Currently, 85 per cent of those living with HIV in Singapore know they have the virus, said the Ministry of Health. - PHOTO: ST FILE
SINGAPORE (The Straits Times/ANN): A recent law change that removes the requirement for some people living with the human immunodeficiency virus (HIV) to disclose their condition to their sexual partners, provided they maintain an undetectable viral load, will help Singapore meet global targets to end HIV as a public health threat, said health experts.
This is because the amendment to the Infectious Diseases Act that passed in Parliament on March 7 is likely to encourage more individuals living with HIV to get tested and start treatment, said Assistant Professor Dariusz Piotr Olszyna, director of the HIV Programme at the National University Hospital.
The Joint United Nations Programme on HIV/Aids’ (UNAids) 95-95-95 targets for 2025 emphasise viral suppression among HIV patients, with 95 per cent of people living with HIV/Aids knowing their status, and 95 per cent of this group undergoing treatment. The third goal is for 95 per cent of people undergoing treatment to be virally suppressed.
Currently, 85 per cent of those living with HIV here know they have the virus, said the Ministry of Health (MOH). Of these, 94 per cent are on HIV treatment and, among those on treatment, 94 per cent have achieved viral suppression, the ministry said in response to queries.
Essentially, Singapore’s main challenge in meeting UNAids’ 2025 targets is to get more people who may be living with HIV to come forward to be tested, which the legal amendment incentivises, said Assistant Professor Rayner Tan at the Saw Swee Hock School of Public Health.
“The fact is that the first 95 (per cent) is the most important, and stigma has been a key challenge to getting people tested,” he said.
This is a point recognised by the authorities: The 2023 National HIV Testing Recommendations state that the Republic needs to, in particular, improve efforts to meet the first UNAids target, and that more needs to be done to increase the uptake of HIV testing.
Prof Tan noted his research found that key populations vulnerable to HIV have been fearful of testing because of the current laws.
“With the updated exemption, it incentivises people living with HIV to stay on treatment and monitor their viral load regularly,” he said.
“If everyone did this, we can expect zero HIV transmission and zero new cases of HIV arising from local transmission thereafter.”
MOH told The Straits Times that it aims to achieve the 95-95-95 targets, and is working with partners such as the National Centre for Infectious Diseases (NCID) and non-governmental organisation Action for Aids (AfA) to implement initiatives that increase access to testing and care for people who test positive for HIV, and to make antiretroviral treatment more affordable.
HIV drugs were included in the Standard Drug List and Medication Assistance Fund scheme in September 2020 to lower the cost of antiretroviral treatment, it noted.
“We are lowering barriers to testing through anonymous HIV test sites, making HIV self-testing kits available at pilot sites, and rapid HIV testing at GP (general practitioner) clinics,” added MOH.
On what else needs to be done to tackle HIV transmission in Singapore, experts said overcoming public stigma of HIV is key.
Dr Wong Chen Seong, director of the National HIV Programme at NCID, said discrimination is still a pressing problem for people living with HIV, and may discourage those at risk of infection from getting tested and diagnosed.
“It is critical that we continue to work to reduce HIV-related stigma and discrimination at every level of society, through efforts to increase awareness and understanding, as well as encouraging individuals, organisations and the community at large to be more welcoming of all persons, regardless of HIV status,” added Dr Wong.
AfA president Roy Chan said laws that specifically criminalise the possibility of HIV transmission have not been shown to reduce the spread of HIV.
Instead, the prospect of prosecution and public shaming should one fall foul of such laws results in people putting off testing and treatment and in continued HIV transmission in the community, he said.
Another UNAids target for 2025 is for fewer than 10 per cent of countries to criminalise HIV non-disclosure.
To benefit from the amended law, which has yet to take effect, people living with HIV will have to have maintained an undetectable viral load for at least six months.
They must also have test results showing an undetectable viral load dated nine months or less before the date they have sex, and must have adhered to their medical treatment during this time.
The law will continue to criminalise HIV non-disclosure for people living with HIV who have not suppressed their viral load.
This is as the aim is not to relax public health safeguards against HIV transmission, but to encourage infected people to come forward to be tested and treated, thereby better protecting their sexual partners, Senior Parliamentary Secretary for Health Rahayu Mahzam told Parliament during the debate on the amendment.
“Irresponsible behaviour that can lead to the transmission of HIV remains an offence in Singapore, and appropriate enforcement action will be taken as required,” she said then. - The Straits Times/ANN
