Speech by Senior Minister of State for Health, Dr Amy Khor, at the Tan Tock Seng Hospital World AIDS Day Celebrations, 1 December 2015

Dr Eugene Fidelis Soh, CEO, Tan Tock Seng Hospital

Dr Jamie Mervyn Lim, COO, Tan Tock Seng Hospital

A/P Lim Poh Lian, Head, Department of Infectious Diseases, Tan Tock Seng Hospital

Distinguished guests,

Ladies and Gentlemen,

Good morning.

I am pleased to join you today at this year’s World AIDS Day event.

Reducing Stigma, Increasing Acceptance

2.    As the Chairperson of the National HIV/AIDS Policy Committee (NHPC), I have had the chance to interact with HIV patients and their caregivers. From them, I hear stories of stigma and discrimination.

3.    The lack of social support can exert a heavy psychological toll on the mental health of People Living with HIV (PLHIV). Many PLHIV feel the need to conceal their diagnosis for fear of the repercussions. Stigma affects their ability to function socially as they are worried about how others view their HIV status. It can also prevent them from having regular medical follow-ups, which will affect their quality of life.

4.    Tan Tock Seng Hospital’s 4-year campaign, entitled ‘Be With Me’, aims to reduce the stigma and discrimination against PLHIV. The theme for this year’s campaign is “I have HIV, will you eat with me?” This seemingly innocuous question can provoke different responses in many people. We know that HIV is not spread through casual contact such as having a meal together. Yet many people continue to harbour such misconceptions and fears about HIV.

5.    Our surveys do show a gradual improvement in accepting attitudes towards PLHIV over the years. 42% of those surveyed in 2014 were willing to share a meal with a person living with HIV/AIDS, as compared to about 30% in 2012. Slightly more than half (55%) said that they would be willing to care for a person living with HIV compared to 49% in 2012. We still have some way to go in improving attitudes towards PLHIV.

6.    Besides public education, we should also be addressing stigma and discrimination at a systemic level. The NHPC continues to work with stakeholders from other public sector agencies, community organisations and workplaces. Such multi-sectoral engagement enables us to more effectively tackle a range of HIV-related issues, and to design relevant and effective policies and programmes that address these issues.

Prevention & Education

7.    Fundamentally, the most important area of our work is prevention. Every individual matters, and every case of HIV/AIDS is one case too many. HIV is preventable.

8.    We are fortunate that in Singapore, the prevalence of HIV remains low – at 0.2% -- amongst the general population. Our blood supply remains safe, and we continue to see no cases of HIV transmission from blood donation. With an antenatal screening programme that has been part of our standard care for over 10 years, we did not see any cases of mother-to-child HIV transmission last year. We also have very few cases of HIV transmission through intravenous drug use. The number of new HIV cases over the last five years have been around 450 annually.

9.    However, Singapore’s HIV infections continue to be driven by sexual transmission. Persons who engage in casual or commercial sex with multiple sexual partners continue to be a major risk group.

10.    Our latest survey results show that more than 7 in 10 heterosexual males who engage in casual sex consistently do not use condoms. And almost 3 in 10 of those who engaged in casual sex also reported having sex with a regular partner within the past six months, thereby putting their regular partners and spouses at risk. Amongst Men who have Sex with Men (MSM), about 4 in 10 reported that they consistently do not use condoms with their casual partners. These statistics show we still have much room for improvement.

11.    The Health Promotion Board’s public education campaigns will continue to stress HIV prevention messages: Abstinence, Be Faithful, Consistent Condom Use and Early Detection (and Testing).

12.    We need to redouble our efforts to engage, educate and empower at-risk groups to take charge of their own health, and to take steps to protect themselves and their loved ones from infection. We must also ensure that they know where to go for care, treatment and support, if infected.          

Early Testing

13.    Regular testing is an important element in stemming further HIV transmission. With early diagnosis, a HIV positive person can get access to care and treatment earlier, and can also take steps to prevent further spread of HIV/AIDS.

14.    HIV testing is widely available at polyclinics, GP clinics and hospitals in Singapore. Members of the public can voluntarily go for a HIV rapid test at more than 60 GP clinics across Singapore and get their screening results within 20 minutes. Public hospitals also offer opt-out HIV testing to all inpatients. In addition, anonymous HIV testing is available at 10 convenient locations across Singapore for individuals who would like to be tested but prefer not to be identified. We are also working with our partners to facilitate anonymous testing for at-risk groups. Action for AIDS (AfA), for instance, has a mobile testing van which brings anonymous HIV testing to at-risk persons at various outreach venues. As a result of our gradual expansion of options for anonymous HIV testing, I am pleased to see that our anonymous testing numbers have improved, from 11,900 in 2012 to more than 14,000 last year.

15.    Despite the easy access to HIV testing, late stage HIV diagnosis remains a concern locally. The proportion of late-stage HIV infection amongst newly diagnosed cases has remained at around 50% over the past five years. In the first six months of 2015, almost 39% of new cases already had late-stage HIV infection. At the same time, the proportion of cases diagnosed through voluntary testing has remained low, not exceeding 22%  over the past five years. We must work harder to improve this situation.

16.    While we can encourage more persons to be tested for HIV by making the tests more accessible and convenient, stigma and fear of the HIV diagnosis remain barriers to HIV testing. We – this includes family, friends, colleagues, and the community – can all do our part to create a non-threatening and supportive environment to encourage those at risk to come forward to be tested early.

Support for Treatment

17.    Good treatment regimens are available for PLHIV, and these can effectively allow them to lead productive lives for many years. The Government has been working over the years to improve the affordability of anti-retroviral (ARV) drugs for Singaporeans, so that cost does not deter PLHIV from seeking treatment and remaining on treatment.

18.    Individuals can use up to $550 per month from their Medisave to pay for their ARVs, and Medifund remains a safety net for needy patients, to cover the cost of their treatment. Since September last year, ARV drugs for HIV treatment have become subsidised for lower to middle-income patients on a means-tested basis at our public hospitals and institutions. As at March this year, more than 570 applications had been approved for assistance under this subsidy scheme, with an average assistance of about $525 per application.

19.    These schemes have relieved the financial burden of those who are most needy, and have enabled those who require treatment to access treatment. With improved ARV affordability, it is my hope that more individuals will come forward for early testing and treatment.

Community support

20.    Today, let us reflect on how far we have come in HIV prevention and control, and the remaining challenges that we must address to create a society where PLHIV can live without fear of stigma and discrimination. Singapore saw its first HIV patient thirty years ago. The TTSH Communicable Disease Centre has been journeying with many PLHIV over these three decades. With the availability of treatment and the potential for HIV patients to live for many years after their diagnosis, the concern is no longer about death but about living.

21.    Quality of life is important for people living with HIV. This is why I am heartened by the good work and dedication of our healthcare workers in supporting PLHIVs. I would like to take this opportunity to commend the Communicable Disease Centre’s dedicated volunteers, who faithfully visit patients every week in the wards to offer them care, support and friendship.  Your care and concern go a long way to helping PLHIV cope with the initial news of their positive diagnosis, as well as the longer term challenges of living with HIV. Thank you for surrounding them with community, and for making a positive difference in their lives.

Conclusion

22.    On that note, I would like to thank all our stakeholders here for your partnership and hard work. I hope that today’s event will inspire us to renew our commitment towards HIV prevention, and help those living with HIV. Together, we can mount a robust and effective response to HIV/AIDS, and make a positive difference in the lives of those living with this infection. Your support of PLHIVs will enable them to carry on contributing to society in meaningful ways.  I wish you all a very meaningful and memorable World AIDS Day.

Thank you.