Minister of State for Health Amy Khor took over as head of the national policy committee for HIV and Aids at the beginning of this month, reported the Straits Times, 25 October 2011. She “succeeds” the late Balaji Sadasivan who died September 2010. That the position remained vacant for over 12 months tells you how much importance the government attaches to HIV and Aids.
The committee helps the Ministry of Health formulate policies and strategies for the prevention and treatment of the disease, said the newspaper. On it are 15 other members representing voluntary welfare organisations such as Action for Aids, health agencies like the Health Promotion Board, and other ministries.
Dr Khor said the challenge in Singapore’s fight against HIV and AIDS involves the early identification of those infected.
She also hoped to reduce the ignorance, fear and stigma that work against the early detection and treatment of HIV.
— Channel NewsAsia, 24 Oct 2011, Amy Khor appointed chair of national HIV committee. Link.
Indeed, early testing and treatment is a key issue in Singapore. Most cases surface only when the patient is already at a late stage. However, our policy-makers are only paying lip-service to this mission; there is no sign that they are prepared to do what is necessary to effect real change on the ground. They may think the problem is located in social attitudes and are fiendishly complex, but this is only true to a degree. In several ways, the government is the problem.
At the social level, the obstruction to early testing is simple, something I described in the earlier article Seeing a tiger when it’s just a cat. To begin with, the government refuses to subsidise treatment.
See it from the person’s perspective: Getting tested and finding out that one is HIV-positive is thus the gateway to financial ruin. On top of that, there is social stigma. Here again, the government has done nothing to educate the population that there should be no discrimination against HIV-positive persons; that they are not a threat to the community.
So, is it any wonder, if testing is the shortcut to financial and social death, people would not want to test? Won’t the average person try to put off facing that Hobson’s Choice as long as possible? Exhorting people to get tested is meaningless without addressing questions of cost and discrimination.
Yet exhorting is the route the government prefers because it is cheap. There is a debilitating paranoia about becoming a “welfare state”. Related to it is a tendency to see process as a good enough substitute for results; thus an unwillingness to recognise when exhortation does not work, doing it year after year – witness examples in Courtesy campaigns and Speak Good English campaigns. Recognition of ineffectiveness is too painful to bear for two reasons: officials who dreamt up exhortation cannot bring themselves to admit failure (and these officials, including politicians, stay in positions of power so long, there is little chance of fresh minds being brought to bear on the issue); and if cheap exhortation is conceded not to be working, the stark reality of more costly solutions loom, something they don’t want to think about.
Even more ridiculous is the fact exhortation itself has to bow to political sensitivity. The message being proclaimed is not the needed message but the one that moralists can stomach. Is it any wonder that results are elusive? The ministry avoids talking about condoms – the single most effective way to prevent spread of HIV. Instead it focuses on abstinence. In this is a fallacious belief that no one seems ever to have questioned: that sexually active persons can or will become abstinent. Ha! That is as likely as curry-lovers eschewing spices. Do our officials all live in cloud-cuckoo land?
If not abstinence, the government talks about being faithful. Once again, nobody seems to apply his mind. Not everybody has someone to be faithful to. Many people just aren’t in a relationship, especially those in at-risk groups. How do people become monogamous without being a relationship?
Watch this Mediacorp Channel 5 advertisement and see if you can catch any mention of **gasp** condoms:
Did you notice another thing about the message in the ad above? The first part of it goes all out to paint a scary picture of an advancing invasion. “Asia has the second-highest number of people living with HIV. . . . In Singapore nearly one person is newly diagnosed with HIV every day.” After creating such a scenario of threat, you still expect people tobe nice and friendly to the infected? Such mixed messages are all too common in our local efforts, an issue I will return to further down.
But first, compare the local ad with the much more informative, more targetted campaign for gay men in Vancouver. It gives people a clearer assessment of risk, it explains how exactly early testing benefits you, and most important of all, it uses sex-positive language. And it uses, as you will no doubt notice, sex-positive images.
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Now come to the question of stigma. Social stigma discourages testing. Someone with a known HIV-positive status will likely find himself without a job, without which, he cannot pay for medication. Moreover, without an income, what quality of life is he going to have? The rational thing to do is to avoid testing.
And what tool is the government disposed to use to combat stigma? Exhortation again. Let us preach to employers not to discriminate. Great use that is. You might as well sing to mud.
Why isn’t anti-discrimination legislation considered? My guess is that such would run up against an ideological wall. If there is one “civil right” the Singapore government is earnest about defending, it is the “right” of Singaporeans to inflict their prejudice on others.
There isn’t even any understanding of where stigma comes from, such is the intellectual obtuseness that prevails. Consider this: Not all infectious diseases lead to stigma. Friends will happily tell each other about their experience of dengue fever or hepatitis. The front page of the Straits Times on 25 October 2011 carried a photo of a schoolgirl with tuberculosis.
The infections that carry stigma tend to be ones that are associated with sex – syphilis, chlamydia, gonorrhea and HIV. And this points to the negative associations people make with sex as the root source of stigma. Stigma is moral condemnation made sticky on the persons. Therefore it will be ultimately futile to exhort people not to stigmatise HIV-positive persons while all our other messages and actions scream sexual moralism – the cowardly response to the Abercorombie and Fitch advertisement painted on its temporary hoarding on Orchard Road comes to mind.
Let me use dengue fever as an analogy for a moment: It’s no use treating patients for dengue fever if we make no effort to eradicate mosquito breeding. By the same token, all the exhortation to not discriminate against HIV-positive persons will lead nowhere if we do not stop indulging in our sex-negativity and pandering to self-righteous moralisers.
If Amy Khor hopes for a more enlightened policy and a social environment that is less prohibitive of progress on the HIV-front, there is no better place to start than to encourage positive views of the sexual. If she wants to battle HIV, she must first defeat the homophobes and the prudes.