HIV/AIDS Project

It goes without a doubt that to stick to the status quo in response to the HIV/AIDS problem in Singapore would result in more HIV infection cases, more AIDS sufferers, in future as trend statistics from the Ministry of Health (MOH) website demonstrates. This must change. Can we get past the bureacracy, past the selfish agendas, past the apathy, and come together for an attempt to positively change lives of HIV/AIDS patients?

Apathy describes the mindset of most Singaporeans with regards to HIV/AIDS. We know from a young age in science classes that HIV/AIDS spread from unprotected sexual contact, contaminated needles, mother to child etc. We know the mechanism of transmission of the virus, its symptoms; we know it is incurable. We hear from our friends, learn from websites, the unspoken presence of social stigma; that the disease targets the promiscuous, the homosexuals, the drug addicts. “It does not affect us”, we believe this.

That is why we do not get HIV tested. That is why we do not talk about HIV/AIDS, talk about our sexual histories. That is why we do not stand in support of HIV/AIDS victims. Because we are afraid to be associated with this “unclean” disease, to be painted with the same ugly stigma.

Find out! Reach out! Stand up! We can rise above the fear and confusion to confront HIV/AIDS with courage and understanding!

Find out about HIV/AIDS, because that is the first step towards being part of the solution. With accurate knowledge about HIV/AIDS we can eliminate prejudices and social stigma, take precautionary measures against infection, and help others to do the same.

Reach out to HIV/AIDS victims, because everyone is a victim under the indiscriminating assault by the disease, our common enemy. People could have made mistakes that gave them HIV, but ultimately, no one chose the disease, it chose them. The disease breaks up families, crushes hopes and dreams, makes suspicious strangers of neighbours and friends. We need to stand united. Show that we are capable of love and compassion, Singapore!

Stand out to speak and act in response to our HIV/AIDS problem even if no one else will, because one person willing to stand out and speak out about HIV/AIDS, its problem, and possible solutions, to his famiy, relatives, friends, groups, community, and government can make those individuals and groups be aware of the issues and confront them.

If you are interested in contributing to the dialogue on HIV/AIDS, have an idea or feedback to share, please join the SYINC (a Singapore youth not-for-profit organisation) on facebook to connect with other youths passionate about igniting social change.

SYINC group
http://www.facebook.com/group.php?gid=6108504756

SYINC - HIV/AIDS
http://www.facebook.com/group.php?gid=24065851670

SYINC homepage
http://syinc.org/

If there are specific comments, suggestions or ideas pertaining to what I have written, you can contact me through my email edfu2k (at) gmail (dot) com

Once is all it takes to make a difference

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In order to reduce the spread of HIV, we need knowledge, both of our HIV status and that of our partners. It is easy to get HIV tested, but there is social stigma against it. There are no proper channels to share the knowledge of our HIV status; social norm does not demand it. It is my proposal that providing an avenue for people to mutually share knowledge of their HIV statuses would be a highly effective solution to reducing the spread of HIV.

The HIV/ AIDS problem in Singapore has no easy solutions. Perhaps the only real solution is an HIV/AIDS cure. But after 2 decades of research, HIV/ AIDS have proved resilient to attempts to eradicate it. Nonetheless, inasmuch as a HIV/ AIDS cure is important, preventing the spread of HIV is at least equally so, and it is a worthwhile goal to work towards in the interim. It is with that in mind that I propose the following solution to our HIV/ AIDS problem.

The main mode of transmission of HIV (ie. whereby most people get infected) is through sexual contact, both heterosexual (the larger group) and homosexual modes. I believe the key to reducing such transmission of HIV is through information. In every encounter leading up to sexual contact and the act itself, there is asymmetric information between both persons. This occurs when one person has more relevant or better information than the other. Information in this context refers to sexual history, HIV status, STDs contracted, high-risk behaviours engaged in, etc. details that are relevant to the risk that particular individual has of spreading the HIV virus through sexual contact.

