Senior Minister of State for Health Balaji Sadasivan named gay men's unsafe sexual practices the biggest cause of concern in a speech to doctors at a hospital on Wednesday night.
According to the World Health Organisation (WHO), there are about 4,000 people in Singapore with HIV, and less than half of them have been diagnosed, he said.
In his speech, he said Singapore was fortunate that HIV had not entered the general population in a big way, with the disease generally limited to two distinct groups of men that needed attention: "MSM i.e. the gays, and heterosexual men having casual sex in other countries."
He added, "Of the two, the gays are the bigger concern."
Dr Balaji pointed to the sharp rise in new AIDS infections among homosexuals, from 54 cases last year to 77 in the first 10 months of this year.
"CDC (Communicable Disease Centre) believes that there is a real explosion of the disease among gays. CDC doctors told me that the gays are themselves concerned by the increase in AIDS among gays. This recent explosion of cases is due to the promiscuous and unsafe lifestyle advocated and practiced by some gays. Men who have sex with men are at extremely high risk because of the variety of their sexual practices, the large number of sexual partners with whom they engage with in these sexual practices, and the high percentage of homosexual men who are already HIV- positive."
Dr Balaji criticised Action for Aids (AfA), a Non Governmental Organisation (NGO) that does AIDS prevention education in Singapore for not doing enough to promote safe sex. He highlighted a statement on its web site which he had found to be misleading:
"Not everyone who has sex with an infected person will get infected."
While he admitted that the statement is true, he felt that it misleads and promotes the spread of the infection by giving assurance when alarm would be more appropriate.
AfA clarified that the statement from the Question and Answer page is part of the answer to a very commonly asked question: "Does everyone who comes into contact with HIV get infected?" and was quoted out of context.
AfA responded in a statement: "The best medical and scientific evidence to date puts the risk of becoming infected with HIV from a single unprotected episode of vaginal or anal sex at less than one per cent.
"The statement has never figured prominently in any of our print or publicity material we distribute for the very reason Dr Balaji has mentioned - we do NOT want to encourage risk behaviour. As part of the response to this question and also in responses to other questions on that same web page, we emphasise that unprotected sex IS high risk, we discourage unsafe sexual practices, we discourage young people from having sex, and we specify clearly what constitutes and does not constitute unsafe sex.
"We shall, however, review the statement in our web page based on the concerns he has expressed."
A thirty-something volunteer with AfA who prefers not to named told Fridae that given the laws against gay sex, the policies by the different governmental agencies are not clear. He cited an instance where an AfA booth at the gay Nation party in August this year was asked to shut down by the local police jurisdiction who thought that giving out safer sex brochure and condom packs was promoting gay sex.
Earlier this year, the 15-year-old NGO did not have a chance to circulate its new range of safer sex postcards after being warned by the Advertising Standards Authority of Singapore which objected to the images used.
Roger Winder, AfA's Programme Director told Fridae, "We did receive a warning letter from the Advertising Standards Authority of Singapore in relation to the images on the postcards being unacceptable and our references to oral and anal sex (which they reminded us were illegal)."
Although the Ministry of Health launched its first education programme against HIV/AIDS 1985 and had over the years promoted safer sex to some degree but mostly encouraging monogamy, abstinence, reminding audiences that 'AIDS Kills' and usually avoiding advocating the use of condoms, it never had a single programme that had addressed MSM directly.
Winder said, "We have no problems about advocating monogamy/abstinence ourselves but there also needs to be a realisation that abstinence and monogamy are not practical options for many. The 'AIDS Kills' message is problematic for us because it encourages irrational fear and stigma."
In the speech, Dr Balaji also opposed the use of the term MSM or men who have sex with men as he found the term "a bit graphic and prefer gay which at least has a happy connotation associated with it."
Winder explains: "'MSM' is not meant to be interchangeable with 'gay' or 'homosexual' - 'MSM' is an epidemiological term, 'gay' a more socio-political one, and 'homosexual' a more medical/behavioural/scientific one. The term 'MSM' is supposed to include those who are homosexual [who may or may not identify as 'gay'] but also those who are bisexual [whether they identify as bisexual or not]. In terms of identity, there are males who have sex with other males but who may even identify as heterosexual or 'straight.' The term 'MSM' is meant to ensure that none of the groups mentioned are inadvertently left out in intervention measures. In any case, hardly anyone would socially identify themselves as 'MSM'.
Dr Balaji also mentioned that a recent Fridae article was advocating a promiscuous and reckless lifestyle. He said: "From a public health perspective, the lifestyle advocated in the website which is a life-style of reckless regard to sexual health and safety is dangerous. Those who follow such a lifestyle will run the risk of getting AIDS."
Fridae urges for the article mentioned to be considered in a larger context.
"As the region's largest gay and lesbian web portal and a trusted information source, we recognise the important role we play in the fight against AIDS. We strongly believe that acknowledging a healthy sexual lifestyle is important in getting our readers to relate to our public health messages, which in turn has the highest chance of success in encouraging safe sex behaviours. It is clear that continuing a simple message of abstinence or faithfulness to one's spouse (which has no relevance to many in the MSM community) has extremely limited efficacy," said Stuart Koe, CEO, Fridae.
He however thanked Dr Balaji for breaking the silence and shining the spotlight on a community that has been struggling on its own for the past two decades.
He added, "Despite not receiving any public health funding or being targeted by any of the Ministry of Health's AIDS prevention messages, the gay community has nevertheless recognised the severity and importance of this epidemic, and mobilised itself to fight this disease."
Dr Koe urges all stakeholders to put aside their prejudices, and strive towards an open and honest dialog to continue to develop targeted, effective, sustained prevention efforts that build community capacity to deliver ongoing, lifelong prevention programming for those at risk and those already infected.
For these public health efforts to have effect in the MSM community, the authorities have to first agree to work WITH the MSM community. The consequences of not doing so will be a continued disconnect between the two parties, and a potentially dire impact on the rates of HIV transmission in Singapore," he said.