Singapore’s HIV policy neither rational nor compassionate

Which of these two options would a rational person choose?

1. Live normally but die an early death, or

2. Live longer, but starting tomorrow, life becomes a living hell for the rest of your (longer) years.

I would be extremely surprised if anyone can claim to be rational and still pick #2. Yet our Health Ministry, by their impenetrable logic, expects people to choose the second.

As I mentioned in the essay Horny straight guys’ choices,

Health Minister Khaw Boon Wan’s chief message at the [Aids] conference was to do more to promote early testing. “Our current challenge remains early identification of those who are infected,” he said in his keynote speech.  “More than half of our new cases are diagnosed when their infection has reached an advanced stage.”

It was also revealed by his ministry that 80 percent of hospital patients opted out of HIV testing when offered this upon admission. Of the 20 percent who agreed to be tested, 50 individuals were found to be HIV-positive. How many of the untested were also HIV-positive is anyone’s guess. There is no doubt that there is a significant pool of asymptomatic, undetected HIV infections in the population.

Thus Khaw’s focus on getting more people to go for voluntary testing.

Yet, doing so is contraindicated by the consequences should the result turn out positive (and confirmed by additional tests), for then:

1. You are mandatorily reported to the ministry once you seek treatment locally;

2. You may be put on medication that costs up to S$1,000 – S$2,000 a month;

3. Even if you have lots of money in your Medisave account, you can use only $550 per month from it;

4. You are almost certain to lose your job if your employer finds out;

5. You cannot travel to work or study in some countries which bar HIV-positive persons from long-stay visas;

6.  Your family and friends may avoid you;

7. You may suffer depression;

8. You may never have sex again because by law you have to inform all future sexual partners that you are HIV-positive even if you have every intention to use a condom.

Who is going to freely choose this life?  Yet our Health Ministry does not see it, and keeps bleating about the need to get tested. That bleating almost sounds like a diversionary tactic to hide the fact that they are doing very little in terms of practical, meaningful measures to mitigate the above-named consequences. Let’s look more closely at two areas: Money and law.

Money

The government refuses to subsidise the cost of medication. Singapore is one of the few countries in the world that take this hardline position. Many countries, not as wealthy as Singapore, with sovereign wealth funds not as bulging as ours, do so out of a sense of moral responsibility to their citizens. But not this government, which only a few days ago saw the prime minister boasting that our “social safety net is working well” and that the government will keep finding ways to improve it (Straits Times, 3 Dec 2020, Govt to keep boosting social safety net: PM)

In Singapore, healthcare payments have three tiers.

1. Medisave — a compulsory saving scheme deducted from a person’s salary. Although it is technically one’s own money, there are all sorts of rules regarding withdrawals from one’s personal Medisave account. As mentioned above, there’s a spending limit of S$550 a month buying HIV medication.

2. Medishield — a nationwide health insurance scheme, but it is useless for HIV needs, because the terms specifically exclude HIV-related treatments. However, please pay your premiums on time.

3. Medifund — government-endowed money meant to help the neediest by way of grants.

It was only in February this year, after many years of lobbying by activists, that the government finally agreed to help patients via Medifund. A press release from the ministry said:

From 1 February 2010, the Ministry of Health (MOH) will extend Medifund assistance to needy Singaporeans who require HIV treatment, including medications. MOH will inject $8.5 mil of Medifund to the hospitals to support this extension.

This decision is in response to feedback from some VWOs and doctors treating HIV patients, that some of these patients would require additional financial assistance to cover their treatment.

The Medifund assistance will be subject to means-testing and proven financial needs.

– Ministry of Health, 15 January 2010, Press release.

By October, 1,500 people had climbed on board, which is about half of the 3,000+ persons living with HIV/Aids in Singapore. That sounds encouraging, except that there are a few not so well-known facts:

1. To pass means-testing , you have to show not only that you are totally broke — no more money in the bank — but so are other members of your immediate family. This accords with the government’s ideology that the family must be the first line of support. Don’t bother approaching Medifund for help until your parents and siblings are broke too. As Paul Ananth Tambyah said at the Aids Conference, “you have to sell your house, your car and your children” before you qualify for Medifund.

2. The grant is only for six months.

Yes, 1,500 people have been helped, but it also means that 1,500 extended families had been reduced to penury before that. Perhaps the government was moved to help when faced with the prospect of 7,500 desperate suicides.

Astute buying?

