The HIV-gay link: When Science makes that link
Is prejudice, discrimination or even religious belief really groundless, baseless and without scientific support? What happens when prejudice stems from a scientific observation?
Homosexual-bashers often claim that “AIDS is a gay disease.”
People standing up against anti-gay discrimination, however, claim that the “AIDS is a gay disease” statement is a statement of prejudice, not fact.
‘Stick to scientific facts!’ Both sides claim in equally loud voices, each side dragging up their favourite scientific experiments. Reminds me of the way Charlotte Wong cited an Utah research paper showing how abstinence-only programmes were most beneficial.
The link between Homosexuality and AIDs was apparently made very early on, by scientists.
“Serum samples from 88 percent of patients with AIDS andfrom 79 percent of homosexual men with signs and symptoms that frequently precede AIDS, but from less than 1 percent of heterosexual subjects, have antibodies reactive against antigens of HTLV-III.”
(HTLV-III was a name of the Human Immunodeficiency Virus, or HIV, before scientists agreed to standardize the use of “HIV” as the name of the virus that causes AIDS, the diseases characterized by a particular group of signs and symptoms) (isolation_of_HIV_nobel_winner.pdf)
That sentence came from the Abstract of one of the earliest scientific studies that described the link between the causative virus and AIDS.
Today, we read that paper with the benefit of hindsight. I am reading it through colored lens after 25 years, of someone who campaigns against the discrimination of homosexuals and HIV affected persons.
Invitation to you, the Reader, to comment
I wish to invite you, my readers, to read this paper, and to comment. What did you think? How did you feel? About the authors? About HIV? About Science? Or anything else?
I don’t want to say too much and color your opinion. I want to hear your views.
When you comment, do say where you are coming from eg. What’s your area of expertise? What was your original position on HIV/AIDS, homosexuality, religion etc etc
The reason I’m asking you to state where you’re coming from is that, often, our background , knowledge and culture influences the way we interpret things that we read, and it will be very helpful to understand how your reading and your position influence each other.
Background:
“On May 4, 1984, Dr. Robert Gallo, currently the director of the Institute of Human Virology at the University of Maryland School of Medicine, and his collaborators published a series of four remarkable papers in the journal Science, which demonstrated convincingly that a retrovirus they and others had isolated, called HTLV-III, was the cause if a new and deadly epidemic that was just beginning to sweep across the nation and the world : acquired immunodeficiency syndrome, or AIDs…. The four original papers of Gallo and his colleagues have been reprinted in this special Science booklet commemorating the 25th anniversary of their landmark discovery”
- E. Albert Reece, “From Cause to Care – Commemorating 25 Years of HIV/AIDS Research”
- (HTLV-III was a name of the Human Immunodeficiency Virus, or HIV, before scientists agreed to standardize the use of “HIV” as the name of the virus that causes AIDS, the diseases characterized by a particular group of signs and symptoms)
If you don’t have access to Science, but wish to read these articles, feel free to email me for them.
I’m only putting up the 4th one because that’s the one which mentions homosexuality. The other 3 are quite technical (HIV_homosexuality.pdf)
Robert Gallo was one of those who were considered, but not awarded, the Nobel prize for the discovery of HIV
http://www.npr.org/templates/story/story.php?storyId=95442769
The paper that won the Nobel prize is here: (isolation_of_HIV_nobel_winner.pdf)
——————————————————————–
Excerpts:
The results are presented in Table 1. Of
49 clinically diagnosed AIDS patients, 43
(88 percent) showed serum reactivity in
this assay. Two of the subjects whose
serum reacted positively with the HTLV
preparation had developed AIDS after
receiving blood transfusions, one in Haiti
and the other in Aruba. Of 14 homosexual
men with pre-AIDS, 11 (79 percent)
were positive. Of 17 homosexual
men with no clinical symptoms of AIDS,
seven were positive. At least one of
these was known to be a long-time sexual
partner of a patient with clinically
diagnosed AIDS. Another had persistent
fatigue and possibly other early symptoms
of AIDS. Because these 17 men
had been seeking medical assistance,
they are not a representative sample of
the homosexual population, and the high
incidence of HTLV-III-specific antibodies
in their sera may not reflect the true
incidence in the homosexual population.
One of the three intravenous drug abusers
that were positive for serum antibodies
to HTLV-III was also a homosexual.
Serum samples from only one’of 186
control subjects reacted positively in this
test. These control subjects included
three with hepatitis B virus infection,
one with rheumatoid arthritis, six with
systemic lupus erythematosus, four with
acute mononucleosis, and eight with various
forms of lymphatic leukemias and
lymphomas, some of whom were positive
for HTLV-I. The rest were normal
donors of unknown sexual preference
including laboratory workers ranging in
age from 22 to 50
Among the antibody-positive
cases reported here a few are of particular
importance with respect to the transmission
of the disease. For example, the
mother of the baby with AIDS was positive
for HTLV-III as was a long-term
sexual partner of a homosexual with
AIDS. Recipients of blood products originating
from individuals at risk for AIDS
were also positive for HTLV-III and, as
described in an accompanying report
(31), the virus has been isolated from
several children with AIDS as well as
from their mothers. The data presented
here and in the accompanying reports
(30-32) suggest that HTLV-III is the
primary cause of AIDS.
