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 City Hall 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.
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.