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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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What are the Common Misconceptions that People have about HIV?

There are multitude of misconceptions associated with HIV. These are some of the most common ones:
1) HIV is the same as AIDS. HIV (Human Immunodeficiency Virus) refers to the virus itself, whereas AIDS (Acquired Immunodeficiency Syndrome) refers to a spectrum of potentially life-threatening conditions that are caused by the virus.

Read: HIV, AIDS & Opportunistic Infection

2) HIV is a death sentenceThis may have been the case several decades ago, where without prompt and adequate 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 may never develop AIDS. This is why it is imperative to be on treatment, ideally as soon as possible after a diagnosis of HIV is made. It is also important to undergo regular HIV screening.

READ: HIV Treatment & Management

3) HIV can be 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/tissues such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission.

READ: How Long Can HIV Survived Outside The Body


Is a person infected by HIV any different from that of an uninfected person?

With or without treatment, a person infected with HIV may not appear any different from that of an uninfected person.
HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage may present with lymph node swelling, but most patients do not have any symptoms at all. The second stage (Clinical Latency) 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. Lastly, the third stage is the presentation of AIDS symptoms.
HIV infected patients should receive prompt long term treatment and undergo regular follow up blood tests in order to reduce the viral load in their bodies to low levels. This allows their immune system to continue to function well and minimizes the risk of progression to AIDS. By doing so, they can essentially live very normal lives not any different from that of an uninfected person.

What are some of the treatments that a patient will receive upon diagnosis of HIV infection?

Upon diagnosis of HIV infection, a patient will have to start taking a combination of long-term daily medications. These are antiviral medications that work to prevent the virus from replicating. The patient will then be required to return regularly for blood tests to monitor the levels of HIV and the immune system. The goal of treatment is to keep the levels of HIV low, and thus allow the immune system to continue to function well.

How does AIDS affect a person’s health? What do AIDS patients die of?

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. HIV Related Opportunistic infections such as tuberculosis, recurrent pneumonia and esophageal candidiasis,  may occur as well. AIDS patients could also develop various viral-induced cancers.
The leading causes of death worldwide in patients with AIDS are, as mentioned, opportunistic infections and cancer.

Recently it was reported that in London, an HIV patient who underwent a bone marrow transplant subsequently had undetectable HIV levels. Does this mean that he is fully cured of HIV?


This is the 2nd ever reported case of an HIV patient being “cured” of HIV. In 2007, a patient in Berlin was also reported to have been cleared of the virus. Both of these cases have similarities: both HIV infected patients concurrently suffered from cancer (Berlin patient had Acute Myeloid Leukaemia; London patient had Hodgkin’s Lymphoma) and both patients received bone marrow transplant by donors who carried the rare CCR5 genetic mutation.
CCR5 is a protein on the surface of white blood cells that is involved in the immune system. It is one of the co-receptors that HIV uses to enter target immunological cells. This means that via CCR5, HIV is able to gain a mode of entry into a person’s immune system. People with CCR5 genetic mutation have resistance to HIV infection because the virus is unable to enter into their immune system like it usually does.
In the case of the London patient, subsequent blood tests have shown that the virus cannot be detected. However, this does not necessarily mean that he has been fully “cured” – the virus may simply be in a dormant, or “sleeping” state.
While the outcome was favourable in the two examples stated above, this form of treatment is not a viable large-scale strategy because bone marrow transplants carry significant risks and are extremely costly. However, it is undeniable that these two cases are landmark moments in the war against HIV as scientists continue to hunt for a cure. The hope is that by conducting more research on the editing of the CCR5 gene, we will one day be able to develop a safe, cost-effective and easy solution.

READ: HIV CCR5 Mutation & CCR5 Testing

Do you think that mankind can eradicate HIV eventually? Before this happens, what kind of support can we give to HIV infected patients?

