Sick, sick people 10

AIDS, and with it the topic of men having sex with men and S377A, come into the news again.


Review needed for Aids education
Four suggestions to improve prevention programmes here
Letter from Assoc Prof Roy Chan
President, Action for Aids, Singapore

WE refer to the report, "Record HIV cases last year" (June 15). Action for Aids notes the increasing rate of HIV infection with concern and would like to reiterate our strategies to enhance prevention programmes in Singapore.

Firstly, there must be clear, unambiguous messages that include the consistent and correct use of condoms in educational campaigns. For too long, public education has skirted around the issue of safe sex.

While we have no problems with advice to have sex within marriages, it is inadequate if this is the only message — relegating the promotion of condom use to a back seat.

Shying away in embarrassment from dealing with youth sexuality more directly is also jeopardising the health of our young citizens.

The escalating rates of HIV infection and sexually transmitted diseases are the result of this shortsighted approach. Action for Aids is appealing to the relevant authorities to review their educational programmes urgently.

Secondly, there must be universal access to treatment. Advocating testing without providing affordable and effective anti-retroviral medication is simply inadequate.

Majority of the infected persons cannot afford HIV medication. Many resort to seeking cheaper generic alternatives from Thailand and Malaysia. Some others do not receive treatment at all. Furthermore, supplies of generic drugs may be inconsistent and quality cannot be assured.

Action for Aids believes that providing even partially subsidised medication will contribute to effective HIV suppression, maximise clinical response to treatment and reduce infectiousness.

Thirdly, there should be a clear direction from our leaders on the issue of Aids-related stigma and discrimination. The prevalence of such prejudice has a negative impact on prevention programmes. Appropriate legislation to address this should be put in place.

Lastly, those who run a higher risk of infection must be empowered to take action and responsibility. In Singapore, men who have sex with men (MSM) are at the greatest risk of HIV infection, in my opinion.

To engage them, they must be encouraged to seek counselling and testing, and be given relevant and appropriate information. Barriers that stand in the way of these efforts should be removed.

In particular, we call for the urgent repeal of Sections 377 and 377A of the Penal Code that criminalise homosexual behaviour. These have been obstacles to targeted educational campaigns and our ability to reach out especially to young MSM who are the most vulnerable.


angry doc wonders why Prof Chan felt the need to qualify his statment that men who have sex with men (MSM) are at the greatest risk of HIV infection with an 'in my opinion'. Perhaps it is an indication of how it is difficult to gather meaningful data on the local MSM population in a setting where admitting to being one is equivalent to confessing to a criminal offence.

Intervention programmes aimed at MSM have been shown to be effective in reducing risky sexual behaviour (see here and here), so if indeed S377A is an obstacle to educational campaigns locally, then it is an aspect of the issue we should look at.

Nevertheless, while angry doc is tempted to support Prof Chan's call for the repeal of S377A, he feels that to argue for the repeal of the law on grounds of public health would be intellectually-equivalent to arguing against decriminalisation on grounds of public health. Repeal of the law, in his opinion, should come from the fundamental principle of non-discrimination, and not be based on public health reasons.