HIV CASES ON THE RISE IN 2007- MOH urges at-risk groups to go for voluntary testing

In the first 10 months of 2007 (Jan-October), there were a total of 356 reported new HIV cases in Singapore. In comparison, there were 357 HIV cases notified for the whole of 2006. It can be expected that the total number of notified HIV cases in 2007 will exceed that of last year.

Regular HIV testing can help limit the spread of the disease. This is especially crucial for people who engage in risky sexual behaviour.  HIV testing is available in most medical clinics. The identities of persons who come forward for testing and those who are found to be HIV positive will be kept strictly confidential.

To encourage more to come forward for voluntary testing, MOH has since August allowed medical clinics to offer HIV testing using oral-fluid or blood-based rapid HIV test kits. These rapid HIV tests are screening tests that can produce results in approximately 20 minutes. Medical clinics that wish to offer HIV testing with rapid HIV test kits must first participate in an MOH training workshop on the use of these test kits. To date, close to 200 clinics have participated in these and nearly 100 clinics are currently offering HIV testing with rapid HIV test kits.

Anonymous HIV testing using rapid HIV test kits is also available in three sites in Singapore – 2 GP clinics (Anteh Dispensary and Cambridge Clinic) and the Action for AIDS anonymous HIV test site.

Between January and September 2007, a total of 5,967 anonymous HIV tests were carried out at the three sites, compared to a total of 3,416 anonymous HIV tests between July and Dec last year.

As more HIV testing is carried out, we would expect an increasing number of new HIV cases to be notified to MOH. However, this does not necessarily mean that there are more new infections. As people who are infected with HIV may not present with symptoms for several years, people who are newly detected to have HIV may in fact have acquired their infection several years ago.

With HIV testing made more convenient, MOH hopes to see a decrease in the number of people who present in late-stage HIV infection. In the first 6 months of 2007, more than half (55%) of the new cases already had late-stage HIV infection when they were diagnosed, similar to the pattern seen in 2006. This underscores the importance of people who are at risk of HIV infection going for regular HIV testing, as early diagnosis and treatment can help to significantly delay the onset of AIDS and reduce the risk of death.

New cases of HIV infection reported between July through October 2007

Between July and October 2007, another 192 new HIV cases were reported. These are in addition to the 164 cases reported earlier in the first 6 months of 2007. giving a total of 356 cases from Jan to October 2007. The additional new cases are currently undergoing further investigation, and more information on them will be released at a later date.

MOH regularly updates information on new HIV cases on its website. Data for the first 6 months of 2007 is reproduced in Annex A.

How individuals and employers can help prevent HIV

Public education and prevention of new cases of HIV infection is the key to controlling the HIV epidemic in Singapore. Individuals must take responsibility to protect themselves from HIV infection. Those who engage in risky sexual behaviour are strongly encouraged to use condoms to protect themselves from HIV infection and to go for regular HIV testing. Examples of risky sexual behaviour include:

(a) having unprotected sex with someone who is HIV-infected or who is at high risk of being infected with HIV, such as men who have sex with men, and commercial sex workers and their clients; and

(b) having unprotected sex with multiple partners.

As the statistics showed that 90% of newly diagnosed HIV cases are in the economically productive age groups of 20-59 years, MOH strongly encourages employers to adopt a more pro-active role in HIV prevention at the workplace. Suitable HIV/AIDS prevention and education programmes can be introduced at the workplace to reach this target group.

One example is the programme, entitled RESPECT (Rallying Employers to Support the Prevention, Education and Control of STI/HIV/AIDS) which was developed by the Health Promotion Board in 2004. The programme equips working adults with skills to protect themselves from HIV/AIDS, and also seeks to educate them about HIV/AIDS so as to reduce discrimination and stigmatization of people living with HIV/AIDS.

For more information about HIV testing, visit the HPB website at http://www.hpb.gov.sg/aids/page6.htm. For more information about the workplace HIV/AIDS programme, contact the Health Promotion Board at HPB_CDE@hpb.gov.sg, Tel: 6435-3178.

ANNEX A

Characteristics of new cases of HIV infection reported in first 6 months of 2007

Out of the164 Singaporeans detected to be HIV infected in the first six month, about 93% of the new cases detected this year were males and 7% were females.

Sexual transmission remains the main mode of HIV transmission among Singaporeans.  Of the 164 cases reported in the first 6 months of 2007, 155 cases acquired the infection through the sexual route, with heterosexual transmission accounting for 67% of infections, homosexual transmission 24% and bisexual transmission 3%.  Intravenous drug use (4 cases) accounted for 2%.

More than three-quarter (78%) of all new cases reported in the first 6 months of 2007 were aged between 30 to 59 years of age.  Approximately 52% were single, while 32% were married, and 13% were divorced or separated.

In the first 6 months of 2007, more than half (55%) of the new cases already had late-stage HIV infection[1]when they were diagnosed. This was similar to the pattern in the previous year.

Most of the new cases in the first 6 months of 2007 (76%) had their HIV detected when they had HIV testing in the course of some form of medical care. A much smaller proportion were detected as a result of voluntary HIV screening (12%). The rest were detected through contact tracing and other screening. When differentiated by sexual orientation, a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (31% vs 5%).

Characteristics of all HIV infected Singaporeans (as at end June 2007)

The total number of HIV infected Singaporeans as at end-June 2007 is 3,224 (Table 1).  Of these, 1,380 are asymptomatic carriers, 752 have AIDS-related illnesses and 1,092 have died.

Heterosexual transmission has been the most common mode of HIV transmission among Singaporeans since 1991 (Table 2).  Most of these cases contracted the infection through casual sex and sex with prostitutes in Singapore and overseas.

The majority of HIV infected Singaporeans are male with 2,870 cases; 354 are female (Table 3), giving a sex ratio of eight males to one female.  Among the males, 60% were single at the point of diagnosis.  For the females, however, the majority (60%) were married. 

About 83% of HIV cases are Chinese, 10% are Malays and 4% are Indian (Table 4).  The majority of cases (59%) were diagnosed when they were between 30 and 49 years of age (Table 5). Nearly a fifth (17%) of cases were diagnosed when they were between 20 and 29 years of age. 

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

TABLE 1
NUMBER OF SINGAPORE RESIDENTS REPORTED WITH HIV /AIDS
(1985 – JUN 2007)

                  *            per million population

TABLE 2
DISTRIBUTION OF HIV/AIDS - INFECTED SINGAPORE RESIDENTS
BY MODES OF TRANSMISSION
(1985 – JUN 2007)

TABLE 3
HIV/AIDS - INFECTED SINGAPORE RESIDENTS
BY MARITAL STATUS AND SEX
(1985 – JUN 2007)

TABLE 4

HIV/AIDS - INFECTED SINGAPORE RESIDENTS BY ETHNIC GROUP

(1985 – JUN 2007)

TABLE 5
HIV/AIDS - INFECTED SINGAPORE RESIDENTS BY AGE AND SEX
(1985 – JUN 2007)