U=U: Science, Not Stigma

Sexual transmission of HIV can be stopped. While there are many barriers to ultimately reaching this goal, one of the most exciting and recently validated concepts resulting from large-scale studies is that of U=U, or Undetectable = Untransmissible.

U=U means that people living with HIV (PLHIV) with a suppressed/undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The landmark trial of HPTN 052, and subsequent PARTNER, and Opposites Attract studies showed that no linked HIV transmissions were detected between thousands of serodiscordant couples (where one partner is known HIV-positive and one is HIV-negative) as long as the viral load remained undetectable throughout the relationship. This was demonstrated for both heterosexual and homosexual couples, and the greater acceptance of the science has potentially vast implications for personal and public health, social and behavioural norms, and even legal matters.

In order for someone living with HIV to reach undetectable viral load, they will need to be on daily antiretroviral therapy (ART) for at least 3-6 months, and must continue on the medication to maintain viral suppression. Treatment as Prevention (TasP) has been strongly advocated for many years now by HIV specialists and other healthcare providers, but the science and messaging has finally caught up. And for PLHIV, growing awareness and acceptance of U=U will hopefully serve to reduce stigma and discrimination, as well as improve compliance to treatment and follow up.

In 2014, UNAIDS launched the 90-90-90 program which aims to diagnose 90% of all HIV-positive individuals, provide antiretroviral therapy to 90% of the people diagnosed and achieve viral suppression for 90% of those treated by 2020. Current estimates from the Ministry of Health are that only 72% of people living with HIV in Singapore know their status, out of which 89% are on treatment, with the proportion of people on treatment who had achieved viral suppression fairly high at 94%. While the latter two figures are encouraging, more needs to be done to improve HIV testing and diagnosis. Local data shows that only 23% of HIV cases are currently being detected via voluntary screening, while 41% of HIV cases are diagnosed in a late stage.

With over 6,000 people in Singapore currently diagnosed as living with HIV, this means that close to 2,500 are estimated to have the infection without knowing their status. With U=U being a reality, getting at-risk individuals tested and on treatment as early as possible is essential in our fight against HIV. For those who already know their HIV-positive status, there is now additional cause to adhere to ART, as doing so will protect potential future partners from potential transmission.

While U=U is great news overall, there are certain caveats we must remember. For U=U to be considered effective, PLHIV must have an undetectable viral load for a duration of at least 6 months on follow up. Furthermore, studies which have shown that over a quarter of HIV-positive gay and bisexual men in a serodiscordant relationship did not have an accurate understanding of their current viral load, with around 20% of men who believed they were undetectable actually having a detectable viral load. As such, regular condom use and testing is still strongly recommended, as is the wider uptake of Pre-Exposure Prophylaxis (PrEP). It’s also important to note that U=U only applies to HIV infection, so precautions should still be taken against other more common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis.

U=U is a simple but important message based on a foundation of scientific evidence. The campaign makes a strong case for adherence to treatment and follow up, and allows PLHIV and the community to understand that they can live long, healthy lives, have children, and enjoy relationships without having to fear passing the infection to others. It will hopefully bring us a few steps closer to achieving the UNAIDS’ 90-90-90 target and help to reduce the stigma still faced by many living with HIV today.


Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

We touched on the COVID19 situation and the active steps one can take to minimize and prevent infection risks on our past two articles.

Furthermore in our last article we also delved deeper into some of the situations one may face whilst at home, running out of needed medications or even repeated sneezing and scaring away every around. 

But wait, I don’t need further medications, I don’t need to get my sneezing checked but I have this fever which I am worried about. What should I do doc? 

Fever is one of the classic symptoms of one’s body responding to an infection. It is a signal that the immune system is reacting to a foreign invader. These foreign invaders can be anything from the seasonal Influenza Viruses, upper respiratory tract bacterial infections, Dengue fever, the dreaded COVID19 virus or even worse, the most feared HIV virus.

Before we get carried away, let’s explore the facts behind each of these concerns and hopefully we can provide you a handle on how to get these concerns further addressed. From the recapitulation of COVID19, to upper respiratory tract infections and last but not least prolonged fever from possible HIV. 

COVID 19 

Let’s start with a short recap of COVID 19, from the WHO-China joint COVID 19 mission, it was studied that those who are at great risk of severe disease and death include those above 60, those with underlying chronic conditions. And of course as previously discussed, the risks of COVID19 include travel to at risk countries including China, especially Wuhan and Hubei provinces, South Korea, Iran and Northern Italy as of March 2020.

Practically the same advice shared previously of personal hygiene and avoidance of crowded places and even ordering in the medications you need delivered to your home would still stand.