I believe that with continued advances in medical research, there is hope of a cure for HIV in the future. However, this is a long and slow process that may require many years or decades. Until then, the best option is to ensure that the public are able to gain access to undergo HIV screening even if the risk is not high, and that HIV infected patients are able to receive prompt and long term treatment.
From the initial shock and disbelief of receiving a diagnosis of HIV; having to accept the reality of the situation; to having to live with HIV daily, these are just a few examples of the tremendous challenges that HIV patients face in their lives, and for many patients these have a detrimental impact on their psychosocial well-being.
There is still a terrible stigma today surrounding HIV, and it remains very much a taboo subject that most people are afraid to speak about or face up to. Nevertheless, we can offer many forms of support for HIV patients. For starters, government and healthcare organisations need to continue in their best efforts to increase awareness and educate the public about HIV and its misconceptions. If you have a family member or loved one who lives with HIV, the best kind of support would be your understanding, care and acceptance.
Lastly, if you are a person living with HIV, do not despair. Seek the appropriate treatment that you require, and turn to your family and friends for moral support.
Take Care!
Tags: hiv screening singapore, hiv test


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)
  14. HIV Pro-Viral DNA Test


Advisory: On the Unauthorised Possession and Disclosure of Information from MOH’s HIV Registry

Singapore, 28 January 2019 – Singapore’s Ministry of Health (MOH) held a press conference to inform the public that the confidential information of 14,200 people living with HIV were leaked. This included 5,400 Singaporeans and 8,800 foreigners (source: https://www.straitstimes.com/singapore/data-of-14200-singapore-patients-with-hiv-leaked-online-by-american-fraudster-who-was). The records of the 5,400 Singaporeans leaked were up to January 2013. The records of the 8,800 Foreigners leaked were up to December 2011.

 

This is a trying time for people living with HIV in Singapore. For Singaporeans diagnosed after January 2013, there is no need to be concerned until more information is available from MOH. For queries, we urge you to contact the MOH hotline on +65 6325-9220.

 

Under the Infectious Diseases Act of Singapore, we would like to remind the community that it is an offence to disclose the identity of a person living with HIV except under very specific conditions (see Addendum 1 below). If anyone comes into contact with such information, we urge you to notify the Singapore police immediately at https://eservices.police.gov.sg/homepage.

 

We hope that even if the identities of people living with HIV are leaked that they are shown the same support and respect we have always given them. People living with HIV are no different from any of us. They are also of no danger to anyone. You cannot get HIV from casual contact such as shaking hands, hugging, sharing food or sharing a toilet.

 

We hope in this difficult time all Singaporeans can band together to show support for people living with HIV. They are our loved ones, our colleagues, our friends and our families.

 

 

Addendum 1: Singapore Infectious Diseases Act

Protection of identity of a person with AIDS, HIV Infection or other sexually transmitted diseases.

 25.—(1)  Any person who, in the performance or exercise of his functions or duties under this Act, is aware or has reasonable grounds for believing that another person has AIDS or HIV Infection or is suffering from a sexually transmitted disease or is a carrier of that disease shall not disclose any information which may identify the other person except —

(a) with the consent of the other person;

(b) when it is necessary to do so in connection with the administration or execution of anything under this Act;

(ba) when it is necessary to do so in connection with the provision of information to a police officer under section 22 or 424 of the Criminal Procedure Code 2010;

[10/2008 wef 10/06/2008]

[15/2010 wef 02/01/2011]

(c) when ordered to do so by a court;

(d) to any medical practitioner or other health staff who is treating or caring for, or counselling, the other person;

[10/2008 wef 10/06/2008]

(e) to any blood, organ, semen or breast milk bank that has received or will receive any blood, organ, semen or breast milk from the other person;

(f) for statistical reports and epidemiological purposes if the information is used in such a way that the identity of the other person is not made known;

(g) to the victim of a sexual assault by the other person;

(h) to the Controller of Immigration for the purposes of the Immigration Act (Cap. 133);

 (i) to the next-of-kin of the other person upon the death of such person;

 (j) to any person or class of persons to whom, in the opinion of the Director, it is in the public interest that the information be given; or

 (k) when authorised by the Minister to publish such information for the purposes of public health or public safety.

[5/92; 13/99]

(2)  Any person who contravenes subsection (1) shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 3 months or to both.

 
Dr. Tan Kok Kuan

10 Famous People with HIV

1.) Charlie Sheen

The actor who is best known for the long-running TV series Two and a Half Men. Charlie Sheen revealed his HIV status in 2015. He was known to have used illegal drugs and had high-risk sex.

2.) Freddie Mercury

The famous frontman of the rock band Queen, Freddie Mercury died from complications of AIDS in 1991 at just 45 years old.

3.) Magic Johnson

The basketball superstar of the LA Lakers, Magic Johnson went public with his HIV status in 1991. He is still in good health with daily medications to control his HIV infection.