Some readers may recall another piece of “good news” just a week ago.

The price of drugs that can help prolong the lives of HIV-positive patients has been slashed by about two-thirds at one clinic – thanks to Medifund.

[snip]

Associate Professor Leo Yee Sin, clinical director of the Communicable Disease Centre (CDC), said it has led to a far larger number of patients buying the drugs from the CDC. This has allowed the centre – which treats 70 per cent of Singapore’s HIV sufferers – to negotiate lower prices from its suppliers.

‘This price reduction…is able to cut the price by at least threefold. It’s a very significant reduction,’ she said, adding it could pave the way for cheaper HIV drugs at the other public hospitals.

The antiretroviral drug treatment Combivir, which used to cost $629 a month in the middle of this year, now sells for $161 at the CDC. Stavudine, which used to cost $434 a month, now costs $68.

Patients used to pay $900 to $1,500 for a cocktail of drugs, but now pay between $200 and $600.

– Straits Times, 30 Nov 2010, HIV patients can now pay less for drugs

Did you notice the wonderful piece of propagandistic writing in the very first sentence: “slashed by about two-thirds at one clinic — thanks to Medifund”?

Firstly, I’m not sure what Medifund has to do with it, because the rest of the article says the clinic selling these cheaper drugs is the Communicable Disease Centre (CDC). Might it be that the newspaper got it wrong? Secondly, I have since found out that the price reduction was not due to any astute negotiations by a government buyer, but simply because the patents of these older drugs have run out, and prices are falling anyway!

But hey, no reason not to pile on the praise for our “caring” government!

Older drugs doesn’t mean they are less effective, as Roy Chan, President of Action for Aids, told me. These drugs are proven, their side effects are known and they constitute an effective first line of treatment.

But what about those who need stronger drugs? Pay the full price, no subsidies available.

Economics of present policy

Admittedly, whether subsidising medication or giving out Medifund grants, both can be costly to the state. However, as I noted in the lemon-yellow sidebar above, so are cancer drugs and we have no hesitation subsidising them.

Possibly the fear of institutionalising a “subsidy mentality” is what stops the government from helping out with the cost of HIV medication. But what is the effect? People avoid testing because they know the cost of medication is ruinous. But since they avoid testing, their HIV-infection remains unmanaged (because undiscovered), which means they fall very sick within a few years. Then when they get diagnosed, they are hit with huge bills (including lengthy hospitalisation). The family goes broke and the state has to step in with financial aid anyway.

If the state offers to subsidise medication, people will be more willing to test early, their infection is managed, they stay productive and employable for the rest of their lives. Society continues benefit from their economic contributions and the state from their taxes. It sounds to me like the far more sensible policy even if we want to be hardheaded about it (i.e. excluding compassion from policy-making). Yet we are currently doing the exact opposite.

Law

One more thing to bear in mind: Even when an HIV-positive person’s health and infection is successfully managed, stigma and ignorance are so widespread that most employers will get rid of a worker as soon as they discover he or she is HIV-positive. Knowing this, other countries have instituted anti-discrimination laws that make it illegal for an employer to fire an employee just because of HIV-status. Why does Singapore not do the same?

In a nutshell

The call to people to get themselves tested early is so obviously contraindicated by other discouragements, it is mind-boggling that the government does not see the contradictions. Is the government so stupid they cannot see them? Have they no understanding of how human rationality operates? Or do they not want to see it, instead trying to pin the blame for the spread of HIV onto private choices (avoiding test), absolving themselves of responsibility for counter-productive public policy (disincentivising early testing)?

Don’t get me wrong — I will affirm that it is good to know one’s HIV status and I would encourage early testing. But what I am saying here is that the government is doing everything to discourage people from doing the right thing.

25 Responses to “Singapore’s HIV policy neither rational nor compassionate”


  1. 1 georgia tong 8 December 2010 at 11:27

    Thanks for the enlightening article.

  2. 2 thornofplenty 8 December 2010 at 14:09

    Thank you for writing this, more people need to be saying this in more places. The policy is cruel.

    In the section on the economics of the policy, you miss one very important effect of people not getting tested. More people get infected. This is an economic issue because more people are then going to go through the chain of events you described.

    Cruel, counter productive policy.

  3. 3 yuen 8 December 2010 at 14:12

    >surprised if anyone can claim to be rational and still pick #2.

    isnt that circular? anyone picking 2 would be considered irrational, right?

    the significant point is: you acknowledge that such people exist, and need to be controlled; since no one else seems to be able to do much about it, the government has to impose some control measures; no wonder they believe they are the only ones with answers!!

