In January 2019, the Singapore Ministry of Health made a public announcement that the personal data of 14,200 HIV-positive (Human Immunodeficiency Virus) people living in Singapore had been illicitly obtained and leaked back in 2016. Information had been released to the public more than 2 years after the leak so as not to cause public panic. Now, whilst MoH has since announced that they have put in place multiple-factor authentication amidst a system of checks and balances to prevent such an incident from happening again, the damage has been done. AIDS (Acquired Immunodeficiency Syndrome) is a condition heavily stigmatised by society, and the irreparable feeling of everything coming undone won’t be simply placated away.
So exactly how much of an issue is HIV/AIDS in Singapore these days? Is the HIV registry necessary as a means of controlling the spread of HIV? And have the existing measures been effective at curbing the spread of HIV? Let’s take a look.
How the HIV Registry Works:
After a patient tests positive for HIV at any testing clinic in Singapore, the clinic has 72 hours to upload the patient’s particulars into the system. There are a couple of places that provide walk-in, anonymous testing, but should the patient start treatment, all of their personal information will be recorded. According to the Ministry of Health announcements, registry information includes: their contact number, home address, how they came to contract HIV/how HIV was detected and any related medical conditions and information about the patient.
In theory, the registry can be used to monitor the spread of HIV throughout Singapore – for instance, if there have been a particularly high number of cases within an age group, then the ministry also knows where to direct their education efforts. The registry also allows healthcare workers or any first responders who may have been exposed to the blood or other bodily fluids of an HIV-positive person to take appropriate action. As such, having a unified way to keep track of everyone who is HIV positive does make sense in preventing the disease from negatively impacting society in a more widespread fashion.
However, I do not believe that it is necessary to include information such as a patient’s home address or telephone number on the HIV registry. To my understanding, such information is already stored in the database of the various polyclinics that form the basis of Singapore’s public healthcare system. Should the information need to be retrieved for whatever reason, it should be a simple matter of searching up the patient’s Identification Number. Since anti-retroviral therapy would likely affect any other medical treatment sought by the patient in question, it seems such cross-referencing would likely take place anyway, making it fairly redundant to include such information in 2 separate databases.
In my opinion, tacking on additional information that would provide a malignant entity with the means to physically accost and/or blackmail someone seems like something that would wildly backfire – and it did, in a rather horrifying fashion. While I can understand the argument for the home addresses providing information on where epidemics of the disease might be located, in reality, given how small Singapore is a country and how easy it is to meet up with people all around the nation, home address isn’t an effective indicator. If the Ministry of Health wishes to take legal action against individuals not engaging in treatment for HIV, then the police as the usual option for doing so seems more apropos. Yes, I concede that there is an argument that a malignant entity could simply just cross-reference the information as one would through the proper channels and obtain damaging personal information that way; however, I would like to raise the point that it’s probably much harder to do so for 14,200 individuals than just 1. Concentrating all this information in 1 location isn’t the most elegant solution in my opinion.
Part 4 of the Infectious Diseases Act:
Provisions to curb the spread of HIV were added in the 2nd version of the Infectious Diseases Act in 1992. It requires anyone who has contracted HIV to undergo treatment and to inform any potential sexual partners about their HIV positive status. People with HIV also cannot engage in any activities which may otherwise spread the disease, such as donating blood. Since AIDS is at present incurable, it makes a lot of sense to compel anyone who is HIV positive to share such information with their sexual partners so that they are informed of the risk of potentially contracting HIV through their intercourse.
Unfortunately, I do think there are issues with the current legal framework revolving around informed consent when engaging in intercourse with HIV-positive people. For instance, it is unclear as to how much onus is placed on the individual to know whether or not they have HIV. Though most infections are spread through sexual intercourse, those working at high-risk exposure jobs such as in healthcare are more liable to be exposed to contaminated materials – how judicious should they be in getting frequently tested before engaging in intercourse with their partner?
