“It’s been more than six months since news of the HIV database leak surfaced.
The conversation about HIV has grown the past few months. We’ve talked about everything from the misconceptions about the risk of transmission to the stigma towards patients with HIV.
A medical report published in June 2019 by the Saw Swee Hock School of Public Health (SSHSPH) identified four ‘hidden’ groups of people that are most likely to acquire and transmit HIV. They are men who have sex with men, male clients of female sex workers, female sex workers and intravenous drug users.
The number of new yearly HIV infections have remained at about 450 since 2005. Ninety-three percent of the 313 new cases in 2018 were male.
This means that 95% of the new transmissions were acquired through sexual intercourse and that four in 10 of these transmissions occurred between men who have sex with men.
In comparing the numbers from the MOH update and the SSHSPH Hidden Population studies, it’s evident that the population subgroups most at risk are men who have sex with men.
As such, it’s commonly assumed that HIV and Aids do not not affect people outside of this demographic. But the reality is quite different.
A pregnant woman with a HIV infection
I remember seeing Yvonne and her husband for the first time early this year.
She was in her 30s and enthused by her first pregnancy. She recounted that in her first few weeks of pregnancy, she started to feel extremely lethargic all the time, unable to get through her daily chores.
As part of her routine first trimester check at her first gynae visit, a HIV test was done. Yvonne’s HIV results came back positive.
Yvonne and her husband were unable to accept this piece of news, especially since they were monogamous and didn’t have previous sexual partners. They asked for another test as they hoped that the initial results were a fluke.
As we waited for the results of the rapid HIV test, I enquired further and found out that Yvonne had received an intravenous fluid infusion whilst suffering from dysentery during a trip to a developing country a few years ago. Her husband looked stoic as I confirmed the bad news with them.
We discussed the significance of the results and decided to have him rested as well. His results came back negative.
Devastated, he cast a suspicious glance to his wife. But before he said something accusatory, I suggested the possibility that Yvonne got infected during her overseas hospitalisation a few years ago.
We sat in my consultation room for the next hour thinking about what we could do for Yvonne and this pregnancy. We knew that with early treatment and suppression of the viral load, we can prevent the transmission of the virus to her unborn child.
Undetectable HIV viral loads are untransmissible. We also focused on how new medications in the class of Pre Exposure Prophylaxis (PrEP) can protect her husband so that he can continue to have sexual relations with his wife.
PrEP is recommended to those at risk of a HIV infection and is a greater impetus to screen for HIV from ages 15 to 65.
As I arranged for tertiary specialist care for Yvonne, she and her husband mustered hope that with the proper treatment, life can still go on as normally as possible for them. They wished to watch her child grow up free from the burden of this disease.
Reframing how we view HIV in Singapore
The onus has always been on healthcare professionals to safeguard patients’ data, but that’s not to say stigma and fear of people with the condition don’t exist. It doesn’t help that studies have shown that HIV criminalisation is detrimental to HIV prevention as individuals may be deterred from getting tested or even seeking treatment.
The recent ‘HIV laws out of touch with scientific evidence and should be amended’ article by Professor Roy Chan and Associate Professor Rayner Tan reiterates this. Modern science has shown that HIV is no longer the same unknown and scary virus that Mrs Iris Verghese and her colleagues first experienced at Middle Road hospital in 1985.
There is still a growing role for anonymous HIV testing (AHT) in Singapore.
The SSHSPH and MOH reports allow for the planning of healthcare resources by those in charge, but ultimately, it would require a partnership between public and private sectors to triumph in our fight to end HIV in Singapore by 2030.
I hope that with time, new information regarding HIV and afflicted patients will be added to our collective understanding, and that negative perspectives or stigma will be corrected. An updated attitude and approach towards HIV and PLHIV should be instilled.
Being a part of this fight to end HIV always seems daunting alone. But together, we can make it a reality.”
Dr Julian Hong is a resident physician at Dr Tan and Partners Holland Village. Dr Tan & Partners (DTAP clinic) is in support of the initiative to end HIV in Singapore by 2030.