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10 Jun 2009

2.6% HIV prevalence rate among MSM in Singapore

Although figures from the Health Ministry showing new HIV cases among MSM in Singapore to be at an all time high, two sets of data are showing the HIV prevalence rate among MSM in Singapore to be relatively low.

The latest 2008/9 MSM community testing project showed the prevalence to be 2.6 percent, down from 3.1 percent a year earlier, Prof Roy Chan, President Action for AIDS (AfA), told Fridae when asked to comment on the record number of new cases. Some 1,200 men were tested in the latest project compared to 960 the year before. The voluntary, free and anonymous testing service was made available at selected MSM frequented venues including bars and saunas late last year.

The HIV prevalence rate among MSM at the anonymous test clinic run by AfA also saw a decrease from 5.7 percent in 2007 to 4.7 percent in 2008.

"Efforts to increase HIV awareness has not fallen on deaf ears. AfA believes that our efforts to stem the spread of HIV in Singapore in the last 21 years has been reasonably successful among MSM. HIV seroprevalence has remained stable... We have one of the lowest infection rates in any major metropolitan area in the world," said Prof Chan.

"However we cannot be complacent. MSM individuals and groups must continue to mobilise to increase awareness and action to stop the spread of HIV in the community."

According to statistics released by the Health Ministry (MOH) on its website last Wednesday, the number of new HIV infection cases among gay men and bisexuals recorded last year is at the highest since Singapore began keeping track in 1985.

Although the number of HIV cases from heterosexual transmission has fallen from 255 in 2007 to 248 last year, the number of new cases among gay men increased from 130 to 151 during the same period. The number of bisexuals who tested positive also increased from 15 to 34. About 93 percent of the total number of new cases detected were males.

In total, 456 Singapore residents were newly reported with HIV infection last year bringing the total number of HIV infected Singaporeans to 3,941 as of end 2008. If those, 1,799 are asymptomatic carriers, 914 had AIDS-related illnesses and 1,228 have died.

The statement further noted that 50 percent of the new cases last year already had late-stage HIV infection when they were diagnosed, mirroring a similar trend found in previous years.

When asked to comment on the record number of new cases, Prof Chan told Fridae that it is "troubling that we continue to record increasing numbers of HIV infections in the country, despite increased funding and expanded and more intensive educational programming."

He also highlighted that the increase in numbers may be the result of an increase in the number of MSM (men who have sex with men) who undergo voluntary testing as they are "more aware than others of the risks of contracting diseases through unprotected sex." The Health Ministry’s press release noted that “a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (24 percent vs 3 percent), similar to 2007 (29 percent vs 5 percent).

"However we cannot deny that there are still significant numbers of MSM who indulge in unsafe sexual practices. The majority of MSM are educated and knowledgeable, and are well aware of the risks of such behaviour; however for a variety of reasons some have chosen to be reckless and careless." Said Prof Chan who has been involved in the voluntary community-based organisation since the late 80s.

He further said that many MSM have multiple concurrent partners, which carry the highest risk of disease transmission if sex is unprotected, compared to having serial multiple partners.

Citing "ever increasing opportunities for meeting and having sex - whether it be in saunas, bars, clubs, parties or over the Internet," Prof Chan urge venue and business owners to play their part to ensure that clients and customers are well informed, and behave in responsible manner when they are in their premises or communicating in cyberspace. 

Experts recommend that sexually active gay men get tested for HIV every 12 months.

Action For AIDS Anonymous HIV Testing & Counselling Clinic
DSC Clinic, 31 Kelantan Lane, #01-16, S200031
Tue: 6.30 to 8.00pm
Wed: 6.30 to 8.00pm
Sat: 1.30 to 3.30pm
(except on public holidays) $20 per HIV test (blood or oral fluid)
$20 per Syphilis test
No personal particulars are recorded even with positive results. Results are returned in approximately 20 minutes.

For a list of six other clinics that provide anonymous HIV antibody testing in Singapore, click onto hpb.gov.sg/aids

For anonymous testing sites in other Asian cities, click onto fridae.asia/kys and select <WHERE>.


Reader's Comments

1. 2009-06-10 23:08  
then one wonders where the government is getting figures from. if people down below are getting different figures, that's just plain odd...
2. 2009-06-11 00:28  
Want to know what it is like going for a test at the AFA Anonymous Test Site? Watch this: http://www.youtube.com/watch?v=Ff_eIKs5lmg
3. 2009-06-11 05:00  
I'm not sure I believe these figures. I think many Singaporeans and Singaporean residents test outside Singapore and conceal their status from the government.