The current response to asymmetric information is to judge based on appearance (perhaps even stereotypes) to gauge the risk of getting HIV from an individual through sexual contact. “Is that person known to have many sexual partners?” is the question asked, and often not even that. It might be expected of the other party to be decent enough to declare his HIV status such that precautionary measures can be taken. But due to the stigma surrounding HIV, most people who engage in high-risk behaviour do not get tested. Therein lies the problem. Furthermore, Singaporean society is conservative and talking about sex (a taboo topic) would hurt sensibilities. Few people talk openly about their sexual history. By lacking the relevant information, every sexual encounter becomes a gamble. Gamble enough times and you will unwittingly have to pay the price.

Is there any way to correct this situation of asymmetric information?

My proposed solution (inspired by economist George Akerlof’s 1970 The Market for Lemons paper) acknowledges the disincentive for high-risk individuals to get tested and/or declare their HIV status. Just as car salesmen have used warranties as a signal of quality assured cars, Singapore can implement a system whereby individuals can get tested for HIV and signal their status should they be HIV negative.

Why would individuals who are HIV negative want to declare their status?

In theory, it would be the first step towards establishing an honest relationship with others. It is a declaration to others that you are self-respecting/empowered enough to say no to unsafe sex, that you are responsible enough to say no to intravenous drug abuse; this will encourage others to avoid high-risk behaviour, to get HIV tested. You will find that people of the same values are attracted to you. There would be no social repercussions; social perception of the individual can only be more positive rather than less. Importantly, declaring your HIV status to others will implicitly call for a reciprocal declaration of others’ HIV status, which reduces the asymmetric information and accordingly reduces your risk of HIV infection.

It would encourage people to be HIV tested; there will be less stigma surrounding it. It will make the HIV/ AIDS problem in Singapore more visible when it becomes increasingly common to be HIV tested.

People who frequently engage in high-risk behaviour and do not want to get HIV tested, or who are HIV positive but seldom inform their partner or take precautionary measures against spreading HIV, will find themselves pressured to change their behaviour. As more people get HIV tested, those who do not do so will become more visible. People who engage in high-risk behaviour, who unwittingly put themselves and others at risk of HIV infection, can no longer do so at whim and will have to change.

Feasible changes

To reduce the asymmetry with regards to HIV information, I see merit in implementing an endorsement tool much like warranties as used in response to George Akerlof’s The Market for Lemons. It could be a simple identification card with given to people after they get HIV tested (if they so choose). This ID would contain information on the person’s HIV status and the date of HIV testing. This information can optionally be reflected in an online database. People will be encouraged to get HIV tested at least annually; the more frequently one is HIV tested and found to be HIV negative, the less risk associated with sexual contact with that individual. Once the critical mass of HIV negative people declaring their statuses is reached, the rest naturally follow suit to avoid social stigma. The visibility of everyone’s HIV statuses will increase the stakes for one to be HIV negative. People will take precautionary steps against HIV infection that they would not otherwise because the cost associated with taking the risk will be much greater.

Action for AIDS (AFA) has an existing programme of anonymous HIV testing and counseling. More details can be found at http://www.afa.org.sg/clinical.asp It would be worthwhile to explore the possibility of establishing a partnership with AFA, to tap into their expertise and resources, to implement this proposal.

Foreseeable problems

Without the proper education, stigma against HIV positive individuals might worsen in response to greater visibility of HIV/ AIDS. These HIV positive individuals might have less anonymity against the visibility of HIV negative individuals who declare their HIV status. This problem must be anticipated and prevented, perhaps through greater public emphasis on the common threat of the virus and the plight of the involuntary victims in its wake. My greatest worry will be for HIV positive individuals who will find themselves singled out as HIV negative people get tested and declare their statuses. My initial conclusion was that HIV negative people will only declare their HIV status to their partners before sexual contact (when it becomes necessary and expected) hence this information will only be confined to their private spaces. However, if HIV negative individuals use my proposed method of mutual identification to identify HIV positive individuals by elimination, it could be a tool for discrimination or worse… Education has served to bring understanding and compassion to the HIV/ AIDS problem so far; it is my sincerest hope that people can continue to find in their noble heart a place for unfortunate others.

