I recently visited the Vatican City, at the same time when protest marches were being held in Ireland over the child abuse scandals against the Roman Catholic church.
The most beautiful thing about the Vatican City that struck me was neither the art nor the architecture – those were pretty but were cloying after a while. The most beautiful thing I saw were actually 2 men. One of them was the ticket seller to the Vatican Museum — he had only one finger and a slight stump of a thumb. Yet he was collecting money, giving change, dispensing tickets, with the speed and efficiency of any other ticket seller.
Having grown up in a culture where fetuses are screened and aborted for abnormalities, where disadvantaged persons can only sell tissue paper, where we are taught to pity them with paltry donations into tin cans, I’ve been flooded all my life with messages that disadvantaged persons were a liability to society. In the recent few past years, greater awareness about their abilities have been campaigned for, and I came to think that disadvantaged people could be as contributive to society as any other person could be — all a disadvantaged person had to do was a job that did not depend primarily on the skills he was handicapped for, and for society to give him that chance.
But the Vatican City ticket seller challenged my view completely. It said something about a society who would hire a person with only 1.5 fingers to sell tickets to thousands. It said something about a person who would take a job that primarily made use of a skill he was handicapped for – and excel at it.
The other person who touched me was the locker room (where visitors could deposit their bags and bulky items in lockers and pigeon holes) attendant. Visitors did not deposit their items into the lockers directly – they passed it to the attendant over the counter who then had to make sure everything was in place. This attendant had Downs’ Syndrome (or something similar, by his looks), and was as efficient and orderly as any good attendant I’ve ever come across.
I long for the day where my society would not see cheap foreign labor as the first choice for these jobs, and cease to see disadvantaged people as being disabled.
But I do think we are getting there. In the recent few years past, I have come across people with Downs’ Syndrome travelling by themselves on the MRT, very competently like any other normal person. A decade ago, such people were always accompanied by caregivers. Just seeing these people on the MRT more than convinces me that, if society gave them an education that is every citizen’s right, people with handicaps could be no less functional than a “normal” person. The image of a disabled person staring blankly into space, depending entirely on her caregiver, is one that is the fault of a society which has already condemned the person from birth, and has shirked its duty of investing in that person’s well being and education.
Visiting both the Vatican and Ireland during this period also is a reminder that no organization is perfectly good or perfectly bad. It was at the Vatican that I saw the most beautiful accordance of respect and dignity to people who have long suffered unjust and undue discrimination. Yet it is within the same Roman Catholic church system, that gross widespread child abuse has taken place. It really highlights the importance of not demonizing organizations or people, and the dangers of idolizing organizations of people. We need to look beyond identities, and look at each deed for itself, evaluate each deed for itself, so that the good can be recognized and reinforced, and the bad can be stopped and brought to justice.
It reminded me of a conversation I had with a Chinese friend. When I pointed out the atrocities of the Chinese Communist Party, he pointed out that Communism in China actually brought equality to women by allowing them to equal status in the workforce, that slavery in Tibet was abolished, and that prosperity has grown. Of course, we who have been influenced by the Western media would look at each of these achievements with a raised eyebrow, yet what we really need to do is to stop seeing these organizations as morally responsible persons, but start looking at each deed for itself, because you will find both good and bad.
When the Western and Islamic countries demonize each other, their accusations are probably true. But to the people that belong to each of these groups, they would see themselves for the good that they are, and very understandably feel a sense of injustice done towards them , when they are accused of being the monsters they do not see in themselves, their families and friends. And we all know that injustice and a threat to the safety of your loved ones are the strongest motivations for a person to risk life and limb to fight against the “enemy”. Is there any wonder we’re not going to solve the threat of terrorism in a long long time?
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%).”
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