AWARE’s Comprehensive Sexuality Education (CSE) : Re Homosexuality, anal sex, pre-marital sex
I know the way things sound with homosexuality , anal sex being noramal and all. Frankly, the instructor’s manual was confidential for a reason – you had to go through the training, and understand the values. And I must say the instructor’s manual was written very carelessly and politically insensitively (hence very open to misinterpretation) because we always trusted our trainers to respect its confidential nature — back to the trust that Constance Singham was talking about. The students’ manual says no such thing however, about pre-marital sex, homosexuality or anal sex.
Because of our value system of not imposing our values, we do NOT EVER tell students that homosexuality or anal sex or what have you is MORALLY OK — because in our value system all these are morally neutral. Of course, you don’t discuss the concept of what morally neutral means with kids – it’s not a philosophy class. You simply demonstrate it through your choice of language (elaborated later).
What I would say to the class is this (abbreviated/summarised here): “This is NOT a moral education class. This is a HEALTH education class. 3 kinds of sex is possible –oral , anal, vaginal. All 3 are at risk for STIs, unless you use condoms. Only through vaginal sex can you get pregnant, although heavy petting does result in pregnancy too. There are religions that believe homosexuality is wrong. There are also people who believe homosexuality is OK. Just like there are religions who believe eating meat or other kinds of food is wrong, and there are people who believe in eating everything. What’s important is that we respect each other. That means if you believe in a particular religion, you should be able to hold your beliefs without feeling shame or discriminated. Likewise, if you don’t believe in that religion, you should be able to hold your values without feeling shame or discriminated. Respect also means that while we hold on to our belief system, we do not have to impose on others, and insist that they also practice our religions practices.”
You know what? I’ve NEVER had a problem with teachers (we even did workshops for teachers), or any students, saying this. At 14, they UNDERSTAND the meaning of respect and religious freedom. I’ve a lot of hope in the next generation — 80% of girls I meet believe that homosexuals should be treated and respected just like anyone else, although they are different, but orientation-wise only. Plus I’m sure you recognise that sex ed for homosexuals must start young too, and that you couldn’t impart any knowledge by telling them they are morally wrong?
And BEFORE we even go into all this, we first talk about what it means to respect each other’s choice. What consent is? What’s love? Does changing for a person demonstrate love? Does sacrifice demonstrate love?(Answer: What’s the difference between someone who wants you to change/sacrifice for HIS own benefit, versus someone who wants you to change for YOUR own good? I ask this question, and the students’ answers are always unanimous and mature.) Does sex mean love? Is pain bad? In that context, we talk about the vaginal sex — is it painful the first time? Should it hurt? What signs and symptoms do you watch for before you go to the doctor? (Answer: ANYTHING out of the ordinary. Don’t even ignore a minor, bearable itch!) We talk about anal sex – is it painful? Should it be? What kind of lubricants will /not compromise the quality of the condoms? (Answer: Please don’t ever use baby lotion or hair gel or what have you) If you’re under 14 and pregnant or get an STI, what do you do? (Answer: your health is first priority, NEVER avoid the doctor because you don’t want you beloved boyfriend to go to jail) Does being married protect you from STIs? (Answer: Where STIs are concerned, whether you’re married, or having pre-marital sex, you can still get STIs. Fact is most female HIV patients in Singapore get HIV from their spouses, and most women who have abortions are married)
Where views & values are concern, we leave it open to the girls to air their 101 views so that they realise there’s so much diversity with views and values, it’s disrespectful to impose and insist. With facts, we provide answers in a morally neutral fashion, using morally neutral language, — but we don’t even have to articulate the moral neutrality.
An example of a morally neutral statement: Anal sex carries a higher risk of STIs because the anus skin tends to tear more easily. Condoms are the only means of reducing the risk of STIs, if you choose to engage in sexual activity, provided they are used correctly and 100% of the time.
By informing students of the consequences, and letting them know it’s a choice they make, you empower them and respect them as humans capable of making good choices. Making moral prescriptions – whether positive or negative – both disempowers and disrespects the students.
All these values and preparations is not put in the manual — it’s part of the value system trainers hold to get selected, and is reinforced in the training and in AWARE’s value system. And this is what we focus on in class.
But when you take 3 lines out of a manual, out of the entire class context —- that’s when things get messy and misinterpreted. Like we said at the EGM, the New Exco clearly flouted our confidentiality agreements and intellectual property rights when they made that disclosure. And I’ll even say slander when they put my name and Joo Hymns’ on the website in a derogatory fashion.
HIV is LIKELY to go undetected or misdiagnosed – So how?
Have you ever been tested for HIV when you went to see your GP for a cold or flu?
My bet is No, even though the typical, early symptoms of HIV are almost EXACTLY the same as a bad cold/flu – high fever, aching joints, swollen lymph nodes, bad cough etc.
So think about it. If you were never tested for HIV when you went to see your doctor for a flu, what makes you think that HIV infected people will be correctly diagnosed at that early stage? Wouldn’t they be misdiagnosed for a flu?
That’s exactly what happens.
“In 2006, more than half (58%) of the new cases already had late-stage HIV infection when they were diagnosed. This was similar to the pattern in previous years……
Most of the new cases in 2006 (78%) had their HIV detected when they had HIV testing in the course of some form of medical care. A much smaller proportion were detected as a result of voluntary HIV screening (13%). The rest were detected through contact tracing and other screening. When differentiated by sexual orientation, a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (35% vs 3%).”