Also read: STAYING AT HOME AND ORDERING IN (A PIZZA) YOUR MEDICATIONS

Upper Respiratory Tract Infections 

Secondly if it were an upper respiratory tract infection caused by other viruses or bacteria, it would be good to have your doctor assess you especially if there are symptoms of fever, cough, sore throat or runny nose. In the current climate, these symptoms would warrant one to get extended rest at home with a doctor’s note (medical certificate) for at least 5 days. When we get an infection in the upper respiratory tract – nasal passages or throat, it is usually caused by either a bacteria or virus.

SYMPTOMS OF A COLD

A cold is a viral infection of our respiratory tract, and there are more than 200 types of viruses which can cause this. It is also a gradual Onset.

SYMPTOMS OF FLU

Sudden onset. Contagious after coming into contact with droplets. The FLU virus can cause a lung infection called pneumonia.

So doc, i’ve heard alot about antibiotics as well, can I just get them prescribed to me for my fever?

Antibiotics however only work against bacteria infections.

Instead of taking too many unnecessary medications, you can get tested to see if you have the flu or a bacterial infection.

Point of care testing is convenient, accurate and gives you an answer in 15mins. Furthermore for those at risk or diagnosed with Influenza (above 60 or have chronic diseases) – antivirals can be prescribed. These include XOFLUZA (a one off treatment) or TAMIFLU and lastly if it is likely a cold, vitamin C and zinc are shown to aid in recovery.

And last but not least, especially for those at risk, please do not forget your twice yearly flu vaccinations (Northern and Southern hemisphere strains respectively) and 2 different jabs for a lifetime protection against Pneumonia.


Fever from HIV

But that being said, what happens then if one’s fever is still persistent and there were concerns from a recent sexual exposure? Especially if it was a causal partner and or someone you met overseas?

The CDC page tells us that HIV is spread when anal or vaginal sex, without a condom occurs with someone who has HIV. The other way HIV is spread is through the sharing of needles or syringes, or even equipment used to prepare drugs for injection with someone who has HIV. Some studies have shown that HIV can survive in a used needle for up to 42 days depending on environmental factors. Temperature etc.

In rarer cases, HIV can be spread through oral sex.

The main transmission medium of HIV however is through fluids and these are predominantly blood, vaginal fluid, semen and even saliva. Here are some statistics from medical studies that have been done. And as you can see, needle sharing, needle use has the highest risk followed by anal intercourse.

Ultimately all these statistics mean nothing, if the concern is still there and there is an exposure, the best thing to do for an ease of mind would be to speak to your doctors and decide whether the Rapid HIV test is something necessary for you.

In summary, there are many causes of fever. In the current climate, fever persisting for more than 5 days can be worrisome. And common things being common, in the absence of a travel history, it is most likely due to an upper respiratory tract infection arising from a cold, influenza or even bacteria. The likelihood of COVID19 is low, but one must also keep a suspicion for infections such as dengue and in the rarest of events HIV. Seeing a doctor early would help you get some point of care tests done with results almost immediately to guide your clinical care and most importantly give you a peace of mind.

Take care, stay safe.


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  • References
  • Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  • Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  • Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  • Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  • Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006


People Living With HIV In Singapore

The alarm chimes to life. As the incessant ringing crescendos the clock face starts to flash an LED blue. Mr. J stretches a slim arm out from under the blankets and pushes down on the snooze button. It was 6:00am on another nice balmy morning in Singapore. Because it was approaching the year end it was a cool 24°C. Jumping out of bed, Mr. J prepares for his morning run on the Park Connector, a network of roads and paths linking the various parks and gardens in Singapore.
A quick shower follows his run and he slips into his shite cotton shirt and blue cotton pants, all ready for a 20 minutes ride on the MRT to Raffles Place and his office in the financial hub of Singapore. After a hard day’s work a 10 minute walk takes him to Fullerton One where he enjoys a well earned dinner and drinks with his friends while the sun sets behind the Marina Bay Sands integrated resort. Another most typical day for a typical Singaporean in Singapore. Except for one difference. Mr. J is one of the almost 7000 people living with HIV in Singapore. 
I set up our first clinic at Robertson Walk in 2005 and in 2008 was awarded the mandate to conduct anonymous HIV tests. Mr. J saw me in 2009. He was recently married. His wife had to spend a few days out of town and he saw no harm in engaging the services of a sex worker. He did not use a condom. As the positive line slowly materialized on the test strip, I turned to Mr. J and said “It looks like the test is positive.”
He screamed and he screamed. He could not stop screaming. He grabbed the pillow on my examination couch and screamed into that. Even in the state he was in, he was considerate enough not to scare the other patients in the waiting room. He finally picked up his phone and called his brother. Soon after, his mother and his brother arrived. They spoke and they cried. I told him it was going to be OK but I knew nothing I said was getting through. A few days later Mr. J came back to the clinic, this time with his wife. She tested negative. She had forgiven him and they were going to have a family together. He would be strong, he would take his medicines and he would live what I promised was a long healthy and meaningful life. 


