Update on the HIV/AIDS situation in Singapore 2007

17 Sep 2007

Question No:  331  

Question

Name of the Person: Dr Lim Wee Kiak

To ask the Minister for Health (a) if he will provide an update on the HIV/AIDS  situation in Singapore; and (b) what steps, if any, will the Ministry take in light of a recent report that revealed 1 in 350 non-HIV in-patients’ blood sample was found to be HIV positive.

Reply

Reply From MOH

The WHO (World Health Organisation) and UNAIDS (Joint United Nations Programme on HIV/AIDS) classify HIV epidemics into 3 categories: low-level, concentrated and generalised, in ascending order of severity. Singapore’s HIV epidemic is classified as a low-level epidemic.  But it is at risk of shifting into the concentrated category, meaning the prevalence in the general population is low (below 1%) but among a specific high-risk population, the prevalence is high (above 5%). Hence, we must not be complacent, particularly because our region has high HIV prevalence.

Let me provide some statistics.  Up till the end of last year, 3,060 HIV-positive cases had been diagnosed, of which 1,048 had died.  In the first 7 months of this year, 237 Singaporeans were newly diagnosed, bringing the total number of known HIV-infected Singaporeans to 3,297. Our prevalence of known HIV cases among the resident population aged 15 years and above, is 0.07%.  Ten years ago, it was 0.02%.  So it has been on a rising trend.

What is however not known is the prevalence of undiagnosed HIV.  There have been various estimates. UNAIDS, in 2005, estimated our total adult prevalence, diagnosed plus undiagnosed, at 0.3%.  This is higher than their estimates for Australia, New Zealand, Japan or Korea which were all below 0.1%. 

Early this year, my Ministry did a survey to determine the HIV prevalence among the patients in our public hospitals. Discarded blood samples of all patients who were not known to be HIV-positive, were tested anonymously for HIV.  Based on this study, we estimated that 1 in 350 hospital patients were HIV-positive, giving an undiagnosed prevalence of 0.28%. 

As patients are not representative of the general population, we should not extrapolate the hospital prevalence nation-wide.  Nevertheless, it would suggest that the number of undiagnosed HIV-positive patients is more than the number of known carriers of this virus. The Singapore experience is not unique.  This is a common problem all over the world.  There are many HIV-positive patients out there who are not aware of their infection.  

While some of these patients may choose to be ignorant of their infection, we have to be concerned about the significant number of undiagnosed HIV cases.  From the public health point of view, all persons who are HIV-infected should know their status. First, they can receive early treatment.  Second, they can be counselled on how they can avoid infecting their loved ones.  For example, a HIV-infected pregnant mother can significantly reduce the risk of infecting her child if the obstetrician is aware of her infection.  Likewise, a HIV-infected man can reduce the risk of infecting his sexual partner if he takes proper precautions. 

Furthermore, in a hospital or a clinic, being aware of one’s HIV status can minimise accidental transmission of the virus, for example through a needle prick or cut during a surgical operation.  The transmission can go from an infected healthcare worker to a patient but much more likely, from an infected patient to a healthcare worker.  While all healthcare workers will routinely take proper infection control measures, being alerted to the HIV status of the patient will be extremely helpful to all.

Every day, we treat about 4,500 inpatients in public hospitals alone.  If the hospital study is representative, then some 12 unknown HIV patients come into close contact with healthcare workers every day.  The risk of accidental transmission is not trivial.

That is why the US CDC (Centers for Disease Control and Prevention) has issued recommendations that require (a) certain categories of healthcare workers e.g. surgeons, to know their HIV status, and (b) adult patients to be offered HIV screening.  The first measure is to avoid infected healthcare workers from participating in procedures which are prone to accidental transmission.  The second measure is to pick up the infected patients for early treatment and counselling.

Our public hospitals are progressively implementing the US CDC recommendations.  HIV testing will be included in the regular health screening of healthcare workers, on a voluntary basis.  Changi General Hospital has started doing so. As for screening of patients, we have begun doing so for all pregnant mothers and have already saved about 30 babies from unnecessary HIV transmission in the last two years.  Later this year, we will also start offering HIV testing to adult male inpatients on a voluntary basis. 

A simple HIV test is all that is needed to diagnose the infection. HIV testing is now widely available in GP clinics and hospitals and my Ministry has just allowed the use of rapid HIV test kits in medical clinics.  In trained hands, the kit can give accurate and reliable results in 20 minutes. We should take advantage of this to promote regular HIV screening among the population.  It is an important measure in HIV prevention. In particular, all individuals who engage in high-risk sexual behaviour must go for regular HIV testing.  The Infectious Diseases Act makes it an offence for someone who is HIV-positive to have sex without informing his sexual partner of his HIV status.  I will soon come to this House to amend the Act to clarify that ignorance of one’s HIV status will not be a defence for those who engage in high-risk sexual behaviour. 

In parallel, we will strengthen other prevention efforts.  Last July, SMS Dr Balaji Sadasivan, who chairs the National HIV/AIDS Policy Committee, led a delegation from my Ministry and three NGOs involved in HIV prevention to Sydney to study their prevention efforts.  A key learning point was the strong collaboration among the stakeholders i.e. Government, NGOs and Academia to create an enabling environment that allows people at risk to take personal responsibility to reduce risky behaviours and go for regular testing. My Ministry has formed a working group involving the NGOs to apply what they have learnt in Sydney to further enhance our HIV prevention strategy.