– http://www.moh.gov.sg/mohcorp/currentissues.aspx?id=16114
Which really means that, whenever you decide to engage in sex with anyone, the best thing you can do for yourself is to assume that the person is HIV positive, and use a condom — which is 99% effective if you use it CORRECTLY, and 100% of the time.
In the meantime, these statistics provide a very good argument for automatic, opt-out testing. The government initiative to test all male patients coming into Singapore’s public hospitals, regardless of the illness they came in for, can address this very high rate of misdiagnosis. The number of undiagnosed HIV cases are thought to be about 2x the numbe of diagnosed cases. The idea of automatic testing is not to ostrocise or to “doom” these HIV victims — the idea is to reduce the spread with early detection, and to get treatment to prolong life.
Why is it only restricted to men? Because HIV tests have an inherrant error rate (that’s just the technology limitation), and the HIV infection rates for women are still low enough that it is hard to distiguish the error rate from the real positives, so it is not that helpful as a screening measure for women.
While from a public health perspective, automatic HIV testing is an effective detection measure, the social consequence would be the increased stigma attached to being HIV positive. This is something we cannot ignore, because HIV infected people have a right to be treated with dignity — and that includes the right to keeping their status confidential, their right to treatment, their right to doing all activities that would not result in the further spread of HIV.
Moving forward from Obama’s “We reject as false the choice between our safety and our ideals”, we need to make sure we have strategies that both enhance our health safety as a population, and safeguard the rights of HIV infected people, which they fully deserve. This is fully possible if we want to achieve it, and we have to consciously reject as false any assertion that we have to choose between our public health and human rights.
So auto-testing would enhance our health safety as a population, and enable the HIV patients to start treatment early to prolong their life and enhance their quality of life. I think Singapore got that right
It’s the second part that we need to make sure is in place — and recognise that achieving our ideals of according HIV patients the rights they deserve, need not compromise our health safety at all.
What needs to be in place ? This is a non-exhaustive list which would be nice if readers could add on to.
The State’s to-do list:
1. Affordable treatment .
Affordable not only in the sense that the patients can pay for it, but affordable in the sense that after paying for the treatment, they can still afford to have a normal life — to still be able to pay for their utilities, mortgages, children’s education , even a holiday or two. They should not be enslaved by the cost
2. Accessible treatment of high quality
Treatment that is accessible and affordable should not just be the basic, Third-world, scrapping by type of treatment. In should be in line with the country’s philosophy of having First-world, world-class, health care.
3. Enforced, laws (not guidelines) preventing discrimination at the workplace
HIV CANNOT spread through working together (unless you’re in the unprotected-sex trade/ having unprotected sex with your colleagues). In the same way that the government took concrete action against the discrimination of pregnant women, similar action has to be taken against workplace discrimination.
4. Laws protecting confidentiality
Patients have the right to confidentiality. When this confidentiality is breached, patients should be able to sue the violating parties. In bringing on these lawsuits, patients should have provisions to protect their confidentiality during the legal proceedings, similar to how rape victims are protected during legal proceedings
5. Laws protecting against discrimination
Patients should be able to sue organisations that practice discrimination, similar to the way we can, if we are discriminated based on race / religion etc unnecessarily. This is slightly different from workplace discrimination –which has to be enforced more strongly because it is their means of livelihood. Here, we want to enforced their rights to be treated without discrimination by country clubs, associations, schools, media portrayals etc
6. Family members of HIV patients have to be protected under the same laws, as those above.
7. Have a long-term public education programme against discrimination against people living with HIV
Public education should go beyond stopping the spread of HIV, but should to decrease discrimination amongst those affected. In campaigns for safer sex, other groups of people should not be discriminated against, eg. homosexuals , women (notice how ads always portray women as the agents of infection? women are forced into either categories of being a slut or being a virtuous wife — another false dichotomy). Governmet bodies need not be the ones running these programmes ; they can provide funding to diverse groups who can conduct these campaigns from all the different perspectives
We, the Peoples, to-do list
1. Make friends with people with HIV — we will then learn that they are as human, as good, and as bad as we are
2. Learn more about what living with HIV is like
3. Speak up whenever discriminatory words/acts are observed
4. If you are in the position of power eg. as a policy maker, as a HR manager, as a journalist — exercise your power responsibily
5. Spread the message
HIV and Cervical cancer discoverers win Nobel Prize and say that …
Montagnier and Francoise Barre-Sinoussi, of the Institut Pasteur, shared half of the 2008 (nobel) prize for discovering the virus that has killed 25 million people since the early 1980s.
“I think I feel that we have responsibility to try to influence, especially, the politicians.” Barre-Sinoussi said. “Still, 25 years after the HIV discovery, (there is) discrimination, stigmatization against HIV-infected individuals, even criminalization. This is not acceptable. This is really not acceptable,”
German scientist Harald zur Hausen of the University of Duesseldorf won the other half of the 10-million-Swedish-crown ($1.2 million) award for finding the cause of cervical cancer.
“There’s obviously a belief in many of the politicians and some other people … that you know everything, which of course is nonsense. But in a way indeed I think one cannot ignore this,” zur Hausen said.
Qouted selectively from :
Subsidised drugs for HIV patients
I wake up this morning, to some sort of new dawn.
And I know, that in Singapore, more than 3000 people, multiplied by how ever many family and friends they have, are waking up to a new dawn.