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Current efforts by HIV activists in Singapore have been concentrated in areas of HIV prevention, treatment, research, and awareness, as well as advocacy for rights of HIV patients. Nonetheless, in spite of the fervent campaigns of these activists, HIV infection/ AIDS cases have steadily been increasing in Singapore, and, if left unchecked, would reach pandemic proportions (refer to my previous post on HIV infection/ AIDS trend in SG). Questions we should ask in response is why HIV infection increasing so rapidly in SG? Also, what can we do to reduce the spread of HIV transmission in a world with no effective cure as yet?

My personal take on why HIV infection is increasingly more prevalent in Singapore is not particularly groundbreaking. HIV transmission follows an exponential increase; each person who becomes infected with HIV experiences no characteristic or persistent symptoms for up to 20 years, and acts as a carrier during that long period whereby they can unwittingly pass HIV to many others. As a result of insidious nature of HIV and the increase in pool of possible victims (due to increase in population size), HIV infection rate will increase with no countermeasures taken. This expected increase is both expedited and forestalled by various complex factors.

Expediting factors

Many people have the mistaken perception that HIV is confined to people who engage in high-risk behaviour, such as prostitutes and people who engage their services, intravenous drug abusers, homosexuals, and promiscuous others. This is seen from the stigma held by contemporary society against HIV infected individuals. There is a belief that people infected with HIV deserve it for their “immoral” lifestyle, and that people who lead “virtuous” lives, those in monogamous relationships, will not get HIV infected. This is an erroneous belief which lead to many ignorant people neglecting to take precautionary measures against HIV infection. Although high-risk behaviour puts one at greater risk of HIV infection, HIV does not discriminate; it can infect anyone…

…What does discriminate is people against HIV positive people. The insensitivity and intolerance that HIV positive individuals have to face cause high-risk individuals to avoid being tested for HIV. The opportunity to get early antiviral treatment, counselling, even to make lifestyle changes in the knowledge of their HIV status, is lost.

Forestalling factors

Singapore is a conservative country. There is a stigma attached to even the suggestion of promiscuity, which gives pause to people who want to engage in casual sex. People who do not pay heed will find themselves facing down the glares of disapproval. There is a huge social disincentive to engaging in the high-risk behaviours most conducive to HIV transmission. Furthermore, there are few avenues to do so; prostitution is illegal and drug trafficking carries a death sentence.

What can we do?

This is the situation of the HIV/ AIDS problem in Singapore. What can we do in response within the unique context of Singapore? For one, first recognise that HIV is the enemy; HIV is everyone’s problem. Also, HIV positive individuals are the victims; none of them chose to have their lives ravaged by the disease after all. Within this framework of understanding, our action plan to defeat HIV must be unrelenting, but also mitigated with compassion.

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Source: Singapore Ministry of Health HIV Statistics Information (http://www.moh.gov.sg/mohcorp/statistics.aspx?id=246

Table 1. Number of Singaporeans reported with HIV infections/ AIDS from 1985-2007

As can be seen, there is an increasing trend of an increasing rate of people reported with HIV Infections/ AIDS in Singapore. The distribution of HIV infections/ AIDS in Singapore is largely comprised of the male population. It can reasonably be assumed that since the statistics given is with regards to reported cases of HIV infections/AIDS, the numbers must be underrepresented since there will be people who have HIV infections/ AIDS who choose not to report it (perhaps by not choosing to be tested even though they engage in high risk lifestyle). Also, since HIV infection has a long incubation period whereby the victim suffers no characteristic or persistent symptoms, the statistics of reported cases of HIV infections/ AIDS is only an indicator of infections occurring years, perhaps even decades, ago. A true account of the current year’s number of HIV infection/ AIDS cases will only be apparent in about 10 years time.

Table 2a. Distribution of HIV infected male Singaporeans by marital status from 2001-2007

Table 2b. Distribution of HIV infected female Singaporeans by marital status from 2001-2007

Taking both table 2a and table 2b statistics into account, we can make a comparison between the male and female demographies of people infected with HIV.