Since 2008 our clinic at Robertson Walk has conducted more than thirty thousand anonymous HIV tests. We have given good news most of the time and bad news more often than we would like. We have diagnosed people from all walks of life, all orientations, all genders, all vocations and a huge variety of nationalities with HIV. It is a virus that does not discriminate. Some took the news with stoic calm, some crumbled mentally, emotionally and physically. We tell everyone the same thing: it is going to be OK. HIV is not a death sentence. HIV is a chronic disease. It is no different from diabetes. You just have to take a single pill a day. You just have to see the doctor a couple of times a year. It is not so bad. It is not so bad. It is not so bad. It is going to be OK. We have held hands, wiped tears and held people together as they mended. 
After the initial shock comes acceptance and the relatively mundane work of getting the virus under control. We walk with them every step of the way from their first blood tests to their first pills. We link them up with emotional support services, we counsel them on their medical finances and step by step, piece by piece their lives reassemble and are made whole again.


On the 1st of April 2015, Singapore lifted its travel ban on people living with HIV. We opened our arms to all in the region who wished for our brand of care. We started seeing people living with HIV come from Malaysia, Vietnam, Indonesia and many other countries in the region. We provided the best care we knew how and watched like a proud parent as their viral loads dropped and the CD4 counts rose. 
2 to 3 out of every 1000 people in Singapore is living with HIV. Did you walk past a thousand people today? On the bus, on the train, in the mall, at your office? Then you have walked past a few people living with HIV. They are no different from anyone else. In fact, I often tell my patients that the people living with HIV I know are frequently in much better shape. Perhaps they appreciate their health more. It is also a myth that once a person is diagnosed with HIV in Singapore the authorities will come flying in and inform his family and his employer and every time he goes past immigration the officers will look at their screens and give him a dirty knowing look.
None of these happens. In fact, laws in Singapore protect the anonymity of people living with HIV and punish people who share someone’s status unnecessarily. Another myth is that HIV treatment in Singapore is unaffordable costing thousands of dollars a month. There are now many schemes in place to make treatment extremely affordable. What still needs a lot of work is the stigma and discrimination. That is why almost every person living with HIV in Singapore keeps their status a secret. That is also why we salute Mr. Avin Tan who went public with his HIV status and now works tirelessly to help others.


The theme of this year’s World AIDS Day is “Communities make the difference. Communities are the lifeblood of an effective AIDS response and an important pillar of support.” Because HIV/AIDS is not “their problem”, it is our problem. Less stigma means a lower barrier to testing which leads to earlier diagnosis and decreasing the risk to others. Less discrimination means more willingness to seek help and treatment which leads to earlier viral load control and less contagion. More support means people living with HIV staying on treatment and remaining physically, mentally and emotionally healthy and contributing to society.


READ: WORLD AIDS DAY PRESS STATEMENT

My Facebook just got updated. There’s a picture of Mr. J with his wife and 2 lovely twin daughters at the Singapore Barrage. They look like they are flying kites or at least trying to. His girls must be 6 years old by now. 6 years since I tested both of them to be negative for HIV. They look like a really happy family. A typical Singaporean family.
Speak to your doctor if you have any questions regarding HIV, Anonymous HIV Testing, HIV Screening and HIV Treatment & Management.


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艾滋病 (HIV) 的症状与治疗方法

大家好,今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

在最初感染后的前2-4周内,患者可能会出现流感样症状, 他们称之为“有史以来最严重的流感”。


这被称为急性逆转录病毒综合征。症状包括发烧,腺体肿胀,喉咙痛,皮疹,疲劳,身体疼痛和头痛。

艾滋病毒症状可持续数天至数周。请记住,这些症状可见于其他常见疾病,您不应仅仅因为体验过它而认为您患有艾滋病毒。还要注意许多早期HIV感染者没有症状。


在HIV感染的早期阶段之后,该疾病进入临床潜伏期,其中病毒在体内发展,但没有看到症状。如果您正在接受艾滋病治疗,那么病毒通常会受到控制,您可能会遇到可能持续数十年的无症状期。如果您感染了艾滋病病毒并且没有接受治疗,那么它将进展为艾滋病。您可能会出现严重的症状,包括体重迅速减轻,反复发烧,大量盗汗,极度疲倦,腺体肿胀,腹泻,口腔溃疡,肺部感染和神经系统疾病。

即使您遇到上述症状,除非您接受检测,否则无法确认HIV。


如果你担心自己有可能跟性(爱)产生接触或正在经历类似状况,请到我们的诊所进行相关咨询和诊测。

与医生预约

HIV / AIDS: The Differences & Myths Surrounding Them

HIV & AIDS in Singapore

There were 434 reported cases of HIV infection among Singapore residents in 2017. Of these cases, 94% were male and 6% were female, and 71% were between 20 to 49 years old. Among ethnic groups, 69% were Chinese, 19% were Malay, 6% were Indian and 6% from other ethnicities.
Sexual intercourse remains the main mode of HIV transmission, accounting for 96% of all cases. Heterosexual transmission accounted for 36%, while 51% were from homosexual transmission and 10% from bisexual transmission.  The number of new HIV cases among Singapore residents has remained consistent at about 450 per year since 2008. These are the latest statistics published by the Government Technology Agency of Singapore, which analyzes data provided by the Ministry of Health.
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What’s the difference between the two? 