    • 4 ?? 8 December 2010 at 15:59

      Yuen, please try not to add noise if you do not have anything constructive to add, will you? You’re totally off a tangent!

  4. 5 germane 8 December 2010 at 17:55

    The govt probably subscribes to the twisted line of logic that subsidising HIV treatment too much would encourage promiscuity, unsafe sex and immoral behaviour.

  5. 6 Leuk 8 December 2010 at 18:31

    Great highlight. Actually, all of the antiretroviral drugs remain as “non-standard” i.e. you pay 100%. Just that some of the oldies have gone generic and are now much cheaper compared to the proprietary drugs.

    Just a correction – majority of the new cancer agents that can prolong survival or improve QoL are still non-standards and are 100% on the patient’s account. The state does not subsidise these. Those that are heavily subsidised have been around for a while and the generics are relatively cheap.

    So for the unfortunate chap stricken with liver cancer that can’t be operated on, he still has to fork out ~$1000 at no help from the govt. Although medifund does cover some but with the sort of hazy nebulous process to qualify for medifund, I wonder how many people get the benefits.

  6. 7 Anonymous 8 December 2010 at 18:40

    You introduce some good points on how government policy can make life better for those who test positive. However, out of the 8 consequences that you list, some don’t seem to be under the government’s purview.

    Eg:

    5. You cannot travel to work or study in some countries which bar HIV-positive persons from long-stay visas;

    6. Your family and friends may avoid you;

    7. You may suffer depression;

    While the government can have a better support system and educate the populace so there is less of a stigma, I doubt the above factors can be eliminated by the government.

    Also, you did not elaborate on what you feel should be done (if anything) about consequence 8, never having sex again. Do you feel the law should be modified?

    Maybe you can briefly mention what you think the government can do to address this. Otherwise it seems a little unfair to accuse the government of doing “very little in terms of practical, meaningful measures to mitigate the above-named consequences” especially when it seems to me they can’t seem to do much for (almost) half of them.

  7. 8 yawningbread 8 December 2010 at 19:06

    I have been very fair to the government. Like you said, there are certain things that are largely beyond the power of the Sg govt to solve (e.g. consequences #5/travel), and so nowhere in my article do I demand that the govt deals with it.

    My point is that even the low-hanging fruit are not grasped. Even what they can do (no different from what they do with other diseases) they do not do.

    Leuk above talked about cancer drugs. Some common ones are listed as “standard drugs” with subsidies, while some newer drugs are listed as “non-standard”. Fair enough, a line has to be drawn somewhere. My point is how come with HIV treatment, no drugs at all are listed as “standard” and subsidised?

    • 9 Someone 17 December 2010 at 11:54

      No one is sure how cancer can be prevented. For instance, you may get lung cancer even if you don’t smoke.

      HIV, on the other hand, is an elective condition except for those infected by accidental needle injury or blood transfusion, and babies infected by their mothers. If you choose not to protect yourself against HIV, why should the state subsidize your medicine?

  8. 10 the unnamable 8 December 2010 at 20:49

    Dear Yawningbread,

    What troubles me after reading your essay concerns the confidentiality of medical information and the social structures (giving rise to consequences) that unnecessarily penalise AIDS sufferers. I am going to just raise some questions regarding medical confidentiality.

    In point (1) you claim that if someone is tested positive he is “mandatorily reported to the ministry”. Could you clarify if this is the case for anonymous HIV testing? According to the Health Promotion Board website (http://www.hpb.gov.sg/sexualhealth/article.aspx?id=6368), “personal particulars are not required when signing up for an anonymous HIV test.” Although the person being tested must fill in an anonymous questionnaire, it is claimed that “all details will be kept strictly confidential.” Yet, if confidentiality cannot be assured, as you affirm with certainty, in what sense can HIV testing be anonymous in Singapore? Or (perhaps I may have misread you), do you mean that a HIV-positive person is reported only when “confirmed by additional tests”, that is, on repeat test(s) three months after the first test, and thus have begun the preliminary process of treatment?

    (I also wonder about how often people who want to ensure medical information does not leak out have their medical tests done outside Singapore. Not just for HIV, but for other diseases bearing serious financial implications, e.g. insurance claims.)