HIV drugs for HIV patients are going to be subsidized!
I’m not suggesting that this is a panacea for people living with HIV – we can never understate the horror – but at the very least, these people have some hope and justice accorded to them.
Hope, because with the drugs, they can live healthy, productive, meaningful lives for DECADES on, the way a diabetic or hypertensive patient does. Hope, because their lives need not be centered around the desperation and fear of getting their next dose, or their child’s next meal. Hope, because they can use whatever financial resources they have on their child’s education, on food, on building their lives and relationships, instead of spending every penny, and more, on drugs.
And justice, because nobody, NOBODY , should die from being unable to afford medicines in a country so affluent as Singapore. Not HIV patients, not the low-income, not the old, not the imprisoned, not the smoker, not the ignorant – NO ONE.
For me, there were a second layer to this new dawn.
A reminder that the government is not an impersonal, dehumanized object.
A reminder that that the government is filled with people – people who have feelings, who can sympathize, empathize and rationalize. People who have great power and great responsibility to accord life and death with their deeds and thoughts. People who actually listen to the voices of their fellowman.
There have been so many people who advocate tirelessly and courageously for year after year, banging wall after wall, burying patient after patient, friend after friend.
Today we see that their efforts are not in vain. That for thousands in Singapore, change has come, hope has been given. Because people on the ground have chose to speak up, because 87% of the electorate has voted ‘YES, spend my taxes on subsidies!’, because policy makers have listened.
I have a renewed hope to continue standing up for justice and mercy. To continue screaming out for those without voices. To be our brothers’ and sisters’ keeper.
I have a renewed reason to practice my faith, which says to all
“Speak up for those who cannot speak for themselves, for the rights of all who are destitute.
Speak up and judge fairly; defend the rights of the poor and needy.”
Let no one ever say again, ‘Don’t bother lah , no use one lah’ – because today our bothering has made a change
Let no one ever say again, ‘Government never listen one lah’ – because today the people who make up our government have heard.
Let no one ever say again, ‘Don’t talk to loudly, wait ….” – because today chants of the brave have given many a chance at life.
HIV subsidies: On Waste, Taxation and Justice
I love diversity of views, whether or not I agree with them, so keep them comming!
Here, I respond to a comment made to my earlier post, that I really appreciate, because I think it represents the views of many people. To people with these views, I am not saying I disagree, but I would hope that you can further your views on these 3 points I am making in response.
To summarise, someone raised the points that:
1. HIV subsidies “would be a disproportionate use of resources for a small affected population. “
2. HIV subsidies will come from taxpayer money which might have to be raised
3. Charities should provide the subsidies, not the taxpayers
And my questions to everyone in response:
1. WHERE DO YOU DRAW THE LINE?
You said that “That would be a disproportionate use of resources for a small affected population.” So what proportion of the population has to be afflicted by an illness before we start subsidising? Where and HOW do you decide on this line? SARS affected only less than 100 people. Look at the resources poured in. Was that due to the fast-spreading nature of SARS? AIDS is also an infectious disease which spreads. The numbers looks small, but with half the cases only being detected a few years after infection, and with the rising rates if infection, you can be sure there are many many more undetected HIV cases.
According to MOH statistics the No.10 killer in Singapore “Nephritis, Nephrotic Syndrome & Nephrosis” (layman language : KIDNEY FAILURE) had only 3500 deaths in Singapore in 2007. Shall we also stop all government treatment subsidies (through grants to NKF, through direct medication subsidies, through Medishield coverage) for Kidney patients? Or should the government have the apply the same subsidy model to HIV treatment?
(http://www.moh.gov.sg/mohcorp/statistics.aspx?id=5526)
2. WHERE IS JUSTICE?
AIDS patients have been contributing to society, same as everyone else, through taxes, through their work. Is it justice if some people have their treatments (eg smokers for lung cancer) subsidised, but not others? How do you decide who to subsidise, if justice is your principle criteria? 14,000 women a year abort their babies. They get high subsidies for their abortions, even tho’ it was their “mistake” having unsafe sex, and no one makes a sound about it. Why should 5000 people pay the price of death for the same mistake of unsafe sex? Remembr, drugs can keep them healthy for another 40 yrs. By denying them affordable drugs, you are killing them 40 yrs earlier than necessary.
By relegating the ENTIRE responsibility to Charities (charities are great, as a support structure, as with NKF), you are essentially saying that treatment for HIV patients is a form of underserved mercy to them, because it is the governments role to provide what citizens DESERVE (ie. human rights). Do HIV patients not deserve the treatment they need? Why?
By the way, each year there are only 2 – 4 babies getting HIV from their mother (http://www.moh.gov.sg/mohcorp/statistics.aspx?id=246), that’s like $5000 a month to provide full subsidies for these babies, so let’s not even talk about having to raise taxes yah?
3. WOULD IT ALWAYS BE SUCH A SMALL PORTION, 5000 out of 5million?
Based on the current rising trends (http://www.moh.gov.sg/mohcorp/statistics.aspx?id=246)
the answer is a definate NO. When a family has to spend all its income on treatment because no subsidy is provided, everyone, including their children who need money for schoolm gets affected. How many people must be infected before we start providing treatment subsidies?