HIV is a virus that causes weakening of the body’s immune system. It does so by destroying white blood cells that protect against bacteria, viruses and other harmful pathogens. Without these white blood cells, the body is will no longer be able to defend itself effectively against such infections.
AIDS refers to a spectrum of potentially life-threatening conditions that are caused by the virus, and is the end stage of HIV infection.


How does HIV progress to AIDS? 

HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage (Latent Stage) may present with lymph node swelling, but most patients may not have any symptoms at all. The second stage can last anywhere from a few years to over 20 years. Thus, many HIV-infected patients, especially during this stage, may not even know that they have contracted HIV. Last but not least, the third stage is the presentation of AIDS. 
Without adequate treatment, up to 50% of HIV-infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. Various virus-induced cancers, and opportunistic infections such as tuberculosis and recurrent pneumonia may occur, and these are the leading causes of death worldwide in patients with AIDS.


Who should test for HIV?

Everyone! It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of your routine healthcare. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.


Are you at risk?

If you answer “yes” to any of the questions below, you should get a HIV test if not done recently.

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with a HIV-positive partner?
  • have you had more than one sex partner?
  • have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated hepatitis or tuberculosis?
  • Have you had sex with someone who could answer yes to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are four types of HIV tests available.
1. Nuclecic Acid Test (NAT) 
Also know as a HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/ antibody test at the same time to help in the interpretation of negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT.
NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.
2. Antigen/ Antibody Test
Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.
The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.
3. Antibody test
This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV.
The antibody test is able to detect HIV in the blood approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result.
4. HIV Pro-Viral DNA Test

The HIV Pro-Viral DNA test can be used in specific situations where there are challenges to getting an accurate HIV diagnosis with other available HIV tests including HIV Antibody tests (3rd Generation HIV test), HIV Antibody and Antigen tests (4th Generation HIV test) as well as HIV RNA PCR test.

It is especially useful in the following situations:

  1. Diagnosing HIV in newborns born to HIV +ve mothers
  2. Elite controllers with undetectable HIV viral load despite not being on anti-retroviral treatment
  3. Individual with sero-negative HIV infections i.e. People who get infected with HIV but do not develop anti-HIV antibodies : see FALSE NEGATIVE HIV ELISA TEST

It can be used for situations where the diagnosis of HIV is challenging. It has a lower false positive rate compared to the HIV RNA PCR test when used for diagnosis and it can be done 10 days post exposure.


Can you share the 4 most common myths about HIV? 

1. HIV is a death sentence. 

This may have been the case several decades ago, where without prompt and adequate HIV treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV-infected patients today are still able to lead healthy, productive lives and may never develop AIDS.

2. HIV can spread by kissing, sharing of food or close contact. 

It is extremely unlikely to contract HIV via these methods as HIV is not spread by saliva. However, if the person you are in contact with has mouth sores/ulcers, bleeding gums or open wounds then there is a possible risk. HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission. 

3. HIV can spread through mosquito bites. 

This is completely untrue as the virus cannot survive and replicate within the mosquito’s body.

4. There is no need to use a condom during sexual contact if both partners already have HIV. 

Different strains of HIV exist. If two HIV-infected partners are carrying different strains of HIV, having unprotected sexual intercourse may result in the exchange of these strains, leading to re-infection. Treatment in this situation becomes more difficult as the new HIV strain may be more resistant to the current treatment, or cause the current treatment to become ineffective.


What are the 4 things (facts) we should all know about HIV that we probably don’t know already?

  1. Under the Infectious Diseases Act, it is an offence for people who know that they are infected with HIV or AIDS in Singapore to not inform their sexual partners of their HIV status before engaging in sexual intercourse.
  2. For those who are worried but too afraid to undergo HIV screening, there are 10 clinics in Singapore that offer Anonymous HIV Testing (AHT). AHT is made available so as to encourage more individuals who suspect that they are at risk to go for early HIV screening. There is no requirement to provide any form of personal particulars, even if the test comes back positive.
  3. Persons who plan to engage in high-risk sexual behaviour can reduce their risk of HIV infection by taking Pre-Exposure Prophylaxis (PrEP). This is an oral medication that, when taken correctly, can reduce the risk of HIV transmission through sex by over 90%. Persons who did not take PrEP prior to engaging in high-risk sexual behaviour are eligible for Post-Exposure Prophylaxis (PEP). This is a one month course of oral medications that must be started within 72 hours of the sexual exposure, the earlier the better.
  4. The current tagline in HIV is Undetectable = Untransmittable (U=U). In recent years, there is overwhelming clinical evidence proving that people living with HIV who achieve and maintain an undetectable HIV viral load by adhering to their treatment cannot sexually transmit the virus to uninfected partners. Several large studies had been conducted over a course of 10 years between 2007 to 2016, involving thousands of heterosexual and homosexual couples. In these studies, there was not a single case of HIV transmission from a virally suppressed person to their uninfected partner. This is life changing for people living with HIV. In addition to being able to choose to have sex without a condom, this news allows them to approach existing or new relationships with a sense of liberation. 