In addition, the language in the Act indicates that if people are engaging in behavior that would result in them having a significant risk of contracting HIV, they should also inform their partner. But what constitutes high-risk behavior, and can we expect everyone to know if what they’re doing falls under the banner of high risk? For instance, some may still hold the belief that oral sex doesn’t count as intercourse and therefore there is no risk of transmitting STDs even though the opposite is true. Whilst MoH does encourage people who engage in high-risk sexual behavior to engage in regular testing, not everyone may be aware of such an option, particularly when first engaging in sexual activity.
Finally, considering that engaging in casual sex or engaging in infidelity is frowned upon by Singaporean society, people are also unlikely to be truthful about engaging in high-risk sexual behavior. This means they’re unlikely to admit such behavior to their sexual partner. To keep this behavior secret, they’re also not going to engage in routine testing. There is also no clear-cut benchmark as to what constitutes high-risk behavior. If you have intercourse with 2 people, is that high risk? Can you take what your partner is saying about their sexual experience at face value? Though there are some more blatant cases of deliberate transmission, most situations will lie in a morally grey area, and without more precise guidelines, I don’t think the existing legal infrastructure is capable of dealing with the transmission of HIV.
There is also little evidence to suggest the provisions set forth by the Infectious Diseases Act have been effective in curbing the spread of HIV. According to the historical data provided by MoH, the rate of HIV amongst Singaporeans per capita has generally increased since the implementation of the amendment. From the data collected, we can clearly see that the current legal provisions have not been effective in curbing HIV. Despite MoH’s efforts to target high-risk individuals and communities and educate them about their options for STD testing, HIV infection rates have not reduced – at all, so it might be time to take a different angle of approach.
Sex education in Singapore:
One incredibly obvious hallmark of AIDS is that it’s the most common sexually transmitted disease that cannot currently be cured, at least with the treatment options presently available. Hence, sexual education to educate the populace about how to engage in safe sex to minimise the possibility of disease transmission seems like a good start.
Now, according to the Ministry of Education (MoE) website, sexuality education in Singapore schools aims to ‘help students developed a moral compass…by having positive mainstream values and attitudes about sexuality that are premised on the family as the basic unit of society.’ Later on, it mentions that 1 of the principles of the programme is to ‘encourage heterosexual couples to have healthy relationships…and to build stable nuclear family units.’ It also explicitly mentions how sexuality education in all schools specifically promotes abstinence before marriage.
The first statement implies that any values, attitudes or beliefs that aren’t founded in having children and getting married are somehow immoral, which is a ridiculous statement in and of itself. For a nation whose pledge literally states to be accepting of others regardless of ‘race, language or religion’, dismissing all beliefs but 1 is rather narrow-minded, to say the least. Though I know of many who would love to have children and whom I also believe would make fantastic parents, there are equally many who do not wish to have children when considering their social and employment prospects and others who aren’t in a position to be effective parents.
Being an effective parent to a child is an incredible commitment, and one I believe not everyone is prepared for, nor they should undertake. As a child of a single parent, that is certainly a concept that I am intimately familiar with. I understand the desire to promote childbirth to alleviate Singapore’s aging population crisis, but the harsh reality is, even for heterosexual couples, taking care of a child isn’t in the cards for everyone. There is no single way that a family should look. Having multiple partners and not being in a committed relationship is a reality that works better for some people, and that is something that we as a society should certainly accept.
Now, moving on to the abstinence-only education aspect of the program. Whilst there have been studies primarily made by religious groups to demonstrate the efficacy of abstinence-only education, there has also been overwhelming evidence to suggest that most adolescents and youth in their 20s will end up having sex one way or another. Yes, if you never have sex with literally anyone, you will never contract an STD – considering most people do not identify as asexual, that is a forgone naïve thought. Even if you are in a heterosexual married couple, extramarital affairs aren’t uncommon, so whomever you are, you should be readily equipped with the knowledge to prevent STIs.