    I have done a quick search on Singapore Statutes OnLine on the laws regulating HIV. There doesn’t seem to be any law mandating the tester to submit to the health ministry information or identity of someone tested postive for HIV. Perhaps you are alluding to Chapter 137 of the Infectious Diseases Act? (http://statutes.agc.gov.sg/non_version/cgi-bin/cgi_getdata.pl?actno=2003-REVED-137&doctitle=INFECTIOUS%20DISEASES%20ACT&date=latest&method=part&sl=1&segid=1059724020-000520#1059724020-000523). This law empowers the Director of Medical Services to “require any healthcare professional to obtain from his patient such information as the Director may reasonably require” for investigating (suspected or actual) outbreaks of infectious diseases “and transmit such information to the Director”. Is the current Director instructing HIV-testing centres, including those which offer “anonymous” testing, to pass what is otherwise purely private medical information? What I can tell from a cursory reading of the statutes is that the Director has near-absolute (total when with the minister’s permission) discretion of medical information. As with many areas of Singapore’s laws, “reasonably” in “reasonably require” is phrased so vaguely that it is anyone’s guess how reasonable is “reasonable”.

    We cannot take for granted that people act ethically even if they appear to be or appear to act “reasonably”. What are the Director’s legal responsibilities after gaining access to medical information? Does the law limit what any person–including the Director–should or should not do with the information obtained for purposes otherwise beneficial to public health?

    It is important to change the social structures that are unjustly prejudicial against AIDS sufferers. Your article highlights these problems, which you call “management” (or perhaps more appropriately mismanagement). Certainly, I agree with you that the government is doing a far from ideal job. However, without mitigating this crucial (and valid) criticism of the PAP government, I also think we must address broader social issues going BEYOND the law, government and economics. It is clear that as medical diagnostic tools develop together with rapid advances in biogenetic/medical science, the variety and quantity of biomedical information about people is going to proliferate. People will encounter more and more often pieces of biomedical or genetic information about others, and these pieces of information are never innocuous. Now, if the fact of knowing or not knowing one’s HIV status already carries such precarious social consequences, what about those of genetic and medical information? What consequences await us in knowing some things and not others? If the government is already far from adequately addressing HIV, what more can we expect of the PAP government, given the explosion of biomedical and genetic information, to deal with or address these broader problems of biomedical knowledge and its social consequences? Certainly, the law, in my view, may go some way towards addressing unjust discrimination, but it can never keep up with deep-seated social prejudices. People will find ways and means of excluding, by means of subtle or not-so-subtle signals and measures, HIV-positive individuals or ‘biomedically-marked’ individuals (as in say when biogenetic testing reveals him/her to have 95% probability of developing colon cancer).

    (While I am at it, this is also related to the well-known problem that former criminal offenders face in seeking employment and social acceptance. Should employers know or take into account a prospective employee’s past criminal record? How should they take them into account?)

    But let me just repeat my immediate concern here, regarding the doubts you raise about medical confidentiality, despite official assurances on anonymous testing. Will those of your readers who are considering anonymous testing resolve never to go for it after reading your confident dismissal of medical confidentiality? Caught in an already unforgivingly prejudiced system of social structures, without any foreseeable prospects of change in the short term, what protection do AIDS sufferers in Singapore have against the ubiquitous condemnation of society? In the absence of vigorous holding to account of the government, as well as the absence of healthy debate in the public sphere on consequences of biomedical knowledge, the issue of medical confidentiality, more than ever, may be one of the few crucial bulwarks preserving the social and legal welfare of AIDS sufferers.

  9. 11 Teck Soon 8 December 2010 at 21:45

    I have also noticed that most private insurers do not cover HIV either. Actually, I couldn’t find a single policy that did. The government could simply require that all policies for catastrophic illness (such as cancer and kidney failure) also cover HIV. Insurers are scared of HIV too.

  10. 12 yawningbread 8 December 2010 at 22:22

    The Unnamable – Your long comment has too many points, some touching on issues much broader than the article. I cannot really deal with those issues. What I will clarify is the question of anonymous testing.

    HIV is listed in the First Schedule of the Infectious Diseases Act as a notifiable disease. Exemptions have been granted to AfA and several private clinics to conduct anonymous testing. At these places, even when the results are positive, confidentiality is safeguarded. AfA for example only knows the testee by a number, not a name.

