Take your rights? Don't mind if I do...

A rather serious topic to end the week on, but something we should all think about, I think...

(emphasis mine)

Aids stats point way to HIV tests
Health Minister 'seriously considering' opt-out scheme to stem tide

WITH recent statistics pointing to a worrying Aids trend here, the Government is thinking of extending the opt-out scheme to HIV-testing, too. So, if you are male, admitted to a hospital and have not opted out, then don't be surprised if you are asked to take an HIV test.

The Ministry of Health (MOH) is looking into an opt-out system for HIV testing as statistics show that one in 350 hospital patients is HIV-positive. A recent MOH study of more than 3,000 anonymous blood samples collected in hospitals showed that 0.28 per cent of those who thought they were free of the disease were in fact HIV-positive.

Also, a record 357 Singapore residents were diagnosed with HIV last year, up 12.6 per cent from 317 cases in 2005. Of the new cases, about 91 per cent were males.

Since then, a voluntary welfare organisation has called for mandatory HIV testing for those in high-risk groups — which some have described as intrusive.

Health Minister Khaw Boon Wan said on Friday that while mandatory screening is good from a public health point of view, there are objections and difficulties in implementation.

"The minimum is, I think, we have an opt-out scheme," he said.

For example, it could be administered when a patient is admitted to the hospital as part of standard tests.

"So, you can opt out if you want to, but otherwise people would just take it as a routine exercise like taking high blood pressure (and blood sugar)," said Mr Khaw on the sidelines of a National Day Observance Ceremony at Tien Wah Press.

Mr Khaw added that he was "seriously considering" the move to routinely test adult males on an opt-out basis.

He said: "If you take this rate of 1 in 350. Every day, the public hospitals probably have about 5,000 in-patients ... so at this rate, that means there are about a dozen unknown HIV patients whom we have very close contact with every day.

"As healthcare workers, we have proper infection control — (we wear) double gloves and so on — but accidents do happen ... so it's a problem I cannot ignore."

Of the new HIV cases last year, 78 per cent were detected when they were tested for HIV while receiving other medical care. Only 13 per cent were detected as a result of voluntary HIV screening.

The MOH's opt-out screening for pregnant mothers, implemented in 2004, has been successful in saving babies, with just one case of mother-to-child transmission occurring, and that was because the mother refused her HIV test until very late in her pregnancy.

Less than 1 per cent of pregnant mothers had opted out of the scheme.

While HIV testing "makes a lot of sense", Mr Khaw admitted that a lot of planning would have to be put into the exercise, such as bumping up counselling services for those found to be HIV-positive.

Mr Andrew Tan, a 27-year-old engineer who is single, said: "I am okay with it as I don't think I'm at risk, but I think it may be uneasy for you if you know that you have engaged in risky behaviour (like unprotected sex)."

The chairman for the Government Parliamentary Committee on Health, Mdm Halimah Yacob, described the opt-out HIV testing as an idea worth exploring .

"If you test by selection saying that people are in higher risk groups then one can say that you're passing judgment on lifestyle, choices, et cetera," she said.

"But if it applies to everyone subject to their right to opt out ... then I think it's all right."

Mr Tan Thuan Seng, director of Focus on the Family, which had suggested mandatory HIV testing, said the MOH's move is in line with what it is proposing.

"I think once people get used to the idea that HIV testing will be routinely conducted, they will get used it and eventually most will not opt out," said Mr Tan.


angry doc was brought up in the era when the HIV test, far from being something mandatory or 'opt-out', was a test that required pre-test counseling, on the grounds that it was a serious infection with many implications, that there was no cure for it, and that it was a notifiable disease.

Things may have changed somewhat since then: there are now effective treatment for the disease (although not yet a cure), and testing can now be done anonymously.

Still, as he has mentioned in a previous post, angry doc is not convinced that the figure of 1 in 350, assuming it is representative, necessarily means that the general population is at a high risk of becoming infected with HIV.

Moreover, angry doc questions the reasons for making HIV testing an 'opt-out' test given in the article.

According to the MOH HIV Statistics page, the incidence of perinatal transmission was 1 or 2 per year from 2000 to 2003, rising to 4 cases in 2004 (the year 'opt-out' testing for pregnant women was implemented), 3 cases in 2005, and 2 cases in 2006.

As for the problem of protecting healthcare workers which we 'cannot ignored'? The Ministry's HIV Statistics page does not record any incidence. In any case, Universal Precaution applies for all patients - just because someone is not HIV-positive does not mean you don't need to wear gloves when handling his or her body fluids. Accidents do happen, except they haven't resulted in any patient-to-healthcare worker transmission locally, nor can we eliminate accidents totally even when we know if a patient is HIV-positive. In any case, post-exposure prophylaxis can and is given to healthcare workers involved.

The fact is, the majority of HIV patients are actually adult males who become infected through sexual contact.

Will an 'opt-out' testing system reduce the rate of new infection amongst this group of patients? Probably, if we give them access to counseling, education, and affordable treatment.

Will it reduce the rate of perinatal transmission and transmission to healthcare workers in the course of their work? Well, these groups of people constitute less than 1% of the new infection cases each year, so even if you eliminate them altogether, you will barely put a dent in the total HIV infection rate.

So why use them as the justification for implementing an 'opt-out' system? Well, because if we are going to give up our rights, we would rather be told that we are doing it to protect babies and doctors, and not men who catch HIV from gay or paid sex, wouldn't we?

(Added: See insanepoly's take on this subject here)