4th Singapore Aids Conference

27 Nov 2004

By Dr Balaji Sadasivan, Senior Minister Of State For Information,Communications And The Arts and Health

Venue: Suntec Singapore International Convention and Exhibition Centre

SPEECH BY DR BALAJI SADASIVAN, SENIOR MINISTER OF STATE, MINSTRY OF INFORMATION, COMMUNICATIONS AND THE ARTS & MINISTRY OF HEALTH  AT THE 4^TH SINGAPORE AIDS CONFERENCE ON SATURDAY, 27 NOV 2004 AT SUNTEC SINGAPORE INTERNATIONAL CONVENTION & EXHIBITION CENTRE

A/Prof Roy Chan, Chairman of the organising committee,

Dr Lee Cheng Chuan, Co-Chairman of the organising committee,

Distinguished Guests,

Ladies and Gentleman,

Friends and Colleagues,

1.         I would like towelcome you to today's conference.  I hope conferences like this will spur everyone to think of new and innovative ways to combat Aids. I thank Action for Aids and the Dept of Infectious Disease and the Communicable Disease Center (CDC) of Tan Tock Seng Hospital for inviting me to this conference. About two weeks ago, I spoke to the doctors of Tan Tock Seng Hospital about the AIDS epidemic in Singapore. In mytalk, I told the doctors that we expect a record 300 new cases ofHIV/AIDS to be diagnosed this year. CDC had also identified 2 riskgroups. They are gays or MSM, ie Men having Sex with Men, andheterosexual men having casual sex abroad. The rise of HIV/AIDS among gays is particularly worrying because there were many cases of seroconversion indicating that the infections were recent. In short, our specialists are worried about an explosion of AIDS cases among gays. Yesterday, the Ministry released an update to the media on the HIV/AIDS situation in Singapore. This information is also available on the web and those interested in the details can check the Ministry's web-site.

2.         As a result of themedia coverage of the talk, I received many emails from concerned individuals on what we should do about AIDS. The editorial in yesterday's Straits Times warns of the dangers of taking a moralisticview of what is essentially a health problem. I agree with theeditorial and my Ministry will approach AIDS prevention from ascientific public health point of view and not a moralistic one. I am heartened that Singaporeans see AIDS as a serious problem andthank the many individuals for their ideas and suggestions. The Ministry also had a discussion on the problem with interested individuals from the community. Among those who attended were members from Action for AIDS, Fridae.com, and Aware. The Ministry will continue to have more sessions with more groups to obtain feedback as well as to communicate our strategies to combat this disease.

3.         Currently, 95% of our resources at CDC are being used to treat AIDS patients and about 5% are allocated to preventive measures. If the number of AIDS patients continues to increase rapidly, the care of patients, who today have AIDS, will suffer as the system gets overwhelmed by the new cases. Hence taking preventive measures is important not only to save lives and reduce suffering, but also to ensure that those who already have AIDS will have enough resources available for their care.

4.         The most important preventive measure against the spread of AIDS is health education of the general public. AIDS is a sexually transmitted disease. If we can educate people about the risk factors for catching AIDS, individuals can modify their behavior and reduce their risk of catching AIDS. There are four messages that we want to get across to the public. The members of the community at the Ministry's dialogue last week all agreed that our four messages are correct. However there were opposing views on the emphasis to be given to the different messages. Nevertheless, despite these disagreements, all agreed that there was a need to do more to stop the spread of AIDS and to save lives. My Ministry does not have a monopoly on ideas to stop AIDS. We will continue to engage and work with the community. We will periodically review our strategies and be ready to make changes as necessary. In other words, we will have an open mind to all suggestions even if we do not agree with them at this point in time.

5.         My Ministry hascrystallized four messages that it wants to communicate to the publicin order to educate people on the risks of HIV/AIDS.

6.         The First message is: Have only one sex partner and be faithful to that person. We want to promote safe monogamous relationships. We want to educatepeople not to be promiscuous because having multiple sex partners is arisk factor for catching AIDS. The more the number of sex partners, thegreater the risk of catching AIDS. This is a key message - we must reduce promiscuity. We must get this message across tothe community. We will need the help of community activists, religiousgroups and other socially conscious groups to help us get this messageacross.

7.         Members from Action for Aids and Fridae.com do not think that this message is appropriate for gays and they say it will have no impact on them. It is their opinion that this message should not be relayed to people who are gay. My Ministry does not agree. My Ministry has a duty to educate everyone including gays about the health risks of promiscuity. Promiscuity is a risk factor for both gays and heterosexuals. Both heterosexuals and gays have the ability to modify their behavior if they know the risks. We must not deny gays the right to health information on the basis that they do not have the ability to modify their behavior and reduce their number of sex partners. At last week's speech to Tan Tock Seng Hospital' s doctors, I had mentioned an article in Her World about a gay person who slept with a hundred men. He was terrified when he had to undergo HIV testing because he realized he could be positive. Fortunately for him, his test was negative. According to a web report, after that frightening experience, he has stopped being promiscuous. HIV is a sexually transmitted disease and if people were made aware of the risks, they will modify their sexual behavior to reduce their risks.

8.         The second message is: If a person is having casual sex, the person should practicesafe sex. If a person is having casual sex, a condom should be used. Condoms donot provide 100% protection, but they do provide significant protectionagainst catching HIV/AIDS - up to 80-90% protection if used correctly.The Ministry will target the condom use message to high risk groupssuch as gays and those who plan to visit red light districts at home orabroad. We must be sensitive and careful about how this message will beperceived by low risk groups like teenagers because we do not wantyoung people to think that casual sex is OK as long as they wear acondom. This is not true. Casual sex is not OK and it is still risky. Condom use reduces the health risk significantly but it does not reducethe risk to zero. This is why the Ministry does not support astand-alone condom use message for the general public.