Speak to our doctors for professional advice or if you wish to find out more information on HIV and AIDS.
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World AIDS Day 2019 Press Statement

World AIDS Day is a day to remember all those who have lost their lives to the illness. At the end of 2018, it is estimated that 32 million lives were lost worldwide to the disease. WHO had previously set the 90-90-90 target for countries in the world to achieve by 2020, 90% of those living with HIV will know their status, 90% of those who are positive are on ART treatment and 90% of those who are on treatment have undetectable levels of the virus. Let us take stock of what we have been able to achieve thus far.


Since then Singapore has risen to the challenge to achieve those goals.
 Singapore has done well with 2 of the goals – 89% of those who are positive are on ART treatment and 94% of those who are on treatment achieved undetectable viral loads. However, much has to be done to improve on getting those living with HIV to know their status as only about 72% are aware they are positive for HIV.
Thus we need to encourage more people who are at risk of HIV infection to get tested. At Dr Tan and Partners we have been strong advocates of screening of HIV and STIs for at risk persons and provide a non-judgmental and LGBT-friendly environment to discuss your concerns. This is to help to protect their families and their loved ones. It is not uncommon for people that I see in my practice to tell me one of the reasons why they are reluctant to get tested is because they are afraid of what will happen if their families or their loved ones find out.
The other common concern is that they will lose their jobs. Finally there are still many misconceptions about how HIV is transmitted. I have patients who are concerned that because they share food with their families they can transmit HIV to their family which is of course not true. HIV is NOT transmitted via casual contact like sharing of food and drinks or shaking hands.


Of note in Singapore as of 2018, of all those who were tested positive more LGBTs are stepping up to get voluntary testing for HIV (20%) compared to heterosexuals (9%). Also importantly, in all newly diagnosed HIV persons in Singapore both homosexuals (42%) and heterosexuals (43%) contribute equally to number of cases. What this shows is that contrary to what some believe, HIV is NOT a homosexual disease but it is a disease that affects all sexual orientation.
Finally, there is strong evidence from large studies involving thousands of sero-discordant couples (that is one partner is HIV positive and the other partner is HIV negative) who have sexual acts between 2007-2016 showed that there was not a single case of HIV transmission to the HIV negative partner if the HIV positive treated partner has undetectable levels of HIV virus. This highlights the importance of treatment of HIV, that treatment of HIV can be successful in achieving undetectable levels of virus and that transmission of HIV is effectively blocked when levels of the virus is undetectable.


We are proud that our Doctors at DTAP have been actively involved in the fight against the HIV epidemic. Our Anonymous HIV Testing site at Robertson Walk has provided a safe space for thousands of people seeking confidential HIV testing since 2005. Our Doctors were the lead and co-lead authors of the Community Workforce section in the Blueprint to end HIV transmission and AIDS in Singapore by 2030. Our Doctors were also part of the Singapore HIV PrEP Taskforce and helped write the first ever local Singapore guidelines for the clinical management of HIV PrEP.
We will continue this fight until we see a world free of stigma, free of discrimination and hopefully free of HIV.


Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

A Case of HIV from Vampire Facial

Our clinics recently diagnosed a case of HIV from a vampire facial.
A Vampire Facial is a type of cosmetic treatment that was made popular by celebrity Kim Kardashian.
The treatment involves taking the patient’s own blood and spinning it down until the cells separate out of the liquid portion (plasma). Small needles known as micro-needles are then used to make multiple small holes in the patient’s face. The plasma is then poured over the face so that it soaks into these holes.
Two cases of HIV infection from such treatments were reported earlier this year in Albuquerque, New Mexico in the US. https://www.medscape.com/viewarticle/912436
Vampire Facial treatment is NOT approved in Singapore.

What Can You Do to Protect Yourself?

Before undergoing a treatment, ensure that the establishment has all the proper local licenses required.
Ensure that the therapist conducting the treatment has all the training certifications required.
Do not undergo any treatments in non-medically licensed establishments that involves blood or body fluids.
For treatments that involve puncturing or breaking the skin, ensure that the instruments used are properly packaged and sterilized. 
Insist on seeing the operator open the sealed package in front of you.

If you feel you might have been exposed to an infection, see your local Doctor immediately for a discussion on HIV PEP and screening for other blood-borne infections like Hepatitis B and Hepatitis C.


