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1 Dec 2006

singapore launches new HIV committee, keeps old mindset

Starting 1 Dec 2006, World AIDS Day, a new national policy committee - chaired by Dr Balaji Sadasivan - will work to combat a rise in the number of HIV cases and provide guidance on all policy matters related to HIV/AIDS. Alex Au questions if the absence of gay representation on the panel will prove to be a serious weakness.

The Singapore government is forming a new National HIV/AIDS Policy Committee, starting 1 Dec 2006, to better co-ordinate the fight against the disease. Announcing this, the Health Ministry said the committee is meant to "provide guidance on all policy matters related to HIV/AIDS, including public health, legal, ethical, social and economic issues."

Dr Balaji Sadasivan (right), who already holds two portfolios as Senior Minister of State - in the Ministry of Foreign Affairs, and the Ministry of Information, Communication and the Arts - will chair the new National HIV/AIDS Policy Committee.
Chaired by Dr Balaji Sadasivan (right), who already holds two portfolios as Senior Minister of State - in the Ministry of Foreign Affairs, and the Ministry of Information, Communication and the Arts - the committee is being touted as an inclusive, broad-based body.

Where HIV policy used to be a matter for health-care professionals, the Ministry said in its statement, the new committee will comprise representatives from seven ministries, three health-related government departments and two non-governmental bodies.

Just two.

One of them is Action for Aids and the other is the Aids Business Alliance. There are no representatives from the various communities that are most vulnerable to HIV/AIDS; there is no gay representation on the panel.

The way the committee is structured, heavy with bureaucrats, it looks more like a vehicle for implementation than policy development, despite the stated intentions. Singapore bureaucrats are not known for thinking out of the box and speaking their minds, especially on social issues when the "Singaporeans are conservative" mantra has been given the weight of official dogma, but they can be very efficient in execution when they've been told what to do.

These representatives will come from ministries of Defence, Home Affairs, Youth and Sports, Manpower, Education and Information, beside the Ministry of Health. The three government departments are the Communicable Diseases Centre, the Health Promotion Board and the National Skin Centre (which also looks after other sexually transmitted diseases).

There seems to be very little provision for bottom-up voices from affected segments of the population, such as the gay community. Out of 149 new HIV-positives reported in the first half of this year, 39 (26%) were homosexual, 88 (59%) were heterosexual and 6 (4%) bisexual. Seven cases were infected through intravenous drug use, while nine cases were of uncertain transmission route.

This lack of representation from the community is likely to prove a serious weakness, because it is often non-governmental groups that have novel perspectives on issues, with the guts to say so. If they don't have a voice, then the committee will suffer from both a lack of fresh ideas as well as a real feel of the ground.

For example, gay sauna owners are right there at the frontline in the battle. The way they provide or not provide condoms, lube and information can make a critical difference. What are their difficulties in doing so? What are their concerns?

Do we know whether they remain concerned about whether the police will use the presence of condoms on premises as evidence that homosexual activity is taking place there, something that remains illegal under Singapore law?

And there's the rub: Because the law remains in place, it will be very difficult for ministers and bureaucrats, however well-intentioned, to engage with people who either provide for, or do homosexual sex. Engaging would put them at variance with policy laid down by their political masters, surely not the best career move a bureaucrat can make.

On the other side, the law disincentivises gay people and sex-related businesses from wanting to dialogue with the committee and the government generally, for they may perceive that doing so would either be a waste of time, or even put them at risk of prosecution.

It's hard to imagine how the committee can really "provide guidance" to policy if they remain disconnected from the ground.

In any case, Dr Balaji seems to have made up his mind as to the strategy to be implemented. He wants to treat HIV/AIDS as an infectious epidemiological problem like any other, with an emphasis on testing and contact tracing. He told The Straits Times that people are waking up to the fact that standard disease control methods have to be applied to AIDS to bring it under control.