Talk to any HIV doctor at a major hospital in Bangkok and they will tell you they have a large number of Malaysian and Singaporean patients. Gay men, who are more aware of HIV than the general population, test outside Singapore when possible. That's my experience!
4. 2009-06-11 06:45  
How do you slow down HIV infection rates in a country where you are not allowed to acknowledge that anal sex can be healthy if consent is obtained and if condoms are used?
5. 2009-06-11 10:32  
Re: Percole

Actually Singapore does acknowledge that it's a personal choice with the recent partial repeal of 377 which is rather biased towards heterosexuals.
6. 2009-06-11 11:26  
"The majority of MSM are educated and knowledgeable, and are well aware of the risks of such behaviour; however for a variety of reasons some have chosen to be reckless and careless." Said Prof Chan.

I have yet to see any research on the reasons and motivations for "reckless and careless" choices, other than the usual anecdotal culprits of too much alcohol or drugs impairing judgment. Anybody know of anyone anywhere doing that kind of study in the MSM community?
7. 2009-06-11 13:01  
After decades of reading statistics and studies, articles, anectotes, and editorials and watching TV talk-shows discuss HIV: I've reached a point that I have to take the position of "who cares about reports and statistics"? How do they help us? How do they change OUR behavior? How do they change our governments' behavior? After decades of witnessing friends and family get sick and die, and now witnessing a new generation of youth who really "don't care" about safe sex because thanks to rich, large drug companies HIV is now "manageable" and because living on the edge and taking dangerous risks is "fun". On our TV's, in the media and internet, we've been exposed to X-treme Sports and now it's X-Sex. When it comes to HIV, it's easy to lie, easy to hide and easy to live in denial...in most cases HIV lies dormant for as long as 10 years (or longer)...and in some cases HIV doesn't adversely affect it's host at all. HIV medications (like cold remedies) has become big business. Disease Management has become an emerging and globalized industry, and "cures" just don't fit into the business plan. Producing and distributing anti-viral medications = big money. A CURE for HIV does NOT. As long as SEX and HOMOSEXUALITY are stigmatized, criminalized and people like us are marginalized and fear for our jobs and our lives, the true nature and magnitude of HIV in the homosexual segment will never be understood. One of the "bottom lines": We have to take care of ourselves and be responsible and accountable for our own behavior...no person, no government are really willing or capable to do it for us.
8. 2009-06-11 18:53  
HIV statistics from Singaore often make for interesting reading. For example, it is quite remarkable that a significant majority of new infections arise from heterosexual transactions, yet the gender of the infected individuals is predominantly male. It's relatively unusual for HIV to pass from female to male, yet this is what the numbers suggest.

It is also interesting to ponder the circumstances under which prevalence amongst MSM could decline in the absence of a cure having been discovered.

A conclusion could be that with the exception of the absolute number of notifications of new disgnoses in Singapore (which is most likely reliable), the circumstances by which these infections occured may be less accurate. An environment that encourages sexuality to remain secret might be one that disguises the true nature of the epidemic.

Fridae is a valuable community resource that raises awareness that HIV has little to do with statistics, and much more to do with the decisions we make. I can't help noticing that the reported HIV prevalence amongst Fridae members is considerable less than 1% amongst male members of this site. Does this mean that HIV positive people don't feel welcome here, or that people are not accurate in their response to that part of the profile questions? Or maybe a lot of people who actually don't know their HIV status choose to describe it as negative?
9. 2009-06-12 00:10  
Hi Aput,

I think we may be talking about two different things, even though what you are saying is not unrelated to my point.

I'm talking about public health education, and which better place to start that process than in the schools where you are no longer allowed to say that homosexuality is neutral or that so is consensual anal sex with condoms.

Are there no gay boys in in Singapore's schools. I was one of them and I was out at 14.
10. 2009-06-12 00:12  
Hi laoshiyan,

You may wish to google "social determinants of health + HIV/AIDS".
11. 2009-06-12 00:55  
Hey percole,

We're definitely talking about two different things. LOL~! I was emphasising more on the law and government in general.
12. 2009-06-12 21:59  

Education on safe sex is the most practical - that is if they are truly worried about stemming the uprising trend.
13. 2009-06-13 07:14  
i also would wonder if the people doing the bar/sauna test is bias towards people who believe they have little to worry about... ie i'm behaving well i'll do the test, vs i've been doing lots of unprotected sex... if i do the test.. someone might find out... and if they do.. implications... but in the end the factor in Sg Au or anywhere else is how much viral load the community is carrying, ;thus the need for the medications to bring the viral load down so you don't have the 'land mines' as my dr refers to them, guys who are running very high viral loads and they are very infectious... unlike a positive guy who is on the drugs who is way less infectious.
14. 2009-06-14 07:21  
celibacy is an option...I'm 2 yrs almost, the best choice I ever made given the quality of gay men is usually so low..condoms are no 100% gaurantee and so many squalid queers pull them off any way when they think they can get away with it

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