Speech by Minister of State for Health, Dr Amy Khor, at the 8th Singapore AIDS Conference, 17 November 2012

Distinguished Guests,

Ladies and Gentlemen,

Good morning.

1.            I’m pleased to be able to join you at the 8th Singapore AIDS Conference this morning. It has been slightly more than a year since I became the Chairperson of the National HIV/AIDS Policy Committee – and I must say that it has been a fruitful year of learning for me. For our overseas delegates, Singapore’s National HIV Policy Committee (NHPC) brings together representatives from civil society organizations, clinicians, health agencies and several ministries to assist the Ministry of Health on national policies and strategies for HIV prevention, treatment and care. Set up in 2006, the committee regularly reviews the state of the HIV epidemic in Singapore to ensure that our programmes and policies remain relevant.

2.            Over the past year, I’ve met with HIV patients, their caregivers and community stakeholders to better understand the challenges and concerns faced by People Living with HIV, so that we can better serve this community. It has been a steep learning curve, but the work has also been meaningful, as the committee worked tirelessly toward eradicating or at least minimizing the effects of HIV in our community. When the committee re-convened last year, we decided to focus on three areas, which are also in line with this year’s conference theme “Zero new infections, Zero stigma, Zero deaths”.

Our three areas of focus are:  (1) education on preventing HIV infection, (2) early detection and (3) support for people living with HIV and their families.

3.            A year has since gone by, and this is a good opportunity for me to share a little on the epidemiology of HIV in Singapore, what the NHPC has accomplished in each of its priority areas and what we look forward to achieving in the medium term in Singapore.

Epidemiology of HIV in Singapore

4.            Firstly, I am happy to note that we continue to maintain a low level HIV epidemic in Singapore. This means that the HIV prevalence in the general population is less than one per cent. In 2011, the proportion of adults known to be living with HIV among the resident population was 0.12 per cent.

5.            Because of our successful blood safety and antenatal screening programmes, we also continue to have no cases from blood transfusion or mother-to-child transmission. We also have very few cases through intravenous drug abuse.

6.            Singapore’s HIV epidemic is largely driven by sexual transmission. Heterosexual men engaging in casual or commercial sex and Men-who-have-Sex-with-Men (MSM) continue to be our two biggest risk groups. Of the heterosexual males notified with HIV in 2011, seven out of eight of them had more than one regular sexual partner. Almost half had a history of engaging the services of commercial sex workers.  Among MSMs, the HIV prevalence has ranged between 1.6 and 3.1 per cent over the past five years. This means that we also do not have a concentrated epidemic – or a prevalence of more than 5 per cent in specific high-risk groups – unlike some countries in the region.

7.            Worryingly, however, among males, the number of cases through homosexual transmission has increased steadily over the years, similar to the experience of most countries around the world.  In Singapore, there were 195 HIV cases infected through homosexual transmission in 2011. This for the first time surpassed the 184 male cases infected through heterosexual transmission. The trend looks set to continue this year.

8.            We therefore cannot afford to be complacent and we must think of new ways to continually engage high-risk groups and educate them on how to protect themselves from HIV.

Priority 1: Prevention education

9.            Prevention and education remain a key strategy in our fight against HIV in Singapore. We use the ‘ABC’ approach. This is an easy way to remember the key elements of our HIV prevention message.  “ABC” refers to Abstinence, Being faithful and the correct and consistent use of Condoms. The Health Promotion Board (HPB) carries out a variety of targeted education programmes which cater to the needs of the various risk groups in Singapore. For example, for high risk youth, HPB’s programme uses gender-segregated small group settings where vulnerable youth are encouraged to take ownership of their health and adopt protective behaviors.

10.         For MSM, HPB works closely with partners through venue-based outreach as well as innovative use of social media platforms to connect with hard-to-reach MSM populations. As a result, 90 per cent of MSM surveyed online this year knew that the consistent and correct use of condoms could prevent HIV infection. Despite this, only 75 per cent actually used condoms with a casual partner at their last sexual encounter and only 52 per cent used condoms consistently with casual partners over the past six months.

11.         The gulf between being aware of the risk and adopting protective behavior is not unique to MSMs here. Many HIV control programmes around the world are reporting similar ‘condom fatigue’. Though medical management of HIV has improved to the level where HIV is no longer seen as a death sentence, we must ensure that this does not lead to a sense of complacency among high risk groups.