9.         The third message is: If a person has multiple sex partners, and if there isunprotected sex, the person is at a high risk of contracting HIV/AIDS.So, we advise frequent testing for HIV. The testing should be done several times because there is a time lag between catching the disease and testing positive. If HIV is detected early, treatment can be started early. Although, there is no cure for HIV/AIDS, with treatment the outcome is better.

10.       The fourth message is: If a person is HIV positive, it is a criminal offence for thatperson not to inform his or her sex partner about the HIV status. It is the social responsibility of a person not to spread AIDS. One would expect all HIV/AIDS patients to know this. However, we have received feedback from those with close links to HIV/AIDS patients, that some HIV positive persons deliberately spread the disease as a form of revenge on society. Apparently, gays who test positive feel angry with other gays because one of their gay partners passed the disease to them. So they feel they have a right to pass the disease on to other gays. Likewise, those who catch the disease from sex workers feel they are justified in passing the disease to other sex workers. Some of you may recollect the Straits Times report about the German national who spread the disease to hundreds of women in Thailand. Perhaps he belongs to this category. Despite spreading the disease to so many Thais, he had the right to refuse to be tested and was allowed to leave Thailand. What if he comes to Singapore? We want to make it clear to everyone that it is a criminal offence to deliberately spread HIV/AIDS in Singapore. Hence we have added this fourth message as part of our public education.

11.       The majority of Singaporeans believe in strong family values. They want to live and bring up their families in an environment where strong family values are encouraged and supported. They do not wish the AIDS prevention public education message to inadvertently promote promiscuity or erode familyvalues.  My Ministry will be sensitive to these concerns. This is why we do not support gimmicky events like condom parades, which may make a big splash in the media but which may also send wrong signals to our school going teenagers and young adults about casual sex. We will target our first message on having a single sex partner and avoiding promiscuity to the entire community. We will work withcommunity groups, religious groups, businesses and schools to get thismessage across.

12.       The other three messages will be targeted towards high risk groups like gays and heterosexual menhaving casual sex. My Ministry will work with organizations like AFA,which has links with and understands the behavior of these high riskgroups, to reach out to them.

13.       AIDS is a sexually transmitted disease and most adults who contracted the disease were involved in some form of high risk sexual activity. However there is one subset of HIV patients who are truly totally innocent and do not deserve their fate. These are babies born with HIV. The tragic irony is that we could have actually prevented these babies from having AIDS. If all the mothers had been tested for HIV, and treatment started for HIV positive mothers, the risk of the baby's having AIDS would be reduced from 25% to 2%.  In the last 10 years, 12 babies were born with HIV in Singapore. If the mothers had been tested, probably all 12 babies would have been born free of AIDS.  

14.       I asked CDC for a typical history of one of these babies.  Jane, (the name has been changed)was born in April 2001. She was often ill after her birth and although she was seen by various doctors, her condition did not improve. When she was one year old, she was diagnosed to have AIDS. Her treatment has since been funded by KK Women's and Children's Hospital. Her parents under went HIV testing and both were found to be positive. Both parents have advanced disease and have received treatment with financial help from CDC and a church. The disease in the parents is now under control.Jane's mother does not recall being asked about HIV screening. She regrets that she was not screened as this would have prevented her child from having AIDS.

15.       Apparently, the fact that AIDS in children could be prevented has been known for some time. But because of opposition to mandatory testing from various lobby groups, screening for pregnant mothers was slow in its implementation. Only in 1999, did the Institute of Medicine, the American Academy of Pediatrics and the American Academy of Obstetrics and Gynecology make the recommendationon the screening of all mothers. The effect was quite dramatic. In 1992, 912 babies were born in the US with HIV. In 2002, the number was 90. This is a reduction of 90%.  In 2003, Communicable Disease Centre, Atlanta endorsed the same recommendation. I will not go into the technical details of therecommendations as they can be found on CDC Atlanta's web site. As aresult of these recommendations, more than 90% of pregnant mothers arescreened in the USA. 

16.       In Singapore we have not implemented these recommendations and our screening rate is less than30%.  My Ministry is currently looking into the CDC (Atlanta)'s recommendations and will implement them as soon as possible. No baby should be born with HIV when it can be prevented. I am some what saddened that we did not implement a more vigorous screening program earlier and that 12 babies were born with HIV duringthe last decade. My Ministry will work with urgency to ensure that we minimize the chance of any new baby being born with HIV. I would urgeall obstetricians to go into CDC (Atlanta)'s web page and educate themselves on the current standard of care with regard to HIV prevention in babies.

17.       My Ministry cannot fight the spread of AIDS alone. It needs the help of the community and we look toall community groups to join us as partners in this effort.  In our efforts to stop the spread of AIDS, we must not forget the needs of those already suffering from the disease. Our physicians will approach HIV/Aids as a public health problem and as a medical illness like any other illness.  It is not the functionof physicians to make moral judgments on patients. Every life is important and physicians must do their utmost to save every life. Likemany diseases in the practice of medicine, there is no cure for HIV/AIDS. Physicians must therefore strive to control the disease and always comfort the AIDS patient. Every AIDS patient must be treated with dignity and compassion. We must champion the right of AIDSpatients not to be discriminated against because as physicians we knowand understand the disease and by educating the general public aboutAIDS, we can reduce discrimination against HIV/AIDS patients. This is an integral part of our duty to AIDS patients. So those who suffer from AIDS can be assured that although they are affected they are not alone. Our doctors are with them and will take care of them.

Thank You.