Learn More about Other STDs & Other STD Symptoms

Descovy As New HIV Medication For HIV PrEP

What is HIV Pre-Exposure Prophylaxis (PrEP)?

HIV Pre-Exposure Prophylaxis (PrEP) is the use of medications to effectively prevent the transmission of HIV. Individuals who are taking PrEP can reduce their risk of contracting HIV infection by up to 99% if taken regularly. This type of medication must be taken before exposure to be effective. It is different from Post-Exposure Prophylaxis (PEP), which is taken immediately after possible exposure and uses additional medications.

PrEP is usually taken as a once-daily combination tablet of tenofovir disoproxil fumarate (TDF) + emtricitabine (brand name: Truvada), although other types of dosing regimens are available as well depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density.

FDA Approved

The FDA recently approved a new drug combination of tenofovir alafenamide (TAF) + emtricitabine (brand name: Descovy) for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as the kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity.

The DISCOVER trial for Descovy as PrEP showed that the new drug is as effective as Truvada in preventing HIV transmission in men or transgender women who have sex with men, when taken as a once-daily tablet. They have not yet performed specific studies to evaluate protection in vaginal sex, or with other PrEP dosing schedules (such as Event-Based Dosing, T’s and S’s, etc.).

However, given that Descovy is essentially just a new and improved Truvada (which has been extensively studied in these situations), it is likely just a matter of time before further studies are done and show similar efficacy.

Descovy also includes a warning in usage as PrEP for patients with known hepatitis B infection, stating a potential risk of hepatitis B exacerbation after stopping the drug. While it can still be used as PrEP in patients with a history of hepatitis B infection, close monitoring of liver function and hepatitis B viral load for up to 6 months following discontinuation of Descovy is recommended (same as Truvada).

Speak To Our Doctors Today!

Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you. Dr Jonathan Ti, MB, BCh, BAO (Ireland), MRCP (UK), Cert. Men’s Health, is a member of the Singapore HIV PrEP Taskforce and is a co-author of the Singapore HIV PrEP Guidelines and is currently practising at our Robertson Walk Clinic.

HIV PrEP does not protect the user against other STDs. Therefore, even if you are on HIV PrEP, it is important to still to use a condom regularly, as well as get your regular STD screening & HIV Testing.

If you are interested to find out more about HIV PrEPplease call our any of our clinics or drop us an email at hello@dtapclinic.com for an appointment with our doctors.

Apakah Simtom HIV Dan STD?

Hai, Saya Dr. Taufiq dari Dr. Tan dan Partners, dan hari ini saya ingin bercakap mengenai simtom penyakit kelamin atau STD, dan HIV.

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Apakah simtom HIV dan STD?

Penyakit kelamin atau STD berpunca dari beberapa jenis virus, bakteria atau kuman yang boleh menjangkiti seseorang melalui hubungan seks dengan pasangan yang sudah pun mempunyai jangkitan tersebut. Penyakit HIV pula berpunca dari virus yang dikenali sebagai Human Immunodeficiency Virus, dan ia juga tersebar melalui hubungan seks.


Simtom-simtom STD

Simtom-simtom STD boleh dibahagikan kepada tiga jenis – simtom semasa kencing, simtom pada kulit dan simtom umum. Simtom-simtom STD boleh mengambil masa yang berbeza untuk muncul – ada yang mungkin seawal 3 hari selepas hubungan seks, ada juga yang mengambil masa beberapa minggu atau bulan untuk menjadi jelas. Ada pula sesetengah orang yang dijangkiti STD, tetapi mereka tidak mengalami apa-apa simtom yang nyata.


Jangkitan Chlamydia dan gonorrhea (CGP)

Jangkitan Chlamydia dan gonorrhea (CGP) adalah penyakit STD yang paling kerap dijangkiti. Antara simtom 2 termasuk pengeluaran cecair dari kemaluan.

Ada juga yang dijangkiti tapi tidak menunjukkan apa2 simtom. Jangkitan ini juga boleh membawa kepada kemandulan.
Di klinik kami di somerset, ada meneyediakan khidmat pemeriksaan CGP pantas.

Anda boleh mendapat keputusan dalam masa 24 jam. Pengesanan awal dapat membolehkan rawatan awal.

Simtom-simtom HIV pula mungkin berbeza bergantung pada individu dan peringkat penyakit.


Simtom-simtom HIV

Bagi seseorang yang mengalami jangkitan HIV peringkat awal, mereka mungkin dapat melihat simtom-simtom tertentu dalam masa 2 hingga 4 minggu pertama.

Simtom yang paling ketara pada peringkat awal ialah selsema yang serius, yang selalu disifatkan sebagai “selsema yang paling buruk yang pernah dialami”.