One reason that people do not test for HIV (or opting out of the auto-testing now) , is because there is absolutely no incentive for them to. If you are negative, then no point testing. If you are positive, you will lose your job, you screw up your family, you have to pay for treatments $1000 a month, no one helps you, you die. Why should anyone want to test? For most other diseases eg cancer screening, heart disease screening, you test because you CAN get treated (direct subsidies or Medishield coverage) when you test positive. Not so for HIV.
So with the high risk people not wanting tests, would the infection rates go up or down?
Yes we might have a law that convicts people of transmitting HIV, even unknowingly. But this law is REACTIVE, not PREVENTIVE. And seriously, when the death sentence that is AIDS does not even deter people, what makes you think they will be detered by a jail sentence?
Say YES to AIDS treatment subsidies!
In Singapore, AIDs patients do not get ANY subsidies for their treatment at all. Insurance policies exclude HIV infections and its symptoms; those that provide some coverage exclude HIV infection via sexual means.
Why don’t AIDS patients get subsidies?
The usual excuse is that HIV infected people have brought it upon themselves by engaging in immoral / risky sexual behavior, and hence they and they alone should pay for the consequences.
This continues to be an excuse, even though medical subsidies are still given to smokers who contract lung cancer, to junk food lovers who develop heart conditions , to reckless drivers who crash in their cars.
This continues to be an excuse, even though most women get HIV from being faithful to their husbands, even though all children get HIV from simply being born.
This continues to be an excuse, even though the cost of subsidizing treatment for women and children is $5000/ yr only (AFA estimates). The cost of providing a 50% subsidy to all HIV patients is $ 9.4 m / year only, 0.5% of our $1.8b public expenditure. In 2008, the government increased HIV funding for manpower and prevention programmes, but not for medical subsidies.
What is happening to AIDS patients in Singapore, without subsidies?
HIV infected people die within 5 – 10yrs of infection without medication, but can live for another 40 years – healthily, and without infecting others if they practice safe sex – with the necessary drugs. How many of you reading this are confident of living another 40 years?
A HIV person on the World Health Organization’s (WHO) recommended therapy has to pay about $1650 a month here. Because of the high price, compounded by the fact that HIV patients are often jobless due to job discriminations and unfair dismissal, patients here often cannot afford their drugs.
For most patients, they take their medications whenever they have the money to buy the medicines. When their money runs out, they stop their medication, until they can find money again. But HIV drugs are not like painkillers, where you just have to bear with the pain when you stop the drugs. For HIV drugs, missing just 10% of the needed doses, can make the drugs useless, and 2nd-line, costlier drugs would be needed to help the patient.
When Mr Goh Chok Tong was prime minister, he promised that nobody in Singapore would be denied health care because they could not afford it. This promise has been kept to almost all Singaporeans. Unless you are a HIV patient. Medifund, which Mr Goh started as the last safety net for the poorest people who could not afford medication, does not fund HIV drugs. In this rich 1st world nation, people are dying of AIDS, because they cannot afford their medicines.
Why are AIDS drugs so expensive?
Drugs for treating HIV are expensive. Because Singapore is a first world nation, drug companies sell drugs here at first world prices. For most other illnesses for which government subsidies are provided, such pricing is fair because the cost is spread amongst all the tax payers, and the cost is affordable for a wealthy nation like ours is. But drug companies cannot make an exception with HIV medication simply because the government refuses to subsidize; drug companies are neither charities nor do they have the responsibility of taking care of a country’s citizens. And unlike diseases like diabetes where there is a choice of cheap basic drugs or expensive sophisticated drugs, all the drugs used in HIV treatment is incredibly expensive.
Our “3rd World” neighbors are subsidizing Singaporeans
In Malaysia, the first line treatment for HIV is provided free, and often Singaporeans have to depend on Malaysia – is it fair for Malaysian taxpayers to be subsidizing Singaporeans? In Thailand, the government backs the production of generics which are just as effective as the non-generics, but cost 2 – 10 times less. Hence Singaporeans have to depend on the Thais as well, but custom laws allows them to bring in only 3 months supply at a time, and hence patients, despite their ill health, their work schedule and their depleting funds, have to make this 3 monthly trip to Thailand to survive. In Taiwan, the basic HIV treatment is free, and this has helped reduce treatment because the infectivity of HIV patients on drugs is decreased. The WHO recommends that countries put HIV drugs on their list of subsidized drugs, but Singapore dies not heed this recommendation.
The generic drugs being produced however, are the older generation of drugs which have many undesirable side effects. The new , better drugs, with less side effects, allows the patient to function more normally, but because of World Trade Organisation laws, countries like Thailand and India are not allowed to produce generics.
Hope for Singapore
Today, I read with great hope that Singapore’s Communicable Disease Centre (CDC) said it is confident all HIV patients in Singapore will have access to anti-HIV drugs by 2010. (http://www.channelnewsasia.com/stories/singaporelocalnews/view/393484/1/.html ) At the recent 6th Singapore AIDS conference, there were many doctors from the CDC that spoke up strongly in support of their patients – no longer did they want to prescribe drugs that their patients would never buy because there was no money. No longer did they want to treat patients who would die because there was no money. Dr Arlene Chua reported during the conference, that 50% of the doctors here support enhanced policies to contain HIV, but another 30% choose to remain silent because they believe doctors shouldn’t meddle in politics. Today I read with great hope that perhaps more doctors have realized that to save patients, great medications are not enough; great policies are needed too, and these doctors have decided to take a stand.
