Proposed HIV law is to encourage responsible behaviour

22 Oct 2007, The Straits Times

Question

Name of the Person: Ashok Narandran

Curbing the spread of HIV, criminalisation is not the solution

Proposed amendments to the Infectious Diseases Act (IDA) are up for public consultation on the website of the Ministry of Health. If approved, they are likely to affect a large number of Singaporeans.

Two propositions are particularly worrying. The first is the proposal to 'amend the IDA to empower the Director of Medical Services to obtain residual patient samples (e.g., blood), and to carry out the necessary tests and examinations on such samples'.

That biological samples or material collected by medical professionals can be used without our knowledge for investigative purposes is worrying.

The justification for such a severe measure - to 'help determine if our population is at risk of an outbreak' - seems rather weak. Medical confidentiality and the right to privacy and ownership over our body are sacrosanct and such a drastic incursion into the most private domain of our lives must be justified more strongly.

The second point of contention is with regard to the enhanced measures to contain HIV/Aids. It is currently an offence for a person who knows that he is HIV-infected to have sexual intercourse if he does not first inform his partner of his HIV status, and obtain his partner's agreement to accept the risk of infection.

The new legislation proposes to make engaging in sexual activity a crime for certain people who are deemed to be 'high-risk' individuals, despite their being unaware that they are HIV-positive.

The ambiguity lies in the phrase 'has reason to believe that he has been exposed to the risk of contracting HIV or Aids'. What constitutes reason to believe?

The lack of a clear definition of the term 'high-risk individual' and the absence of an authority to check the Government's opinion on this issue create the notion that anyone can be prosecuted on a hunch.

Determining if an individual had 'reason to believe' that he has been exposed to the virus would involve prying into the lives of people.

To a certain extent, criminalising HIV/Aids ignores the fact that some people might face obstacles in determining whether they are infected or not. Lack of access to testing facilities and poor education are just some of the stumbling blocks.

The key issues here are education and accountability. We need to ensure that cheap, if not free, testing facilities are made readily available and that people are educated rigorously on the disease and the ways in which it can be transmitted. Only then can we say that culpability lies in the hands of the infected.

Reply

Name of the Person: Ms Karen Tan

Director, Corporate Communications

Ministry of Health  

Proposed HIV law is to encourage responsible behaviour

In "Curbing the spread of HIV, criminalisation is not the solution", (ST Oct 18, 2007), Mr Ashok Narandan expressed two main concerns with the proposed amendments to the Infectious Diseases Act

His first concern is that power to acquire left-over patient samples could compromise patient confidentiality. The Ministry would like to assure the public this would not be the case, as the intention here is not to determine the identities of those who could be infected. Rather, this provision is to allow MOH to have aggregated statistical data on the prevalence of a particular infectious disease in Singapore or the level of immunity of the population against emerging infectious diseases which could pose a public health threat to Singapore. We can then devise appropriate and effective action plans to protect the nation on a timely basis.

His second concern is over what constitutes "reason to believe that [a person] has been exposed to the risk of contracting HIV or AIDS" and whether HIV prevention education and testing are easily accessible.

Activities that expose one to higher chances of contracting HIV or AIDS are well-established. These include having unprotected sex with someone infected with HIV or at high-risk of being infected with HIV, such as men who have sex with men, sex workers and their clients, or having multiple sex partners with unknown HIV status, or sharing needles to abuse drugs. The challenge lies with getting such individuals who engage in high-risk sexual behaviour to act responsibly by going for regular HIV testing or use condoms for protection when engaging in casual sex.

We therefore agree with Mr Narandan that MOH must step up public education on how HIV infection is transmitted, the risk behaviours and how the infection can be prevented. We have done so and will intensify our efforts. Confidential HIV testing is also widely available in most, if not all, medical clinics. Anonymous HIV testing is also available at 3 sites in Singapore. Information on where to go for HIV testing is available at the website :http://www.hpb.gov.sg/hpb/default.asp?pg_id=1737