Keadaan ini dikenali sebagai sindrom retroviral akut, atau ARS. Sindrom jangka pendek ini disifatkan dengan sakit tekak, ruam, keletihan, sakit-sakit badan dan sakit kepala. Simtom-simtom HIV boleh berlarutan dari beberapa hari hingga ke
beberapa minggu.

Selepas jangkitan HIV peringkat awal, simtom-simtom penyakit ini mungkin hilang. Tapi awas, jangkitan HIV mungkin sudah mara ke peringkat kedua yang dipanggil peringkat latensi. Pada peringkat ini, virus HIV membiak di dalam tubuh badan, tanpa menunjukkan apa-apa kesan yang jelas seperti simtom- simtom yang telah saya katakan tadi.

Peringkat terakhir jangkitan HIV dikenali sebagai penyakit AIDS. Pada peringkat ini, fungsi perlindungan dalaman atau sistem imun badan akan mula merosot.

Seseorang yang mempunyai penyakit AIDS akan lebih senang jatuh sakit, dan mungkin juga mati kerana sebab-sebab yang pada asasnya, tidak serius.


HIV Rapid Test

Untuk mengesan jangkitan HIV, ujian pantas HIV (HIV Rapid Test) hanya boleh diambil sekurang-kurangnya 14 hari selepas anda terdedah pada aktiviti berisiko tinggi.Ini adalah ujian generasi ke 4 dimana ia boleh mengesan HIV
seawall 14 hari.

Ujian generasi ke 3 pula memakan masa 90 hari selepas pendedahan sebelum boleh mengesan HIV.


PrEP dan PEP

PrEP (Pre-Exposure Prophylaxis) adalah ubat yang diambil untuk mengelak daripada menjangktii virus HIV. PEP (Post exposure Prophylaxis) pula adalah ubat yang diambil setelah terdedah pada virus HIV.

PrEP biasanya digalakkan bagi mereka yang berisiko tinggi untuk mendapat HIV seperti golongan yang mempunyai pasangan yang berbeza, lelaki yang berhubungan sesama lelaki lain.

PEP pula di galakkan bagi golongan yang terdedah pada HIV. Contohnya kondom yang pecah sewaktu bersetubuh, berhubungan dengan pekerja seks tanpa kondom dan pendedahan pada HIV melalui suntikan jarum. (needlestick injury).

Klinik kami di daerah Orchard Road di Somerset ada menyediakan kedua- dua jenis ujian HIV serta perkhidmatan PrEP dan PEP.


Apa itu HPV

HPV atau Human Papilloma Virus adalah sejenis virus yang merebak melalui sentuhun kulit. Ia boleh menyebabkan ketuat (warts) serta kanser pangkal rahim (cervix).

Kini ada vaksin yang bleh melindungi anda daripada 9 jenis virus HPV. Ia dinamakan Human Papillomavirus 9-valent Vaccine. Human Papillomavirus 9-valent Vaccine adalah satu-satunya vaksin yang boleh mengelak daripada kanser. Ia digalakkan bagi lelaki dan perempuan berumur 12 tahun ke atas.

Kami ada menyediakan khidmat vaksin Human Papillomavirus 9-valent Vaccine di klinik kami di daerah Orchard Road di Somerset.

Saya telah pun memberikan penerangan ringkas tentang penyakit STD, HIV dan AIDS.

Sebelum saya akhiri, saya ingin memberi beberapa pesanan.


Kesimpulannya

  • Pertama, saya ingin menegaskan bahawa simtom-simtom seperti selsema, sakit tekak, sakit badan dan sebagainya, sama seperti simtom-simtom untuk penyakit biasa. Jadi, janganlah tergopoh-gapah untuk menganggap bahawa awak telah dijangkiti penyakit HIV hanya kerana awak ada simtom-simtom tersebut. Pada masa yang sama, saya juga ingin mengingatkan bahawa ramai orang yang dijangkiti penyakit HIV tidak menunjukkan apa-apa simtom yang jelas dan nyata.

Jika awak berasa ragu tentang kesihatan awak, adalah wajar untuk berjumpa dengan doktor yang bertauliah untuk mendapatkan pemeriksaan dan kepastian.

  • Kedua, mujurnya, kini kita sudah boleh merawat dan mengawal penyakit HIV dengan lebih berkesan. Sekiranya anda mendapatkan rawatan untuk jangkitan HIV, anda mempunyai peluang untuk hidup dengan sihat, dan bebas dari simtom-simtom ini untuk masa yang lama.
  • Ketiga, anda hanya akan dapat mengesahkan penyakit HIV dan kesihatan anda melalui ujian khas, tiada jalan lain untuk mendapatkan kepastian ini.

Sekiranya anda bimbang tentang kemungkinan pendedahan, atau anda mengalami simtom-simtom STD dan HIV, sila lawati klinik kami untuk penilaian dan ujian yang betul. Kami sedia membantu untuk memberi nasihat dan rawatan
yang diperlukan.