And YOU readers, can do your part, by simply voicing out your support at this ChannelNewsAsia poll here http://www.channelnewsasia.com/polls/commentform.php?id=168
Today I also read with great hope in the Today paper, that WorldVision, which went in rescue of the Myanmar and Sichuan victims, have come to the rescue of AIDS victims here in Singapore. http://www.worldvision.org.sg/st_worldaidsday.php
They are providing educational funds (One Life Fund) to the children who are suffering from HIV, or have parents suffering from HIV. Because most of the family’s income goes towards the expensive medication, and because HIV parents tend to lose their jobs, these children often forfeit their education. World Vision is making sure the children will never have to choose between school or their parent’s lives.
And YOU readers, can do your part too. Buy a M.A.C VIVA GLAM lipstick and support a child living with HIV in Singapore through school.
Visit the M.A.C counter at Tangs Orchard on December 6, 2008 to purchase a VIVA GLAM lipstick. All proceeds from the sale will be donated to the M.A.C AIDS Fund to help those suffering from HIV and AIDS in Singapore. (M A C AIDS Fund is raised for World Vision’s One Life Fund)
And most heartening of all, I read with great JOY and HOPE:
The public CNA poll results: Besides offering voluntary tests at public hospitals, should HIV-positive patients get subsidised treatment?
A resounding 87% say YES!!!!
In case the CNA poll is close, please join this Facebook group: YES to HIV/AIDS treatment subsidies
http://www.facebook.com/profile.php?id=523405834&ref=name#/group.php?gid=47441588351
Preventing HIV/AIDS and STIs : What the State and Church will not tell you
- Many State-run / funded programmes to decrease STIs and unwanted pregnancies need to follow the ABC (Abstinence, Being faithful, Condom use) policy. This is largely due to pressure from conservative / religious groups, to reflect an ideal.
- Abstinence – How practical is this advice? How long can one abstain? Does it apply to just teens, or 30 , 40 year old singles as well? What if you’re gay and cannot marry? If you never marry, will you never have sex too? Fact is, STI rates are highest for the 20 – 40 yr old age group (Teens make up only 10% of STI cases).
More importantly, this is useless advice for married persons. The implied message is of course NOT that celibacy is the ideal state, not when the government is actively trying to get the birth rate up. The implied message is against Premarital Sex.
The implied message is that, somehow Sex is OK when one is married, that somehow Married Sex a person from all STIs and Unwanted pregnancies. IS THAT TRUE???? - Not really. That’s why the 2nd message is BE FAITHFUL
Telling a person that BEING FAITHFUL protects him/her from STIs and Unwanted Pregnancies is the equivalent of telling a person that BEING HONEST protects him/her from being a victim of theft.
In Singapore, 2/3 of HIV positive females are FAITHFUL wives who got HIV from their husband. In other parts of Asia, 25% of HIV patients are women, and 90% of the women get it from their husbands.
The ‘Be Faithful’ message gives people a false sense of security. Being faithful is a MORAL obligation we have to our partners, but is NOT a protective measure for ourselves.
The Be Faithful message is also unhelpful for preventing unwanted pregnancies.
Just because you are married and faithful does not mean you won’t get accidental pregnancies. Just because you are married and faithful does not mean you can afford to keep all the accidental babies.
10, 000 out of the 14,000 abortions performed in Singapore EACH YEAR are on MARRIED women.
In this day and age, in this country, where contraceptives are so easily and cheaply (Pills from polyclinic at $5 a month!) available, why do 10,000 of our women even put themselves in the position where they have to consider an abortion! Is there something wrong with our EDUCATION? ( think about this : each year, there are 26,000 babies born in singapore, of which 13,000 are female babies. And 14,000 women go through abortions each year)
Why don’t our women know how to prevent pregnancies they don’t want? Why do they risk their health and bodies?
- Condom use : probably the most useful and practical advice
Condoms are the ONLY method of preventing STIs and HIV
Pills are cheap and prevent pregnancies, but cannot prevent STIs
What are some issues with condom use and promotion?
- public backlash against overt promotion . Many schools are afraid to dish out this advice, lest parents accuse them of promoting Sex
- How to use condoms properly? Hardly ever taught. BIGGEST cause of condom failure is user ignorance , ie. People use it wrongly.
- Condom use is ranked last in the ABC message : Implicit message that Good girls (A grade!) don’t have sex. Not so good girls (B grade!) have sex, but at least they are faithful. If you really cannot make it or cannot control yourself as a good girl or even as a Not-so-good-girl, at least, please use a condom.The result is that no one wants to admit that they fall into the ‘C – grade’. It reinforces the misconception that if you buy condoms, you’re a slut who is asking for sex!
As a result, people put themselves into the position of having sex without a condom . How so? Because they give themselves this excuse : because “we didn’t mean to have sex. We didn’t plan for it. Only sluts and desperate people plan to have sex. Only sluts and desperate people will carry condom. For us, it was a moment of passion. So no chance to get the condom”
- Emergency Contraception / Plan B / Morning-After pill (Go google for more info)
A pill you take within 72 hours of sex to prevent pregnancy. High dose of hormones, not healthy to be used regularly. Use only when your main mode of contraception failed. Available at GPs.Can prevent you from having to go for an abortion.
Can prevent you from getting pregnant AFTER you have sex.
Does NOT prevent STI, if you kenna already, it cannot help you.