Whilst the MoE program does teach people facts about contraception and preventing STIs, it does not explicitly say that it teaches students how to effectively use contraception, be it condoms or birth control. It also doesn’t explain to people where to obtain contraception should it be needed. On top of that, such an approach doesn’t equip students with the ability to seek help should they have a pregnancy or contract an STD – showing extremely graphic images of disease-ridden genitalia just serve to shame people even further into keeping quiet, and just let the unexpected situation spiral out of control.
One other thing to consider: sexuality education is often presented in a ridiculous and almost comical manner in schools. For one, the analogy of a ‘Relationship Rollercoaster’ with different peaks at ‘Light Petting’ and ‘Heavy Petting’ just seems farcical at best. And although Singapore has switched to a more secular sexuality education curriculum in recent years, it previously often employed external vendors comprised of religious groups such as Focus on the Family to conduct sexuality education. This often included truly bizarre perpetuations of gender stereotypes and gender-segregated sexuality education discussions. By employing such a method of teaching, it’s no wonder that students are unable to take such discussions seriously – and therefore not absorb any useful knowledge that the session is trying to impart. Though we have seen strides towards a more well-rounded sexuality education – the lower rates of HIV infection in more recent years might be a reflection of that – we are still quite far away from a truly effective program.
Now, how has the sexuality education programme in Singapore translate to affecting HIV transmission rates? If people are not taught how to use and obtain contraception effectively, then when they engage in sexual intercourse, they will be reluctant to do so. This means that anyone who does end up engaging in sexual activity won’t have the knowledge to effectively protect themselves, and thus risk contracting a slew of STDs – including HIV. Subsequently, because of the immense shame that such a method of sexuality education imposes on people who do contract a disease, they will be incredibly reluctant to seek help or treatment. This is supported by the fact that the majority of cases of HIV infection are discovered in their late stage, possibly stemming from the mixture of embarrassment and self-denial one acquires after contracting HIV.
This is an effect compounded for anyone that is homosexual – after all, engaging in only post-marital sex isn’t an option for those who cannot get married. Since it is illegal for men to engage in homosexual sex in Singapore, the scope of education in the program is restricted to vaginal intercourse – which in itself prevents effective preventative measures for all kinds of sexual intercourse. Since those who are engaging in homosexual sex will be incredibly reluctant to seek knowledge on how to engage in safe sex for fear of being handed over to the authorities, they are even more likely to engage in reckless sexual behavior. This hypothesis is reflected in the fact that a large proportion of HIV cases are linked to incidences of male homosexual sex, despite there supposedly being a low percentage of non-heterosexual people in the general population.
Final thoughts:
The MoE website says that 1 of the principles of Sexuality Education is to teach people to ‘respect the different attitudes, values and beliefs that different communities may have,’ and it is precisely in that aspect that we as a society are miserably failing in that has resulted in the spread of STDs remaining as high as it is.
My personal opinion that a national way to keep track of all the HIV cases remains necessary in current Singaporean society, though perhaps not as detailed as in its current form. The spread of HIV and other STDs is still a massive problem for us as a society, and will continue to persist as a problem should we continue to persist in holding onto frankly ridiculous and narrow-minded impositions. Until Singapore elects to truly embrace all aspects of the diverse society that it so frequently preaches to be, such drastic measures as a nationwide registry should remain in place to safeguard our nation as a whole.
Websites/articles I looked at, vaguely labelled and sorted.
MOH’s announcement:
MOH Information about new HIV cases:
Part 4 of the Infectious Diseases Act:
https://sso.agc.gov.sg/Act/IDA1976#P1IV-
Singapore Schools’ Sex Education:
https://www.moe.gov.sg/programmes/sexuality-education/scope-and-teaching-approach/
Effectiveness of abstinence-only education:
https://www.jahonline.org/article/S1054-139X(05)00467-2/fulltext
Careful Considerations - Ramblings of an Aspiring Azorius Lawmage 