"Imagine we had SARS [Severe Acute Respiratory Syndrome]," he explained, "and... we mustn't know who has SARS, we can't contact trace how SARS is spread... and you try to control SARS; you will not control it."

He was referring to how people have been extra-sensitive about HIV testing and disclosure in the past.

He realises that for his pet strategy to work, he must combat stigmatisation of People With Aids which may explain the fact that the Aids Business Alliance has been invited to be on the committee.

Its representative, Mr Zulkifli Baharuddin, said his role would be to look at how to reduce discrimination against Aids sufferers in the workplace, and to find ways for the authorities to help businesses with afflicted workers cope.

Yet, before that, at the prevention stage, there is also the question of the stigmatisation of gay people. This is what makes the community hard to reach in terms of educational efforts, hard to persuade to come forward for testing, and hard to do contact tracing, should that be necessary.

Why? Because societal homophobia imposes a cost on gay people should they identify themselves as gay; thus they avoid revealing their identities when socialising sexually - so no plan for contact tracing can work - and they may even think that testing puts their privacy in jeopardy. This is especially as the government has just signalled its intention to keep homosexual sex between men a crime.

So here we have a Minister that wants to destigmatise issues relating to HIV/AIDS, even as his own government is making a deliberate decision to keep it on the law books, thus giving support to a homophobic climate.

This is one of the many conundrums that the committee charged with policy development must sort out, yet the chances are that, without gay representation on board, they won't even know of the problem.

Straight Singaporeans do not make the connection between the anti-gay law and HIV-prevention efforts. They do not see how repeal can be any help in the latter. This is one of the key findings I will be presenting at the upcoming Singapore AIDS Conference.

In a way, this is not surprising because with the relative invisibility of gay characters in media due to censorship, Singaporeans generally have no idea of what it feels like to be gay. Without any opportunity to see life through a gay perspective, they do not have any clue what it feels like to be discriminated against sexually, or to live in the closet.

So when gay Singaporeans say the law is one of the hurdles to a more effective HIV policy, it is met with disbelief.

And without a gay voice in the Dr Balaji's committee, this uncomprehending attitude is likely to persist.

Alex Au has been a gay activist for over 10 years and is the co-founder of gay advocacy group People Like Us. Alex is also the author of the well-known Yawning Bread web site. He will also be speaking at the Singapore AIDS Conference on Dec 2.

Singapore

Reader's Comments

1. 2006-12-01 22:35  
You are born here, you grow up here, and you live here, so get used to Singapore
No gay men in the committee? I wonder who will represent AFA and who will represent NSC
We have to work with the government
Stopping HIV from repeating the ravage it did in the 80s in US, Europe and Australia doesnt have to include gay rights, which is a separate issue
Safe sex message is the same for everyone, men, women, straight, gay:
Always use condoms
Do not take drugs (as it has been shown to result in unsafe sex)
Fight the system, and lose the battle
2. 2006-12-02 00:47  
Been away from SG for a few weeks. Reading this simply makes my heart sink. Balaji and the Ministry of Health, and Singapore in general simply are not adopting best practises when it comes to HIV prevention and care. All talk about engaging the at risk groups in a dialog and involving them in a multi-pronged HIV strategy is merely lip service.

Things are so different in Hong Kong where the Dept of Health has placed MSM on the top of their priorities and are actively engaging MSM in developing programs that will have the best and most effective impact on the community. This is the GIPA principle (Greater Involvement of PLWHA). But I'm sure Balaji has never even heard the term.

Singapore civil servants, clinicians and doctors don't have the guts to tell their administrators that they are wrong, and the result is that more people are going to die because the government has been negligent and just plain stupid. We have a bunch of half-witted ass-kissers trying to win political brownie points running our HIV program, and they will remain so until they change their act.

