The challenge and the hope

Tuesday, December 5, 2006

The challenge and the hope

By Ng Yi-Sheng
The 5th Singapore AIDS Conference was themed "HIV in Singapore: The Challenge and the Hope." Fittingly, speakers seized this opportunity to challenge the government and the public to liberalise laws and attitudes towards MSMs and the HIV-positive community. The 5th Singapore AIDS Conference, held on Saturday, 2 December 2006, was themed "HIV in Singapore: The Challenge and the Hope." Fittingly, speakers seized this opportunity to challenge the government and the public to liberalise laws and attitudes towards MSMs (men who have sex with men) and the HIV-positive community.

From left: Bryan Choong, Oogachaga; Paul Toh of Action for AIDS; Ho Lai Peng, a Medical Officer from Tan Tock Seng Hospital; Dr Stuart Koe, CEO of and gay activist Alex Au. This began with the Welcome Address by Co-Chair of the Conference and President of AfA (Action for AIDS) Dr Roy Chan. In front of the crowd of 600, he condemned Article 377A of the Penal Code, which makes acts of "gross indecency" between men illegal. "This legal barrier has made it impossible to target MSM (men having sex with men), and made us unable to address it within schools," said Dr Chan. "It is the main reason for stigma and pushes (the issue) into the closet. It is not surprising that more young gay men are getting infected."

Some believe these comments were directed at Guest-of-Honour Dr Balaji Sadasivan, Senior Minister of State for the Ministry of Foreign Affairs and Ministry of Information, Communication and the Arts. In his previous capacity as Senior Minister for Health, Dr Balaji has professed support for AfA and is a third-time Guest-of-Honour to the Singapore AIDS Conference. He has been criticised, however, for his failure to support subsidies for HIV medicines or acceptance of homosexuality. In his speech as Guest-of-Honour, Dr Sadasivan gave a fairly formulaic response to Dr Chan, saying, "The committee will take this into consideration."

Yet the issue was not laid to rest. In the Keynote Address which followed, UNAIDS Regional Programme Advisor Dr Swarup Sarkar reiterated the position that "sodomy" laws should be repealed in both his native India and Singapore. These constituted "gaps in prevention," as they made it impossible to communicate a clear message from the government on safer sex. When interviewed, he elaborated that allowing such laws to remain nominally in the books was not an option, as future officials and governments would able to revive such laws as they pleased.

Such declarations of support for the repeal of sodomy laws were all the more remarkable considering the public nature of the biannual conference. Traditionally organised by the AfA and Tan Tock Seng Hospital, this year marked the first time the Health Promotion Board had joined as organiser. The event was held centrally in the Suntec Convention Centre with low registration fees, and the 600-strong audience was a varied group, consisting of activists, health workers, civil servants, volunteers and members of the concerned public, including several schoolchildren involved in the Red Cross.

Dr Chan also discussed the weight of social stigma associated with the disease, leading many HIV-positive individuals to only seek diagnosis and treatment when they had reached terminal stages of AIDS. The twin themes of challenges from institutions and challenges from public perceptions of HIV were to persist throughout the discussions of the day. One symposium dwelt specifically on problems encountered promoting HIV-awareness amongst women. This was illustrated by Chommad Manopaiboon from the Global AIDS Programme in an earlier plenary, noting that many young Thai women were more afraid of the risk of pregnancy than the risk of contracting HIV. Another speech by Lionel Lee of AfA dwelt on the problems of heterosexual male clients of sex workers, many of whom remain unwilling to associate themselves with the thought of HIV risk and are consequently prone to unsafe sex.

Thankfully, "Hope," the second half of the conference's theme, also received significant attention. Dr Patrick French of the Mortimer Market Centre, London, shared with the audience information on the effectiveness of HAART (Highly Active Antiretroviral Therapy), which has radically increased life expectancies of HIV-positive individuals. Medical professionals appeared in force to discuss new advances and applications of HIV treatment. Many, however, noted the obstacle of convincing world governments that treatment programmes should receive government funding, making them affordable to all.

The 5th Singapore AIDS Conference also featured, for the third time, a symposium on men who have sex with men (MSM). A summary of papers presented at this symposium may be viewed on the next page.

The 5th Singapore AIDS Conference included a symposium on the MSM community. It focused on the MSM community with theme on Stigma and Discrimination, and was chaired by President of Singapore Psychological Society Clarence Singam and Associate Professor Khoo Hoon Eng.

2006 MSM KABP (Knowledge, Attitude, Behaviour and Practices) Survey Results
Dr Stuart Koe, CEO of, began by presenting the results of his 2006 MSM KABP survey. The survey, conducted among Internet-savvy MSMs from Singapore, indicated extremely high awareness of HIV services in Singapore, as well as a very high proportion - 81% - of men having undergone HIV tests.

Condom usage is increasing, yet it remains inconsistent. Moreover, no correlation was shown between having had an HIV test and displaying consistent condom use; HIV+ individuals even displayed higher tendencies to practise unsafe sex. This counters the conventional wisdom that promoting HIV tests will also encourage safer sex practices. Dr Koe recommended a more focussed message on condom use and HIV prevention in public programmes.

AfA MSM Programme
Paul Toh of Action for AIDS summarised the work of the MSM Prevention Programmes. This includes outreach to saunas and bars, an MSM drop-in centre, interactive theatre, hotlines, campaigns and meetings and seminars with MSMs in English and Mandarin. New initiatives included Internet outreach, through the infiltration of gay chatrooms by MSM volunteers who explain safe sex queries online.

Counseling and Support for MSMs in Singapore
Bryan Choong, who oversees the Oogachaga MSM Hotline service, presented on the theme of counselling and supporting MSMs in Singapore. He noted the relevance of this theme to HIV as non-acceptance of sexual identity and low self-esteem is often correlated with unprotected sex behaviour in MSMs. Oogachaga's new phone counselling service now provides support for MSMs who desire to remain faceless. However, challenges to counselling remain, including difficulties in outreach to non-gay identified and less educated MSMs and distrust from the closeted gay community.

AIDS Related Stigma/Discrimination
Ho Lai Peng, a Medical Officer from Tan Tock Seng Hospital, spoke on HIV-related stigma and discrimination. She emphasised the problem of HIV existing as a social phenomenon as well as a physical disease, turning HIV+ individuals into social outcasts and discouraging them to lead healthy lives and seek treatment. Even educated professionals show high levels of misconceptions and irrational fear towards the HIV+. She noted that in order for HIV+ people to be accepted and gain equal rights in employment, more must go public, refusing to remain a faceless community.

Overcoming Barriers to HIV Prevention for MSM
Gay activist Alex Au shared the results on his online study amidst politically aware young people. Worryingly, the majority did not regard HIV as a serious issue for Singapore. HIV infection was also associated as stemming from the actions of others, not as the consequence of one's own behaviour. Heterosexuals also found it harder than gay men and women to understand how laws against homosexual acts have a direct bearing on HIV infection rates.

In a question-and-answer session, Alex Au and Dr Koe expressed concerns that the National AIDS Council includes no grassroots representation from at-risk communities like MSMs. They urged audience members to write in to schools and newspapers to correct misinformation on HIV prevention, such as misreported statistics on condom effectiveness. They concluded by asking those present to extend their acceptance to the HIV+ and to spread awareness of the issues by all means possible.