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Contact us


Dr. Tan & Partners @ Somerset
Alamat:

1 Grange Rd,
#10-08 Orchard Building,
Singapore 239693

Telepon: +65 6262 0762

Jam Buka:

Senin sampai selasa:
9:30am–2pm & 3pm –6:30pm

Jumat: 9:30am–1pm & 2pm –6:30pm

Sabtu: 9:00am–1pm

Ditutup pada hari Minggu dan hari libur nasional

Dr. Tan & Partners @ Novena

Alamat:

10 Sinaran Drive,

#08-31 Novena Medical Centre,

Singapore 307506

Telepon: +65 6397 2095

Jam Buka:

Senin sampai Jumat: 8.30 am – 5.30 pm

Sabtu: 9.00 am – 1.00 pm

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Tag: hiv test

HIV Singapore 2019

In June 2019, the Ministry of Health (MOH) released an update on the HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) situation in Singapore 2018.
Here are the salient statistics and a short commentary for each.

  • There were 313 new cases of HIV infections reported among Singapore residents in 2018
    • There were 8,295 HIV-infected Singapore residents as of end 2018, of whom 2,034 had passed away.
    • The number of new HIV cases among Singapore residents has been between 400 to 500 per year from 2007 to 2017

The number of cases has dropped slightly – from 400-500 a year to 313 last year. In 2017 it was 434 new cases. In 2016 it was 408 new cases. While no reasons were provided as to why the numbers last year were lower, it is a step in the right direction for organisations like Action for AIDS, which is committed to ending HIV transmission and AIDS in Singapore by 2030. Safer sex practices such as the consistent and correct use of condoms and reducing high-risk sexual behaviour such as being faithful to one’s partner, avoiding casual sex and avoiding sex with commercial sex workers are some ways we can further reduce transmission of HIV. The usage of medications such as pre-exposure prophylaxis and post-exposure prophylaxis (PrEP and PEP) can also reduce the risk of contracting HIV.

  • The age and sex distribution of the 313 cases
    • 93% were male
    • 62% were between 20 to 49 years old

The majority of new cases are men, and usually in the age group of 20-49. Males of this age group might have a tendency to engage in high-risk sexual behaviour. Education about HIV transmission and prevention for everyone, especially for males aged 20-49 is crucial for the aim of reduction of new cases.

  • 95% acquired the infection through sexual intercourse
    • 43% were from heterosexual transmission
    • 42% were from homosexual transmission
    • 10% were from bisexual transmission.

For the first time, the rate of heterosexual transmission was greater than the rate of homosexual transmission for HIV. This could be due to increased awareness of HIV and its transmission in the homosexual population.
A recent local study by researchers from the Saw Swee Hock School of Public Health at the National University of Singapore (NUS) has estimated that around 210,000 men have sexual intercourse with other men, which is more than twice an earlier estimate of 90,000. The researchers have identified four groups that have the highest risk of getting and transmitting HIV, which are
– Males who have sex with other males (210,000)
– Male clients of female sex workers (72,000)
– Female sex workers (4,200)
– Intravenous drug users (11,000)
These are the groups that are most at risk, and are the groups we need to increase screening rates and education about HIV and sexually transmitted infections (STIs) as well.

  • About 50% had late-stage HIV infection when they were diagnosed

HIV can be treated effectively – it is no longer the death sentence it was when HIV was first discovered. We know that the earlier we initiate treatment for HIV, the better the outcomes and life expectancy. All that is required to test for HIV is a small amount of blood and more importantly, ownership of your health. We highly advise everyone who engages in high-risk sexual behaviour regularly test for not just HIV, but other STIs as well.

  • Methods of detection
    • 57% were detected in the course of medical care provision
      • Such cases are typically at the late stage of HIV infection.
    • 22% were detected during routine programmatic HIV screening
    • 14% were detected from voluntary screening.
      • Such cases were more likely to be at an early stage of infection.

When someone presents at the late stage of HIV infection, outcomes and life expectancy are poorer. HIV ideally should never be discovered this way. HIV infection can be completely asymptomatic, especially in the early stages, and the only way to detect infection is to test for it.
The goal is to increase voluntary screening rates so that we can detect HIV early on, before the onset of AIDS. HIV infected people can lead normal, long, healthy lives with proper treatment. HIV testing is available at polyclinics, private clinics, and hospitals. There are also anonymous HIV test sites, where personal particulars are not required when signing up for an HIV test.
The Health Promotion Board (HPB) has been working with partner organisations to conduct educational programmes and campaigns to reach out to high-risk individuals to urge them to go for regular HIV testing. It is good to know that our government is taking steps to increase awareness and increase rates of HIV screening. We should do ours too by taking charge of our health by reducing high-risk sexual behaviour, and getting tested regularly should there be any high-risk sexual activity.


Other Interesting Reads:

  1. HIV Elite Controllers And Long-Term Non-Progressors
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)