When both hands work together... (Today [Singapore])
13 Aug, 2007
IT IS winning the battle against HIV. The Australian state of New South Wales has seen the number of HIV cases reported each year generally dropping over the past decade. And now Singapore knows why, after its first study trip of this kind.
Close cooperation is needed between the Government and non-governmental organisations (NGO), Dr Balaji Sadasivan, Senior Minister of State (Foreign Affairs and Information, Communications and the Arts), told Today after a trip to Sydney last month.
Easier said than done, though.
A tricky balance needs to be struck when reaching out to the group that is a particularly significant contributor to HIV statistics in developed countries such as Australia and Singapore: Men who have sex with men (MSMs).
Relating the "invaluable" lessons learnt in Sydney, Dr Balaji said: "The health authorities supported the NGOs in the community, and in return the NGOs were sensitive to the conservative majority.
"This cooperation between NGOs and the health authorities - reach out to the MSMs, but at the same time, don't upset the conservative majority - is the key to their success."
In Singapore, where the numbers are going up "relentlessly", 26 per cent of the record 357 new HIV cases reported last year were contracted through homosexual sex. Reducing these numbers will require the Government and NGOs working with MSMs to get over some bumps together at a national level.
According to Mr Stuart Koe, CEO of gay media company Fridae.com, "the left hand is not talking to the right hand" yet.
"The Ministry of Health (MOH) wants to do health prevention through safe sex, but the Media Development Authority says that anything gay is not allowed," he said. "It's a conundrum we're in."
For example, targeted messages that can reach the gay community through gay magazines are not feasible because such publications are not allowed. Currently, safe sex messages are displayed in premises like gay bars and saunas, which have limited reach.
According to Mr Bryan Choong, the MSM HIV coordinator for Oogachaga, a support group for gay, lesbian, bisexual and transgendered individuals, NGOs and the Government also need to get past Section 377A of the Penal Code.
He said, "I think there is a lot of trust building that is needed between MSM-related NGOs and the Government in Singapore. As long as there is no decriminalising, that trust will be eroded."
Mr Choong thinks the number of MSM HIV cases are under-reported, and cited a 60 per cent infection rate as more believable.
Here, the under-reporting stems from late HIV notifications, that is, patients who delay seeking treatment here until required.
Dr Balaji, who had previously told Today that almost all HIV cases are captured in the system eventually - once they seek treatment - has noted the stigmatisation of those who are diagnosed with HIV.
He stressed the need to tackle HIV as a health issue. "Whatever (the NSW) authorities wanted to do, they didn't politicise or extend the debate out of healthcare."
So successful was NSW's anti-HIV efforts that NGOs managed to get up to 80 per cent of MSMs to get tested annually.
Other issues in Singapore include the issue of anti-retroviral medication being unsubsidised. While HIV patients can buy cheaper generic versions overseas, it may be harder for them to stick to the medication regime, thus strengthening the resistance of the viral strain, critics argue.
Cooperation between the Singapore Government and NGOs is slowly strengthening, though. The trip to Sydney included representatives from Action for Aids, Fridae.com and Oogachaga alongside MOH's senior director for operations Koh Peng Keng and deputy director of communicable diseases Dr Jeffery Cutter.
Just before the trip, an MOH survey found one in 350 anonymous hospital blood samples to be HIV-positive, and since then Health Minister Khaw Boon Wan has said he is "seriously considering" opt-out HIV screening for males admitted to hospital.
In response to Today's queries about how the latest information from NSW would be adapted to the local environment, the MOH said: "We will be looking into strengthening our local NGOs in terms of resources and will also seek ways to work more closely together in the design, delivery and monitoring and evaluation of HIV prevention programmes.
"We will also look into how we can better draw upon our local universities to conduct HIV-related research."