There is a clear increasing trend of number of HIV infected males apparent in all the marital status categories (except the male widowed category). Largest, both in absolute numbers and increase in numbers, is the single male category (almost twice as large as married male category). This can reasonably be attributed to the higher risk lifestyle that males tend to lead.

In contrast, the female demography experiences an increasing trend of number of HIV infected females that appears to be decreasing in recent years. Notably, the largest absolute number of HIV infected females is found in the female married category. This seems to show that, at least on the surface, females are more likely to get infected by HIV from their less-than-faithful spouse.

Table 3. Distribution of HIV infected Singaporeans by sexual orientation from 2001-2007

It is a common misconception that HIV/ AIDS are homosexual diseases, ie. diseases that exclusively affects homosexuals. As a result of that belief, many heterosexuals believe that they have no cause for worry, and many fail to that precautionary measures against infection. This erroneous belief does not hold up to the facts. As can be seen from table 3. statistics, the cases of heterosexuals with HIV exceed the number of its combined counterparts. Homosexuals, bisexuals AND heterosexuals do get infected.

Table 4a. Distribution of HIV infected male Singaporeans by age from 2001-2007

Table 4b. Distribution of HIV infected female Singaporeans by age from 2001-2007

Taking both table 4a and table 4b statistics into account, we can make a comparison between the male and female demographies of people infected with HIV by age groups.

In the male demography of people with HIV infection, the largest categories are males in their 30s and 40s. Taking the nature of reported cases into account, the incidence of HIV infection must have occurred during their 20s or 30s.

The female demography of people with HIV infection has a less straightforward trend. Two trends stand out - The number of HIV infected females in their 20s has a decreasing trend, whilst the number of HIV infected females in their 40s sees an increasing trend.

For both genders, the number of people with HIV infection tend towards a larger number of people in older ages. This can be reasonably attributed to the various treatment options for HIV infection and AIDS which extends the life expectancy of people with HIV infection/ AIDS.

Table 5. Distribution of HIV infected Singaporeans by ethnicity from 2001-2007

Table 5. statistics dispel any misconception that HIV infection has racial bias. The number of HIV infected Singaporeans by ethnicity is proportional to that ethnic group’s population size in Singapore. It is clear that all races are susceptible to HIV infection and should take the necessary preventive measures against HIV infection.

Table 6. Distribution of HIV infected Singaporeans by modes of transmission excluding sexual contact from 2001-2007

Note that table 6. statistics excludes sexual contact, and should be taken together with table 3. statistics to get a more complete picture of HIV transmission demography in Singapore.

From table 6. statistics, it is clear that vertical transmission of HIV (mother to child) and transmission through blood transfusion form a small percentage of the total modes of transmission of HIV. This can be attributed to the fact that Singapore is a developed country with the means to perform blood screening and treatment procedures, as well as to provide the appropriate prenatal and postnatal care.

In conclusion

HIV infection, if not properly managed, will rapidly deteriorate to pandemic status in Singapore. The statistics should dispel myths about HIV infection that are not grounded in fact. A solution to the HIV/ AIDS problem must be one that specifically caters to the different groups in the different demographies. Such as targeting the high number of potential HIV infected single males or potential HIV infected married females.

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People say “infection with AIDS”, but to be accurate, the story of infection begins with HIV. HIV (Human immunodeficiency virus) is actually the transmitted virus, AIDS (Acquired immunodeficiency syndrome) being the condition.

How is HIV transmitted?

HIV is transmitted through bodily fluids such as blood, semen, vaginal fluid, pre-ejaculate or breast milk, where the HIV infects the host’s immune cells. As such, people can be infected with HIV through unprotected sexual contact, contaminated needles, transfusion of contaminated blood, breast milk, and vertical transmission from infected mother to baby at birth. In the developed world, screening of blood products and heat treatment has largely eliminated infection from blood transfusion.