Priority 2: Early Detection

12.         One of our key challenges continues to be the early detection of HIV infections. Every year, about half of the new HIV cases reported are already at a late stage of infection when they were diagnosed. Because of this, one of the HPB’s main messages for high risk groups is the benefits of early and regular HIV screening. This forms the fourth element of our key HIV message: ‘D’ for early detection.

13.         In one post-campaign survey among high risk heterosexual men, 83 per cent knew where to go for an anonymous HIV test. However, risk perception was lacking. Almost all (98 per cent) of those surveyed did not think they were at risk of contracting HIV even though they engaged in high risk activities.

14.         HIV testing is more accessible today. Opt-out HIV testing is available to the general population in all our public hospitals and anonymous test sites are available in seven locations throughout Singapore.  At the end of last year, Action for AIDS launched a mobile testing van that will make anonymous HIV testing even more convenient.

15.         We are happy to see that the MSM community is making use of these enhanced testing avenues to go for more regular testing, and so they are less likely to be diagnosed at a late stage than heterosexuals. This could be one reason for the rising number of MSMs detected with HIV in recent years. We would like to see even more MSMs and other high risk groups similarly testing regularly. Early identification of HIV allows positive individuals to seek early treatment so that they can continue leading productive lives. Knowing their status also means that they can take the necessary actions to protect their partners against being infected, such as by using condoms. 

Priority 3: Support for PLHIV and their families

16.         Stigma against people living with HIV remains a barrier for HIV testing. While we do not condone irresponsible behavior, we must accept people living with HIV as part of our communities.

17.         In 2011, we partnered with local celebrities to spearhead the inaugural “Be positive” campaign to create awareness on HIV and soften the stigma toward the disease. Our latest survey shows that accepting attitudes towards people living with HIV have improved. For example, more people are now willing to share a meal or buy food from a person living with HIV. And since HIV cannot be transmitted through food, I hope the next survey will show that even more people feel this way. When we stop discriminating against people living with HIV, individuals will feel safe to seek testing and treatment as early as possible. Everyone, from leaders to community members, has a part to play in this.

18.         Today, people living with HIV have access to many sources of support. All newly diagnosed patients are provided counseling as part of the Positive Prevention Programme at Tan Tock Seng Hospital’s Communicable Diseases Centre (TTSH CDC). TTSH’s Patient Care Centre also provides part-time work opportunities to patients. Several support groups are available and patients report that sharing their experiences and challenges at these platforms benefits them greatly.

19.         VWOs such as Tzu-Chi Foundation and CARE provide further support such as with living expenses and accommodation. In one of the more recent efforts, the South West Community Development Centre – the district which I’m in charge of as Mayor – is tying up corporate partners with TTSH’s Patient Care Centre to offer job opportunities to HIV patients so that they can continue to contribute to society and support their families.

20.         We will continue to ensure that patients are able to access HIV treatment. Patients can use up to $550 per month from their Medisave to pay for HIV drugs. Since 2010, the cost of these drugs has dropped threefold at the CDC through successful negotiations by CDC.  The number of patients using their Medisave to obtain their HIV drugs at the CDC has more than doubled from an average of 300 patients a year prior to 2010 to over 700 patients last year. Medifund continues to help low-income patients who need treatment. If patients can’t afford the drug through Medisave they can resort to Medifund. Since Medifund was extended to HIV patients in 2010, over 500 patients have benefitted in CDC alone.  

HIV Research

21.         Last month, I announced that MOH has set up the new Communicable Diseases-Public Health Research Grant (CD-PHRG) with a commitment of $15 million over the next five years. As we recognize that HIV is an infectious disease of public health importance, I encourage those working in this field to apply to the CD-PHRG if your studies will support public health risk assessment, intervention or policy formulation.   

Conclusion

22.         The core messages on HIV prevention and early testing – summed up in the acronym ABCD – remain relevant and useful no matter what risk group people belong to. 

23.         Our public education campaigns will continue to stress these proven preventive behaviors. Besides preventing HIV, we can extend acceptance to our family, friends and employees who are HIV positive. These positive attitudes would go a long way in encouraging our loved ones to get early testing and treatment so that they can continue to live productive lives.

24.         While MOH remains committed to the fight against HIV/AIDS, we need the support of the community to effect change.  Platforms such as this conference are important to spread knowledge about HIV and re-energize those working in this field.

25.         On that note, I wish you a fruitful and successful conference.

26.         Thank you.

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