Emergency Contraception is NOT ACTIVELY PROMOTED publically à Is it responsible of sex educators (government, mainstream educators, civil groups, religious groups) not to promote the use of EC because of protests from conservative groups???
6. Vaccinations against HPV
HPV causes 90% of cervical cancer cases, and is an INCURABLE STI. The vaccine costs $700. There are no subsidies for this vaccine.
Reason given: it does not cover all strains of HPV, only 70% of the strains.
Currently, regular PAP smears are the main method of preventing cervical cancer. But this is fire-fighting. Because Pap smears detect ABNORMALITIES , which you need to undergo a surgery to remove. Pap smears detect the cancer AFTER you develop the cancer. Vaccines PREVENT the cancer. However, with or without vaccine, please go for PAP smears (VERY CHEAP) because cervical cancer in the early stage is 90% curable, at late stage it becomes incurable.
When should Law and Policy disregard moral values?
In the large majority of cases, the law reflects moral values – its common sense. It’s morally wrong to murder, there’s a law to state what happens to murderers. Same for robbery. Same for whacking up somebody because you felt like it.
But there are some instances, where the law cannot, must not, reflect morality. These are quite a small minority, but a very important minority. What are they? I’ll cover some of these cases here, but these are not exhaustive. They fall mainly into the domain of health. I’m not too sure why; is it because this is the area of my specialty (I’m doing my PhD studying unborn babies….) or because it’s the nature of how our health and psychology works that makes it that way.
Anyway, the areas I’ll be talking about to illustrate my point : 1. Drug use / prostitution 2. Sex with minors (below 16s)/Abortion 3. Euthanasia
- Drug use / prostitution.
During the recent AIDS conference, a HIV prevention activist from Sydney, Australia gave a keynote lecture, describing some of the more successful strategies. Two of them were providing drug addicts with free clean injection needles and de-criminalizing prostitution.
How does that work? Drug addicts who inject drugs usually share needles – they spend all their money on drugs, no money to buy clean needles. Drug addicts also tend to engage in prostitution to support their habit. So the percentage of HIV cases amongst drug addicts is very high because they are constantly engaging in 2 sorts high-risk behavior.
But the percentage of drug addicts amongst the total number of HIV cases is actually very low – because most people in Sydney are not injecting drug abusers!!! However, because enough “normal” men visit prostitutes/ drug users, the prostitutes/drug users become the “seed” through which HIV is spread to the larger community. The “normal” men then take the HIV back to their wives, girlfriends, boyfriends, casual sex partners etc. Therefore, cutting off the infection at the “seed” will reduce spread into the mainstream.
To do that, the Australians set up places where drug users can get FREE CLEAN needles, without getting arrested for drug use. At the same time, the Australians still maintain their opposition to drug abuse.
In the same way, they also set up education programmes to educate and empower prostitutes to practice safe sex , to use condoms, without arresting them for prostitution. At the same time, the Australians still do not view prostitution as a morally acceptable behavior.
Because the drug users/ prostitutes can adopt healthier practices without the fear of being arrested, they of course do! And in doing so, they prevent the rise of HIV infections. If they will be arrested, or if the authorities refuse to help them at all and still criminalize them on moral grounds, then it will drive them underground, where the HIV will go up and go into mainstream society. Not that Australia condones drug use or prostitution – they don’t.
This is a classic example of how, on one hand, everyone holds to the same moral value – NO to drug abuse and prostitution – but policy, (even if the law must be there still) has to be different from the moral values, and TOLERATE it, because the cost of policy adopting a moral high ground would be a much larger cost to the health of a greater number of people.
- Sex with minors (under 16)/Abortion
In Singapore, having sex with a girl under 14 is considered Statutory Rape , with 20 yrs jail, 12 strokes. Having sex with a girl or boy under 16 carries 10 yrs jail. That law upholds the moral value that adults should not take advantage of the ignorance and emotional immaturity of the child. Great moral value there, and certainly a very useful law to bring these child exploiters to justice.
What’s the backlash?
In the course of my work with the teen girls, I’ve met girls who really loved their boyfriends( could be teens like them, even more immature, could be adults), so much so that when they get pregnant, or get an STI, they never go to the doctor, never tell a single soul. Because they are so afraid their boyfriends would have to go to jail for 10 or 20 years, when the doctor finds out.
What do they do?
I tell them, your life and health is the MOST important. No matter what, go to the doctor, ASAP! And no doctor can make you reveal who your boyfriend is. No doctor will imprison you in his clinic for days and days until you confess. If you never reveal, no one can arrest your boyfriend.
There was a recent case, where people were very appalled because a 12 year old girl went to the abortion clinic and she didn’t dare to disclose or report the rapist. The parents didn’t know and so could not help her. The public felt that parents should be made to know, to help her. I fully agree with their thoughts, but I will never want to see parental consent made compulsory by law, because the consequences will mean the deaths of even more young girls. I would rather pay the price of having disobedient or even bullied teenagers. Bad as that may be, death is worse.
- Euthanasia
Firstly, bear in mind that medical care, even the most basic, HAVE to be State subsidized, or else it will be beyond the reach of the majority. Even your polyclinic is VERY VERY subsidized. But countries usually subsidise only a specific list of STANDARD medicines. The newer, more expensive, better medicines are not on the STANDARD list and not subsidized. The number and cost of medicines on the STANDARD list will depend on how much subsidies the State wants to provide. Drug companies tend not to sell lousy medicines when good ones are already available, or they will not make lousy medicines more expensive than good ones – that’s common business sense. Furthermore, if the expensive ones are not better than the cheap ones, your doctor won’t even prescribe to you!! So what’s this argument about expensive not being better?
