Singapore launches new HIV committee, keeps old mindset

Friday, December 1, 2006

Singapore launches new HIV committee, keeps old mindset

by Alex Au
Starting 1 Dec 2006, World AIDS Day, a new national policy committee - chaired by Dr Balaji Sadasivan - will work to combat a rise in the number of HIV cases and provide guidance on all policy matters related to HIV/AIDS. Alex Au questions if the absence of gay representation on the panel will prove to be a serious weakness. The Singapore government is forming a new National HIV/AIDS Policy Committee, starting 1 Dec 2006, to better co-ordinate the fight against the disease. Announcing this, the Health Ministry said the committee is meant to "provide guidance on all policy matters related to HIV/AIDS, including public health, legal, ethical, social and economic issues."

Dr Balaji Sadasivan (right), who already holds two portfolios as Senior Minister of State – in the Ministry of Foreign Affairs, and the Ministry of Information, Communication and the Arts – will chair the new National HIV/AIDS Policy Committee. Chaired by Dr Balaji Sadasivan (right), who already holds two portfolios as Senior Minister of State – in the Ministry of Foreign Affairs, and the Ministry of Information, Communication and the Arts – the committee is being touted as an inclusive, broad-based body.

Where HIV policy used to be a matter for health-care professionals, the Ministry said in its statement, the new committee will comprise representatives from seven ministries, three health-related government departments and two non-governmental bodies.

Just two.

One of them is Action for Aids and the other is the Aids Business Alliance. There are no representatives from the various communities that are most vulnerable to HIV/AIDS; there is no gay representation on the panel. The way the committee is structured, heavy with bureaucrats, it looks more like a vehicle for implementation than policy development, despite the stated intentions. Singapore bureaucrats are not known for thinking out of the box and speaking their minds, especially on social issues when the "Singaporeans are conservative" mantra has been given the weight of official dogma, but they can be very efficient in execution when they've been told what to do.

These representatives will come from ministries of Defence, Home Affairs, Youth and Sports, Manpower, Education and Information, beside the Ministry of Health. The three government departments are the Communicable Diseases Centre, the Health Promotion Board and the National Skin Centre (which also looks after other sexually transmitted diseases). There seems to be very little provision for bottom-up voices from affected segments of the population, such as the gay community. Out of 149 new HIV-positives reported in the first half of this year, 39 (26%) were homosexual, 88 (59%) were heterosexual and 6 (4%) bisexual. Seven cases were infected through intravenous drug use, while nine cases were of uncertain transmission route.

This lack of representation from the community is likely to prove a serious weakness, because it is often non-governmental groups that have novel perspectives on issues, with the guts to say so. If they don't have a voice, then the committee will suffer from both a lack of fresh ideas as well as a real feel of the ground. For example, gay sauna owners are right there at the frontline in the battle. The way they provide or not provide condoms, lube and information can make a critical difference. What are their difficulties in doing so? What are their concerns?

Do we know whether they remain concerned about whether the police will use the presence of condoms on premises as evidence that homosexual activity is taking place there, something that remains illegal under Singapore law? And there's the rub: Because the law remains in place, it will be very difficult for ministers and bureaucrats, however well-intentioned, to engage with people who either provide for, or do homosexual sex. Engaging would put them at variance with policy laid down by their political masters, surely not the best career move a bureaucrat can make.

On the other side, the law disincentivises gay people and sex-related businesses from wanting to dialogue with the committee and the government generally, for they may perceive that doing so would either be a waste of time, or even put them at risk of prosecution. It's hard to imagine how the committee can really "provide guidance" to policy if they remain disconnected from the ground. In any case, Dr Balaji seems to have made up his mind as to the strategy to be implemented. He wants to treat HIV/AIDS as an infectious epidemiological problem like any other, with an emphasis on testing and contact tracing. He told The Straits Times that people are waking up to the fact that standard disease control methods have to be applied to AIDS to bring it under control.

"Imagine we had SARS [Severe Acute Respiratory Syndrome]," he explained, "and... we mustn't know who has SARS, we can't contact trace how SARS is spread... and you try to control SARS; you will not control it." He was referring to how people have been extra-sensitive about HIV testing and disclosure in the past. He realises that for his pet strategy to work, he must combat stigmatisation of People With Aids which may explain the fact that the Aids Business Alliance has been invited to be on the committee.

Its representative, Mr Zulkifli Baharuddin, said his role would be to look at how to reduce discrimination against Aids sufferers in the workplace, and to find ways for the authorities to help businesses with afflicted workers cope. Yet, before that, at the prevention stage, there is also the question of the stigmatisation of gay people. This is what makes the community hard to reach in terms of educational efforts, hard to persuade to come forward for testing, and hard to do contact tracing, should that be necessary.

Why? Because societal homophobia imposes a cost on gay people should they identify themselves as gay; thus they avoid revealing their identities when socialising sexually – so no plan for contact tracing can work – and they may even think that testing puts their privacy in jeopardy. This is especially as the government has just signalled its intention to keep homosexual sex between men a crime. So here we have a Minister that wants to destigmatise issues relating to HIV/AIDS, even as his own government is making a deliberate decision to keep it on the law books, thus giving support to a homophobic climate.

This is one of the many conundrums that the committee charged with policy development must sort out, yet the chances are that, without gay representation on board, they won't even know of the problem.

Straight Singaporeans do not make the connection between the anti-gay law and HIV-prevention efforts. They do not see how repeal can be any help in the latter. This is one of the key findings I will be presenting at the upcoming Singapore AIDS Conference. In a way, this is not surprising because with the relative invisibility of gay characters in media due to censorship, Singaporeans generally have no idea of what it feels like to be gay. Without any opportunity to see life through a gay perspective, they do not have any clue what it feels like to be discriminated against sexually, or to live in the closet.

So when gay Singaporeans say the law is one of the hurdles to a more effective HIV policy, it is met with disbelief. And without a gay voice in the Dr Balaji's committee, this uncomprehending attitude is likely to persist.

Alex Au has been a gay activist for over 10 years and is the co-founder of gay advocacy group People Like Us. Alex is also the author of the well-known Yawning Bread web site. He will also be speaking at the Singapore AIDS Conference on Dec 2.