or risk groups. For instance, abstinence is emphasised amongst youths, while Consistent and Correct Condom use and regular testing for early Detection are the key messages for heterosexual men who engage in commercial sex. 

Early Detection

7.         Early and regular HIV testing is particularly crucial for high risk groups. In the first half of this year, almost half (49%) of all new HIV cases were already at a late stage of infection when they were diagnosed[1]. We must work harder to improve this situation. This is why the Government will maintain, and expand where feasible, the accessibility of HIV testing in Singapore.   

8.         Today, public hospitals offer opt-out HIV testing to all inpatients.  Members of the public can also voluntarily go for a HIV rapid test at more than 60 GP clinics across Singapore and get their screening results within 20 minutes.

9.         While confidential name-based HIV testing is widely available at GP clinics, polyclinics and hospitals, we recognise that there may be individuals who would like to be tested but prefer not to be identified. Anonymous HIV testing hence provides an alternative to conventional HIV testing.

10.       In Singapore, we have seen growing demand for anonymous HIV testing. The total number of anonymous HIV tests increased from about 5,500 tests in 2005 to almost 14,000 tests last year. In response to this rising demand, we expanded the number of anonymous HIV test sites from seven to 10 this year. Spread across the island in various locations, these clinics are convenient for members of the public to discreetly access HIV testing services. Our partners are also doing their part to facilitate anonymous HIV testing for at-risk groups.  Action for AIDS (AfA), for instance, deploys its mobile testing van to various outreach venues to encourage persons at-risk to be tested for HIV on the spot. 

Treatment

11.       By knowing their status early, a HIV-positive person can take measures to prevent further spread of HIV/AIDS. With early diagnosis, he can also access care and treatment earlier. Early detection and treatment benefit both persons living with HIV (PLHIV) and their partners. Studies have shown that treatment involving anti-retroviral (ARV) drugs not only allows PLHIV to lead productive lives, but also decreases the amount of HIV in their body, making them much less likely to pass the virus to others.

12.       Good treatment regimens are available today for PLHIV. Drug costs should also not deter Singaporeans, including the needy, from seeking treatment and sticking to their treatment. Currently, PLHIV can use up to $550 per month from their Medisave to pay for their HIV drugs. And for the most needy patients, Medifund helps to cover the cost of treatment. From September this year, ARV drugs for HIV treatment have also been subsidised for lower to middle-income patients at our public hospitals and institutions, as long as the drugs have been assessed to be clinically necessary and appropriate for treatment. We hope that this will address affordability concerns that may be preventing them from coming forward to be tested for HIV early and to start on treatment early.

Reducing Stigma, Increasing Acceptance

13.       Thestigmatisation of PLHIV also acts as another barrier to discourage those at risk from coming forward to be tested. Our surveys show gradual improvement in accepting attitudes towards PLHIV. Almost 30% of those surveyed in 2012 were willingto either share a meal with or buy food from a PLHIV, as compared to about 20% in 2007. About 2 in 3 of those surveyed in 2012 were willing to work with a colleague who has HIV. While these are encouraging signs, we still have some way to go to raise awareness and public acceptance of PLHIV, which in turn will encourage more to come forward to be tested for HIV early. There is help and support which would especially benefit those who come forward early.  These include counselling for all newly diagnosed patients at Tan Tock Seng Hospital (TTSH) as part of the Positive Prevention Programme at the Communicable Diseases Centre (CDC). Volunteers from Voluntary Welfare Organisations (VWOs) such as AfA also visit patients every week in the ward to offer care and support, while Tzu-Chi Foundation and CARE provide further assistance such as with living expenses and accommodation.

14.       I commend such community-driven efforts, which  assures PLHIV that they are not alone in their struggle. There are others in the community willing to help and walk alongside them in their journey. To actively destigmatise HIV, each of us can do our part by spreading awareness and knowledge about HIV and its prevention.  This is the main thrust of The “Love Me for Who I am” theme of this year’s World AIDS Day campaign. The multi-pronged outreach to enhance awareness and bust HIV myths include English and vernacular radio talk shows, posters, and HIV education packages distributed to 350 workplaces. Through such avenues, we hope to engage and educate the public, including friends and family of PLHIV, on the facts about HIV to engender greater acceptance of PLHIV within our community.

15.       On the NHPC’s part, we will continue to work with stakeholders such as community organisations, companies and other agencies in the public sector on HIV-related issues. Such multi-sectoral engagement is crucial in shaping relevant and effective HIV policies and programmes which take into account stakeholder concerns in mitigating the impact of HIV in Singapore.

Conclusion

16.       On that note, I would like to thank all the NHPC members here for your partnership and hard work. I hope that today’s Conference would not only deepen our knowledge and understanding of HIV issues, but also our commitment towards stemming the disease and helping those with PLHIV. Only by shouldering this collective responsibility can we hone a robust and effective HIV/AIDS response. I wish you all a very fruitful conference.

Thank you. 

[1] CD4+ cell count of less than 200 per cu mm or AIDS-defining opportunistic infections or both.