Professor Roy Chan, President, Action for AIDS Singapore
Professor James Best, Dean, Lee Kong Chian School of Medicine
Professor Leo Yee Sin, Executive Director, National Centre for Infectious Diseases
Distinguished guests
Ladies and gentlemen
Good morning.
It is my pleasure to join you today at the 11th Singapore AIDS Conference. The Singapore AIDS Conference serves as a forum for healthcare providers, public health experts, the community and other stakeholders to come together to share and discuss the latest research and engagement strategies in HIV-related fields. It is an opportunity for us to raise awareness of HIV and take stock of our progress in its prevention and spread.
2. This year is also the 30th anniversary of World AIDS Day, and it is timely that we come together with the rest of the world to pledge to continue the fight against HIV, and to show support for people living with HIV.
SINGAPORE’S PROGRESS ON THE 90-90-90 RESULTS
3. Our efforts have yielded some early results. The number of new HIV cases per year in Singapore has been stable – at about 450 cases yearly since 2008 – even though the population has been steadily growing. Singapore has improved on our “90-90-90”[1] results over the past few years, and is a step closer towards the HIV targets set by the United Nations. Based on results derived from data in 2015[2], similar to previous year’s estimate, 72% of the people living with HIV in Singapore know their status, out of which 89% are on treatment compared to 85% previously. Meanwhile, the proportion of people on treatment who had achieved viral suppression remained high at 94%. It is encouraging that we have improved on the second ‘90’ of linking people living with HIV to treatment.
4. Even though the numbers are encouraging, we can and must do more to help people living with HIV.
EARLY DIAGNOSIS OF HIV
5. The first United Nations target of having at-risk persons know their HIV status is important, and we need to further improve our rates. At-risk persons must know their HIV status. Knowing their HIV status early will help to prevent the spread of the disease, and allow the at-risk persons to seek treatment early. Most importantly, it will also improve their quality of life.
6. The framework for HIV prevention is simple – ‘A’, ‘B’. ‘C’ and ‘D’ - Abstinence, Being faithful, Condom use, and ultimately, Detection. Knowing HIV status relates to ‘D’ – detection. To improve on the first UN target, we need to encourage at-risk persons to be screened for HIV, so that the disease can be detected early. This can be done by increasing the accessibility of testing sites, reducing stigma towards HIV and HIV testing, and providing a supportive environment for people living with HIV.
7. The co-organiser of this event, Action for Aids (AfA), as well as other community partners such as Singapore National Employers Federation (SNEF) have been working to increase access to HIV testing, and to facilitate the creation of a more accepting environment for people living with HIV. Last year, SNEF, together with the Health Promotion Board and Tan Tock Seng Hospital, launched an implementation guide on workplace HIV practices to further strengthen the efforts to create a non-discriminatory work environment for people living with HIV. This implementation guide provides recommendations and case studies to help employers to implement the Guidelines on Managing HIV and Aids in the Workplace, established by SNEF in 1993, and updated in 2011, to better address workplace discrimination against people living with HIV.
8. Since then, SNEF has organised workshops and engaged over 200 employers on the implementation of the guidelines. The guidelines and accompanying implementation guide have been instrumental in educating employers on HIV and dispelling workplace stigma against people living with HIV. Let me cite a real life example to illustrate the impact of the guidelines. To maintain confidentiality, I will use a pseudonym. “Sarah” had been newly diagnosed with HIV, and her employer, concerned that she may have been infected at work, or spread the disease to her colleagues, contacted SNEF to ask if they could terminate “Sarah’s” employment and screen all other employees for HIV. With SNEF’s intervention, “Sarah’s” employer learned that HIV could not be transmitted via casual contact, and that people living with HIV could continue to be productive workers. I’m happy to hear that “Sarah’s” employer has decided to continue employing “Sarah" and is now more aware of managing and supporting workers with HIV.
9. Early detection enables people diagnosed with HIV infection to get started on antiretroviral therapy early. They can then achieve viral load suppression promptly and keep their condition under control. This has been shown to reduce the risk of other infections and complications that may occur in a person with uncontrolled HIV infection. Aside from the benefits to HIV-positive individuals, early intervention in the form of antiretroviral therapy also has positive public health outcomes. There is also growing evidence to show that effective treatment, which results in viral suppression, can prevent the onward transmission of HIV to sexual partners.
DOING MORE THROUGH social and behavioural SCIENCE RESEARCH
10. Besides getting at-risk persons to find out about their HIV status early, we will need to develop greater insights on how we can address HIV. One way we can do so is through social and behavioural science research.
11. HIV is interwoven with individual behaviour and social context, and understanding the socio-behavioural determinants of HIV and incorporating the relevant measures alongside biomedical interventions is crucial in arresting the spread and development of HIV. Socio-behavioural research can help us better understand how to reach out to persons at-risk of, or living with HIV, and target our response to those with the disease. One example of such research is a study by NCID which examined the reasons behind why persons with HIV were skipping their appointments and follow-up care. The study found that lack of time for appointments and scheduling issues were significant barriers to care, and that the use of technology could facilitate adherence to follow-up. Since then, NCID has started offering tele-health services for selected patients, leading to reduced waiting time, and improving patient satisfaction when it comes to providing and receiving HIV outpatient care.
DOING MORE AS A COMMUNITY
12. Addressing HIV is complex and different expertise is required from clinicians, researchers, academics and community based workers. Assistance is needed from the society – employers, friends and families.
13. The ground up initiative – the Community Blueprint to End HIV – as shared by Professor Roy Chan, is also timely. It will give perspective on the community’s efforts and targets to ending HIV in Singapore, and this will allow us to better coordinate and work towards the common goal of addressing the disease. I look forward to hearing AfA’s recommendations when ready.
CLOSING
14. As we make progress to put a stop to HIV, I urge all workers in this field to join in the fight against HIV. Together, we can rally together and work towards ending HIV, and ensure that patients live a fulfilling life. I wish you all a fruitful conference.
Thank you.
[1] As part of the Sustainable Development Goal of ending the AIDS epidemic by 2030, UNAIDS has established three targets to be achieved by 2020. The 90-90-90 target, or the three-part HIV treatment target, includes the following:
By 2020, 90% diagnosed: 90% of all people living with HIV will know their HIV status; 90% on HIV treatment: 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90% suppression: 90% of all people receiving ART will have viral suppression[1].