    But a testing site does not offer treatment, and so an HIV+ positive patient who wants treatment (and naturally he is advised to seek treatment) has to go to the Communicable Diseases Centre or a hospital, and these places are not exempted from notification requirements. (I have amended the relevant sentence in the article to make it clear when reporting to the ministry occurs.) Alternatively, the HIV+ person can decline treatment within Singapore, and go to Thailand or wherever and seek treatment there. That is one way of preserving continued anonymity. But I do not know what the economics of that solution is.

    Re societal stigma, the govt cannot single-handedly solve this, but they can take the lead with the civil service, non-discrimination legislation, etc. As you will agree, they have done nothing of the sort.

  11. 13 yawningbread 8 December 2010 at 22:25

    Teck Soon – That’s what I thought too, but not having done a survey of policies, I wasn’t sure. Here again, the govt can take the lead by (a) including HIV/Aids within Medishield and (b) requiring all private insurance policies to include HIV and Aids.

  12. 14 anagent 9 December 2010 at 00:16

    Hi, I deal with insurance products and as far as I know (but I might be wrong), almost no policies sold by insurance companies in SG cover HIV. This seems to be the case with all STIs.

    The only one I am aware of is a hospitalisation and surgery policy from AIA that pays out $50,000 (can’t confirm) upon diagnosis of HIV 5 years from the date of inception of the policy.

    As for critical illness policies, there are some companies that cover HIV only if it is not sexually acquired; meaning if it’s acquired occupationally like a medical personnel who got infected through needle-stick injury or blood from HIV+ people.

    • 15 thornofplenty 9 December 2010 at 05:12

      @anagent thanks for the information.
      To your last point, this furthers my belief that we have a long way to go in dealing with stigma.
      There is this notion of a victim vs someone who “asks for it”.
      All HIV+ people are victim of a disease and victims of poor public policy. Period.
      It doesn’t matter how you contracted it, poor public policy, by Singapore and other countries before have made it such that you are a victim of the disease and its continued stigma.
      I am referring to murderous officials like Reagan and his silence on the issue despite the disease wiping out practically a generation of gay men in the US.
      And I am talking about Singapore today that talks out one side of its mouth about “reducing stigma” and does ZERO when it really matters.

      • 16 Someone 17 December 2010 at 12:01

        In what way is a HIV positive person a victim (of anything or anyone other than himself) unless he is infected by accidental injury, blood transfusion or a baby whose mother is HIV positive?

        Realistically, what can the government do about the stigma? Have a campaign? *groan*

  13. 17 Arif 11 December 2010 at 13:05

    Just do comnpulsory testiing for all. That will curb the spread of HIV.

  14. 18 winnieyap 11 December 2010 at 17:55

    So you want compulsory testing for all. What happens after that? What policy do you want in place after you have tested positive under this new rule of compulsory testing. Yes, assume that you are among those who have tested positive. What other measures do you wish the state to adopt?

    Concentration camp for you? Confiscate your HDB flat to pay for any medication you may receive while in concentration camp?

    Is this the intellectual level of Singaporeaans?

    • 19 Arif 12 December 2010 at 15:09

      After that there is contact tracing and counselling of the spouse and partners. HIV medication is not that expensive…there is always cheaper generics from Thailand. The health and safety of the community must come first.

      • 20 winnieyap 12 December 2010 at 17:56

        Not that expensive for whom? Do you agree with YB’s point that the govt should subsidise HIV medication?

        As for mandatory testing, infection is not a static thing as people get newly infected all the time. And due to the window period, just because one tests negative in one test does not mean one is uninfected. How often are you going to mandate compulsory testing of the entire population? Once a month?

  15. 21 Lulu 19 April 2011 at 21:39

    Sorry to step in late in the discussion, which is very interesting.
    Just want to say that from a Public Health perspective it is the most stupid thing to do (and Singapore is doing it, no offense) to make it compulsory for people tested HIV positive to report to any Government Agency. People will simply not go for a tuberculosis and/or HIV screening because of this. Especially foreigners. Because I am not sure you guys know about this but Singapore simply requests foreigners tested positive for HIV to leave the country! Bravo! That’s very nice, what solidarity and compassion for Human beings. What a shame!

  16. 22 J 6 May 2011 at 03:25

    Hi, stumbled upon this article while reading your blog regarding the GE.

    Thank you for writing this; I have not had the privilege of attending an AIDS conference in Singapore and thus did not know many of the things that you have mentioned.