HIV is not transmitted through saliva, sweat, tears, urine or feces. HIV is not spread by biting insects such as mosquitoes, or bedbugs. You cannot get HIV through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.

Preventive measures

Because there is no vaccine for HIV, what people can do to prevent infection with the virus is to avoid high risk behaviours such as engaging in unprotected sexual contact or sharing needles. Measures that offer partial protection are usage of male latex condoms, female polyurethane condoms, spermicides during oral, anal, or vaginal sex. Recently, NIAID (National Institute of Allergy and Infectious Diseases)-supported studies have found that adult male medical circumcision reduces a man’s risk of acquiring HIV infection during penile-vaginal sex significantly.

Symptoms/Diagnosis

Once infected, the virus will actively multiply, infect and kill cells of the immune system. HIV infection has four stages: incubation period, acute infection, latency stage and AIDS. The speed at which the patient progresses through the stages depends on his unique viral load, which is measured by his T cell count- the immune system’s key fighters. The initial incubation period upon infection is without symptoms and lasts between 2-4 weeks on average. The second stage of acute infection lasts an average of 28 days, and can include symptoms such as fever, swollen lymph nodes, sore throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage, which occurs third, shows few or no symptoms and can last anywhere from two weeks to twenty years and beyond. AIDS, the fourth and final stage of HIV infection shows as symptoms of various opportunistic infections.

Symptoms of HIV infection are nonspecific and are often not recognized as signs of HIV infection. Because early HIV infection often causes no symptoms, a healthcare provider usually can diagnose it by testing blood for the presence of antibodies to HIV. HIV antibodies generally do not reach noticeable levels to show up in standard blood tests for 1 to 3 months after infection.

Treatment

By getting tested early, a healthcare provider can give advice to an infected person about when to start treatment to help the immune system combat HIV and help prevent the emergence of certain opportunistic infections. Early testing also alerts an infect person to avoid high-risk behaviors that could spread the virus to others.

There is currently no vaccine or cure for HIV or AIDS. The only known method of prevention is avoiding exposure to the virus. However, a course of antiretroviral treatment administered immediately after exposure is believed to reduce the risk of infection if begun as quickly as possible. Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. HAART neither cures the patient nor does it uniformly remove all symptoms. Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to a large reduction in HIV-associated morbidity and mortality in the developed world. One study suggests the average life expectancy of an HIV infected individual is 32 years from the time of infection if treatment is started early. In the absence of HAART, progression from HIV infection to AIDS has been observed to occur on average of 9-10 years and the median survival time after developing AIDS is only 9.2 months.

Anti-retroviral drugs are expensive, and the majority of the world’s infected individuals do not have access to medications and treatments for HIV and AIDS.

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This website serves as a platform for presenting my views on AIDS/HIV and STDs in general as I learn more about the diseases and the problems they cause from practical and ethical POVs. I hope to engage in active discussions with readers about the AIDS epidemic that is facing us today, so as to reach some resolution that translates into action.

I had previous experience writing for Action for AIDS (AfA)’s The Act magazine, which was given out during AfA’s youth seminar in ‘06. AfA is a Non-Governmental Organisation (NGO) that commits to AIDS prevention, advocacy and support. Their mission is to prevention transmission of HIV/AIDS through continuous education targeted at vulnerable groups; to advocate for access to affordable care and against HIV/AIDS discrimination; and to provide support for people with AIDS, caregivers and volunteers.

The article I wrote for The Act had a central theme of “information”; the angle a call for accurate and comprehensive information on sex-related issues such as AIDS/HIV and also sexuality, love and relationships, contraceptives, abortion etc. for teenagers. Ideally, this website will serve as a source of reliable information, especially on AIDS/HIV topics.

The motivation for the creation of this website came as I brainstormed about the AIDS problem and was struck by an idea for a radical solution (which I will write on in-depth separately). This is my attempt at nurturing the idea which will hopefully prove fruitful. I have been thinking for a long while about taking action, doing research, discussing the idea, and the time has come to move past inaction, so this is the first step to possible change.

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