Angry Doctor

Friday, October 05, 2007

Them 4

Who would have thought that the solution to our HIV/AIDS problem was so simple?

(emphasis mine)

When passion gets the better of reason
An ignorance-no-excuse law may yet discourage some from taking HIV tests
Tan Hui Leng

THE law may compel you to do certain things, but can it endow you with reason in the heat of passion?

The Ministry of Health (MOH) certainly hopes so, as it proposes an amendment to the Infectious Diseases Act that makes it an offence for any HIV-positive person to have sex — regardless of whether he knows of his status, as long as he has reason to believe that he has been exposed to the risk of contracting the virus. He is not liable, however, if he has informed his partner who voluntarily agrees to undertake the risk, or if he has practised safe sex or tested negative before the act.

If this legislation is pushed through, Singapore will be the first country with such laws in place.

Yet another punitive approach for the "fine" city? Not so, said the ministry. Rather, this new provision is to make people take personal responsibility and get tested regularly if they are in "high-risk groups".

Speaking to reporters on the sidelines of an event last week, Health Minister Khaw Boon Wan, talking about who would fall into the high-risk groups, explained: "A high-risk one is really simple: 'Do you visit prostitutes?' — that you must know, right? And if you do, then at least, you must do regular testing."

But is it really that simple?

Conservatives may not like this. Parents may not like this. But the truth is: In an increasingly sexually-open society, one can be sexually-active but not necessarily promiscuous. It will not be difficult to find many who have had several, or even many, sexual partners in a number of serious relationships in a lifetime.

If a woman has had sexual intercourse with five boyfriends, would she be considered high-risk? Should she have reason to believe she might have contracted HIV? She certainly might not think so. But if she had contracted HIV in such a manner, would she be liable?

Just as a drunkard tends not to admit he has had too much, a high-risk person would not want to classify himself as such.

Where is the line between safe and high-risk? Such subjectivity can be highly controversial in a court of law.

What is more, it will not be easy to investigate each case. Indeed, even with current legislation, under which it is an offence for an HIV-positive person to have sex without the voluntary consent of his partner, just two people have been found to have run afoul of the law — one was not charged but fined, another left the country before he could be prosecuted.

As a report in the London-based New Scientist magazine said recently, even genetic sequencing may not reveal the HIV source. Given the uncertainty of it all, surely what one should do is to get tested anyway, whether one is high or low-risk.

But why should anyone do so? Especially if one is young (and feels invincible and immortal), especially if one appears healthy and has no symptoms, and especially if one already chooses to live life in a certain way.

In fact, we should be wary that the new laws may end up as a disincentive to getting tested for HIV. After all, whether or not I know of my infection, if I choose to have sex and not be upfront with my partner, I would still have broken the law. Without the test result, I could well carry on with my life — and perhaps never be caught. But what if I decide, one day, to go for a test, and it comes up positive? Will that spark off contact tracing, and will I be hauled to court to answer for the sexual encounters I had before the test?

One wonders, too, what is 10 years' in jail to someone already slapped with a death sentence, or a $50,000 fine to one who has lost almost everything?

A scenario posed by a spokesman for Aids activist group Action for Aids also merits serious consideration: Will the proposed amendments lead to more frequent anonymous and casual encounters, where there is no exchange of identities or contact information between the partners?

Rather than jump into legislation, the Government should continue its efforts on public education and expand its message beyond "abstain, be faithful and use a condom". When announcing the new provision last week, MOH's director of medical services Professor K Satku lamented that some are still not having safe sex or going for regular HIV tests despite public education efforts.

It is a pity the ministry holds that view. Where Aids campaigns are concerned, Singapore remains conservative and could certainly be more creative in exploring its choice of messages and strategies.

For a start, the MOH could do more to demystify the Aids patient, who is hitherto unseen and unheard. It is no wonder people think of Aids as a death sentence — you disappear from public view and are as good as dead even before the illness claims your life. More information on how HIV can be treated, and how one can continue to lead a constructive life even after contracting the virus, will help remove some of the irrational fear that may be stopping people from going for tests.

Getting the individual to take responsibility for his actions may be a righteous move. But in dealing with a problem that has its roots in emotionality and irrationality, punitive measures don't always work.

angry doc must say this is a rather well-written article.

angry doc doesn't think threatening people for not revealing that they have visited prostitutes with a fine or jail term is the solution to our HIV/AIDS problem. It will not, as the article pointed out, encourage people to go for testing.

Not that he has a solution, of course. To begin with he doesn't even know who are the people who are already known to be HIV-positive, or when, where, how, and from whom they contracted the disease.

Does anyone?

Does anyone care?

Or are we just happy to have a law that lets us put those people who are 'high risk' into jail?



  • A well-reasoned piece emanating from MediaCorpse - will wonders never cease? Don't give much odds for the author's future career prospects at S'pore's Pravda, though.

    Yep, this proposal is yet another brilliant wheeze from the nice gent who gave you "NKF, I take my hat off to you" and "Let's turf all our useless, spent oldies off to JB and Batam 'cause the land costs diddly-squat there and they're only an hour away from our medical facilities so why shouldn't they be grateful, hmm?".

    So now you can be charged for a crime you were oblivious of committing. Nice one Saint Khaw, nice one S'pore, once again #1 laughing stock of the world. Doubtless your citizens will immediately curb their lustful human appetites the nanosecond this law is passed (as it unquestionably will be), HIV rates will plummet to vanishing point, and there'll be no need to contemplate the unspeakable notion of using * THE RESERVES * to treat ever more evildoers. Of course most are probably gay anyway and we all know what unsavoury practices *those people* engage in, don't we? Law issued, humanity saved, job done.

    By Anonymous g_e, At October 06, 2007 11:54 am  

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