    There is much less stigma regarding HIV in the UK where I am studying, and it is not exclusively a disease of the young and promiscuous. I have seen a 69 year old woman who contracted the disease from her husband. And there are people in their 40s and 50s who present as new cases.

    There are also people in their 40s and older who have been able to lead ordinary and productive lives after starting HIV treatment, and some of them were diagnosed in the 1990s.

    I believe the stigma in the UK is similar to that surrounding Hepatitis B, which is also sexually transmitted (read: not much).

    I think if the Singapore government should take steps to educate Singaporeans to reduce the stigma surrounding HIV. But first they need to stop making things so difficult for people who happen to have contracted the disease. By allowing them to come out into the open without being shunned, it empowers them to lead productive lives and also take steps to avoid infecting others. Most importantly, it encourages more people who are at risk (eg people who have had unprotected sex with a casual partner) to come forward for testing.

  17. 23 msg4health@yahoo.com 27 May 2011 at 15:35

    Compulsory testing should only be implemented if the Govt provides more support for those who are tested positive. In the case of HIV, one should never bring in morality. Illness and morality should never mix. For your information, its not called an elective illness.

    If your family has history of cancer, does that mean you should avoid having children to “avoid” spreading the faulty genes to them? If you have children, then you have “elected” to possibly pass on these cancer genes?? Sounds crabby right… so does the reasoning of the guy who wrote abt elective illness.

    Everyone should be given a second chance. Everyone including HIV+ can be a productive member of society. Noone should stamp any death sentence or moral judgement over an illness. So please get off your moral high horse before you say anything else.

    If other Govts can subsidies HIV medication, I see no reason why our Govt cannot. Are HIV+ patients exempted from paying taxes then?

    When your own loved one contracts HIV, are you going to just walk away & abandon him/her. Even animals stay with their downfallen (as seen in Japan’s recent tragedy – the dog staying with its companion) – judge others – judge yrself.

  18. 24 concerned citizen 3 June 2011 at 14:18

    Great post highlighting the inconsistencies and utter ineffectiveness of the government’s policies in tackling HIV infection in the country. Much has been said in the articles and the comments, but I’d add a few points here:

    (1) It is misleading that Prof Leo cites the price reduction for Combivir and Stavudine in Singapore as any evidence of progress in the nation’s care for its HIV+ patients. What Prof Leo didn’t mention is that drugs like Stavudine is so old and so toxic that the World Health Organization has long recommended it to be phased out of first line treatment regimens in THIRD WORLD COUNTRIES in favor of newer and less toxic alternatives. It is laughable to read that the best that our government can offer its HIV+ patients is reduced prices for drugs that much of the world is abandoning. As you have rightly pointed out, all the latest drugs that are much more efficacious and much less toxic are out of reach here because they are so expensive. Consequently, in an age when it is medically proven that earlier initiation of treatment improves disease prognosis and reduces transmission, patients here have still have to wait till the last moment for fear of running out of drug choices.

    (2) In a country that prides itself as the medical hub, the standard of care for HIV patients remains on average lower than many developing countries. In the US, drug resistance testing is the standard for all patients starting antiretroviral treatment. In Singapore? Resistance testing is not offered anywhere and patients are advised to travel to Bangkok to get it done if they can afford it. For the vast majority of patients, everyone takes a chance at starting a cocktail that may prove ineffective due to transmitted drug resistance.

    (3) Many HIV+ Singaporeans are not willing to be treated in Singapore for fear of discrimination and a lack of anti-discrimination policies. Those who can travel will fly under MOH’s radar and get treated in neighboring countries with better facilities and access to cheaper and NEWER medication.

    (4) The archaic, inhumane, discriminatory travel ban and deportation of HIV+ foreigners does nothing to curb HIV transmission in the country. All it encourages is more secrecy and fear of being tested and for infected individuals to seek treatment. The government is not able to directly intervene among the high risk groups and therefore promotes a hotbed of transmission.

    I certainly hope that the new cabinet does better to manage the situation.

  19. 25 Mike 15 September 2011 at 22:19

    I am particularly concerned by your point

    ‘8. You may never have sex again because by law you have to inform all future sexual partners that you are HIV-positive even if you have every intention to use a condom.’

    Are you implying that if you have HIV and you plan to use a condom that you shouldn’t have to inform a potential partner?

    The illegality of homosex in Singapore is ridiculous and the removal of it and the implementation of anti discrimination laws would set singapore on par with countries such as Australia and the US.


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