4.) Greg Louganis

Greg Louganis shot to fame for winning multiple gold medals for diving including Olympic gold. He famously hit his head on the springboard during the 1988 Seoul Olympic games sparking fears of HIV possibly spreading to other athletes via his blood being in the diving pool.

5.) Rock Hudson

The American heart-throb TV star of the 50’s and 60’s, Rock Hudson died from complications of AIDS in 1985 at 60 years of age.

6.) Fela Kuti

Famous musician and activist Fela Kuti died from complications of AIDS in 1997 at the age of 59 years old.

7.) Liberace

Famous pianist and showman Liberace died from complications of AIDS in 1987 at the age of 68.

8.) Andy Bell

Pop group Erasure frontman Andy Bell was diagnosed with HIV in 1998.

9.) Tina Chow

Famous model and jewelry designer Tina Chow was diagnosed with HIV in 1989. She became an activist and educated many on HIV and AIDS. She passed away in 1992 at the age of 41 from complications of AIDS
 
 

10.) Paddy Chew

Paddy Chew was the first person with the courage to come out publicly about his HIV status in Singapore. He wrote an autobiographical play called Completely With/Without Character. He passed away in 1999 from AIDS complications.
 
 

Other Related Articles:

 
 
 

Top Travel Tips for Persons Living With HIV (PLHIV)

Planning for a long Vacation or Preparing for a Business trip? The travel preparation can sometimes be challenging for People Living with HIV (PLHIV).
Making sure there is enough medication. Making sure you get the correct travel vaccine or visiting the doctor to get prescription (just in case you might be questioned during immigration check)

Travel Tips For Travelling with HIV (B.R.A.V.E)

B for Board, Bottle

Carry Your HIV Medication with You on Board
Carry your HIV medications with you on Board rather than checking them in and have a memo from the prescribing doctor’s memo with you.

Carry Your Doctor’s Memo with You
The contents of the memo should confirm that the medication is necessary during the trip. It does not need to discuss HIV and can state the medications are for a chronic medical condition and for personal use.

Use Medication’s Original Packet or Bottle
It is also advisable to have the medication’s original packet/ Bottle, showing the name of the person carrying the medication and medication details.

R for Reveal, Reiterate

You Don’t Need to Discuss Your HIV Status!
When crossing international borders, one might be questioned on the medication carried. Preparing for these questions can facilitate an easier border crossing experience. HIV need not be discussed or Revealed and that these medications are for a chronic health problem can be Reiterated.

A for Adjust, Avoid,  Anonymous Testing, Advice

Adjusting Your Dose Timing
Discuss with your doctor dose timing adjustments when travelling across different time zones. Medication can usually be taken one or two hours later for a number of days until the timing fits with the destination country. The process should be reversed on return.

Avoid Missing Your Medication Dose
Missing medication doses should be avoided at all cost. Treatment breaks should be avoided unless discussed with your doctor.
 
 Advice, Anonymous testing
If you are travelling in and out of Singapore and need advice on HIV treatment or testing, At Dr. Tan & Partners, we provide a safe and discreet environment for testing. You can find out more about Anonymous HIV Testing.

V for Vaccinations

General principles for vaccination of PLHIV as follows:

  • Killed or inactivated vaccines do not represent a danger to immunocompromised people and generally should be administered as recommended for other people.
  • Live-virus or live-bacteria vaccines such as BCG, oral poliovirus, typhoid (Ty21a), varicella, Yellow fever should be avoided unless the benefits outweigh the cons

The main vaccinations we recommend for PLHIV besides the country-specific vaccinations are.

  1. HPV Vaccination
  2. Hepatitis A
  3. Hepatitis B
  4. Influenza
  5. Pneumococcal
  6. Meningococcal

E for Extra Medication

Bring Extra Medication
It is imperative to bring enough medication and slightly more for a few days as getting a prescription or purchasing your medications in a foreign country may not always be possible. Furthermore, there is no way to ascertain whether the purchased medication might be of the same quality, type and efficacy.

If you are travelling with a partner/s who are not HIV positive, you can find out more information on getting PrEP (Pre Exposure Prophylaxis) for their protection as well – Non-HIV partners for HIV PrEP.

Here are some further resources you can explore to find out more about the country you are travelling to and its restrictions if any:
1.) www.aidsmap.com – HIV-related services worldwide and access country-specific information and news 
2.) www.hivtravel.org – International database on HIV related travel and occupation

Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.