So, if State subsidies are low, people tend to not get the best treatments, and of course they will suffer! Or they will say, don’t waste more money on medicines. And so they will wish for death. And they will be happy that euthanasia is legal. And since they are allowed to die and solve the problem, why should the State increase medical subsidies or palliative healthcare? Why should I care for you when you can just go and die?
We MUST NEVER support LEGALISED euthanasia, because it is iimportant that you have enough medical subsidies from the government and not have them tell you, sorry too expensive, but we allow you to go and die.
You think such people like the daughter-in-law don’t exist? Then why is there so many old-folks homes? Siblings fighting over who should look after parents? The Parents Act where kids must be forced by law to care for parents?
So yeah, I agree with many people that we have the MORAL right to choose our own death, and I might even do so myself. But I will never agree to LEGALISED (read: State ENDORSED) euthanasia.
Religion and policy were separated a long time ago – and we need to keep that separate.
The above post is 3rd in a series of posts reviewing info brought up during the 6th Singapore AIDS conference. The first described the conference. The second described the life of someone with HIV in Singapore, and hopefully makes you want to do something about the situation. This third post hopefully establishes the principles on which I evaluate and recommend policies with regards to HIV.
Living with HIV in Singapore
If you are a Singaporean, and male, and you went to a public hospital for a twisted ankle, you would be asked to do a HIV test, even though it is completely unrelated to your condition – it’s just screening.
You do have the option to opt out, but, gee, what would the nurse think? More importantly, your wife is sitting beside you. What would she think if you opened your mouth to tell the nurse ‘errr … can don’t want or not?’ ? The nurse would reply ‘ routine testing, nothing one lah, not pain lah, you scared pain ah?’ Your wife would turn to you and say ‘Why, you scared ah? You outside got woman ah? You never do anything wrong, scared what?’
You really don’t want to dig your grave, even though you gave in to pressure from your buddies the last time you guys went to Vietnam for a business trip. But that was a year ago, and you have been fine since. Not like you’re sick and in pain. And she was young, a young teen, couldn’t have had that many men. Oh well, the HIV test would be good too, just to confirm what you already know ie. That you are alright….Right?
The results, unfortunately, are tragic. You do have HIV. In fact, so does your wife. What happens now?
Firstly, you learn that the drugs for HIV in Singapore costs $1000 a month. Plus your wife, that’s $2000. There are no government subsidies at all. Even though you’ve been paying all your taxes all these years. Even though you will continue paying tax. Because it’s your fault , your behavior. Your wife gets no subsidies too. Even though it’s not her fault. Even though she’s always been a faithful wife and a good mother for the required 3 children. You are thankful that your youngest child, was born after you got infected. If your child was HIV positive, your child would not get a single cent of medical help.
Critical Illness private insurance? Doesn’t cover HIV at all. Sorry you’ve been paying so much premiums for nothing. Medishield? No HIV coverage. Medifund? Cannot buy HIV drugs with that. Medisave – sure you can, it’s your own money! And soon there’ll be hardly any!
You ask the doctor, isn’t there any cheap medicine? I don’t need the top quality ones….. I don’t need the “High-end top-of-the-range” medicine, just give me the “ordinary 20-inch” type of drug…. Like what Health Minister say, no need overconsumption……
The doctor explains to you, Well HIV is not like flu or diabetes or illnesses where you have a choice between low end cheap drugs that are subsidized , or high end fancy expensive drugs. For HIV the ONLY options are the expensive one. But Thailand can buy cheaper one, 10 times cheaper, just as good. The government produces the cheap ones for the patients there. So you have to fly to Thailand every 3 months (Singapore Customs let you bring in only 3 months supply) to get drugs for the rest of your life (which can be another 40 yrs , in very good health with the drugs, so actually you can live till 80yrs old, since you’re now only 40. That’s longer than the average life expectancy in Singapore)
Then, as part of your annual medical check up that your company makes you go through, your company learns you are HIV positive. You are fired. Your wife is also fired. There’s no law to protect you from such discrimination. So now you have to pay nearly $2000 for drugs each month or $500 if you get from Thailand, you and your wife have no jobs, and you have 3 children in primary school.
Your relatives don’t ever want to talk to you. They won’t look after your kids when you’re dead. Your church kicks you out because you were immoral. Your neighbours say ‘Luckily euthanasia soon going to be legal, at least they can go and kill themselves if they tah boleh tahan’. Your children have no friends in school because somehow, they found out.
Everybody thinks it’s your fault, you deserve it. And you kinda agree. You have been faithful all along, but that one time, just one time, all your colleagues, including your boss went there, you bo pian, so you go along, and had that girl. Why other people also do the same thing, why you kenna? Why only you get punish? Then your wife leh? Also kenna punish. Other people also have STI, have pregnancy scares, but that’s all. Why you must get AIDS and suffer all this?
More importantly, how now? What can you do to even live?
——————————————————————————————————————
This is not just a true story. This are MANY true stories, that happen in Singapore.
Added on the 2nd December : Please support treatment subsidies at this ChannelNewsAsia Poll (hopefully the govt will get the message!!!) http://www.channelnewsasia.com/polls/commentform.php?id=168
8 comments