It is ludicrous that "Dr" Balaji keeps referring to a "condom parade" whenever someone suggests that emphasis should be placed on promoting condom use, citing that our society is "too conservative" to accept it. Someone high up please do the right thing and put somoene in place who isn't so misinformed and unsuitable to lead our HIV program.
Comment #3 was deleted by its author
4. 2006-12-02 06:23  
the problem will be solved in ten years time. stay tuned!
Comment #5 was deleted by its author
6. 2006-12-02 08:35  
As long as you stay in Singapore, you will be a 2nd class citizen forever. The government only want you when they need you. Look for other alternative. Leave the land that has forsaken you, like me.

Another way is to vote against the government, but tsk tsk, that will have to wait another 5 years. You voted for them right ?? Now they don't need you so why complain and be so worried ??
7. 2006-12-02 18:16  
If you're in Singapore, watch the 10pm news tonight for coverage of the Aids Conference today.
8. 2006-12-03 02:23  
Same old singers with the same old song. Brought to you by the same old people who have lost their grip on what's really going on. Same old overpaid folks who haven't had a clue for a while now. The boys are right: make that choice if you're lucky to make it and leave. Also right about fighting the "system", it IS a losing battle. I've lost friends to AIDS and enough is enough so stay and fight if you want to be a martyr. If not, do your bit and speak out to the world with what you can: by your words to people you meet, with letters, with blogs. There's only so much the regime can handle. Peace.
9. 2006-12-03 10:19  
I am now living in Australia and do not face ssuch descriminations as compared with when I was in Singapore.

My former gay countrymen. Leave Singapore if you can. We are talented people. If you leave and there is a shortage of artistic talents, Singapore will start to think twice. Statistis shows that majority who chose not to live in Singapore achieve better in their careers than those who stay behind. When you leave, you are also helping those who stayed behind.

Food for thought.
10. 2006-12-04 09:13  
all these grumblings about our government is not going to help out with the AIDS situation here. We got to work with them even when we are not represented in the committee. Stop the grumblings. So childish.

11. 2006-12-04 09:23  
Look at what is reported in the Sunday Times (03 Dec 2006). They are gonna consider making "voluntary opt out" compulsory routine testing on your blood for HIV whenever collected, even if you are there for other ailments. What this amounts to is simply a very SERIOUS violation of our basic human rights. They are literally telling you that they are gonna round up all those with HIV and then deal with them. They claimed this follows the US CDC recommendation of how HIV should be managed in the years to come. Pure crap. Singapore loser politicians always love to refer to this reference and that when it suits them but never otherwise.

What is happening to Singapore? First, the stupidity and audacity of the Penal code for allowing straight people to enagage in anal and oral sex but not gay men???!!!; now this? This is absurd?

This reminds me of Hilter butchering the millions of Jews to rid them of a tainted race and only keep only the Supreme white to rule the world. Amazing!

Reflecting on the article Alex wrote, there is a very dark and ominious move by the authorities to "rid" the country of this gay plague and boast to the world that it scored another world's first, in implementiing a complusory, leave no stones unturned, HIV testing success rate...and the 1st to be HIV free, Sars free, chewing gum free, crime free, Soul free, sanity free, conscience free....etc. Geez.

It makes one really ashamed these days to be a Singaporean. Seriously.

Integrated resorts, GST increases, basic utilities hike, transport increases, courting the mega rich Middle East....all these moves spell "SUCK UP" to money and money alone . Nothing else matters in the Singapore administration. People are dispensable.

It's truly really sad. Either migrate or change the administration. Otherwise...die slowly...seriously..
:(
12. 2006-12-07 09:01  
I suggest "Post #8 agks" to travel more often, read widely and open his eyes. This will allow him to have a true understanding of the HIV situation.

Ask yourself, being Homosexual is against the law in Singapore. How do you work with underground activities without breaking the law ??

4D etc etc used to be illegal, the Government made it legal. They have controlled the problems. Why can't the government use the same elements in this logic when tackling HIV issues ???

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