ST Forum: Aids and gays: A flawed response (May 28, 2007)

ST Forum

May 28, 2007

Aids and gays: A flawed response

I REFER to the letter written by Mr Wong Suan Yin, 'Aids: Stop the spread of misinformation' .

The letter misrepresents what I have said. It is not true that I made the statement that homosexuality leads to the spread of Aids and therefore criminalising homosexual sex will prevent the spread of Aids.

My article only mentioned that there is an increased risk of homosexuals engaging in anal intercourse in contracting the HIV virus. The reasons given for this is that anal intercourse is inherently unhealthy and studies have shown that homosexuals are more promiscuous.

Mr Wong has missed the point made by me in the letter and has gone off tangent with his own argument.

Unfortunately his argument is flawed. Let me clarify.

HIV virus is spread in three main ways.

1. From mother to child during birth
2. Sexual contact during intercourse, oral, vaginal and anal
3. Via blood either through contaminated blood, contaminated blood products, contaminated donor organs, tattooing and intravenous drug abuse

According to WHO statistics, there is a higher incidence of HIV in women and children in Third World countries compared to the rest of the world.

It is just as true that in Singapore and in the United States, there is a high incidence of HIV among homosexual men who engage in anal sex.

How do we reconcile this? Obviously there must be environmental factors involved that lead to differences between the two. Unfortunately WHO statistics from most Third World countries do not show the mode of infection.

There are so many unanswered questions. We do not know how many of the mothers contracted HIV because of drug abuse or how many of their husbands were drug abusers.

We do not know how many of their husbands had intercourse with high-risk individuals. We do not know the incidence of bisexual men who are married.

In some African cultures, bisexual behaviour is rampant. Culturally, in some countries, young men are sent by their fathers to prostitutes for their first sexual experience.

Some studies have shown that the incidence of HIV among young children is higher than that of mothers in Africa. This implies that children are getting HIV from sources other than their mothers. Contaminated needles? Contaminated dental equipment?

How many adults are infected through contaminated medical equipment due to poor health care? All these cultural, social and environmental factors affect the behaviour and sexual practices of individuals and therefore account for the different figures seen in different countries.

We cannot apply these figures to the situation in Singapore because the environment is different.

Let me illustrate with an example.

We know that poverty leading to malnutrition and starvation is statistically one of the leading causes of death among children in the world. Obviously it is illogical to put all our resources in eradicating malnutrition and starvation to lower the death rate of children in Singapore. This will not help at all as it is not a leading cause of death in Singapore.

Similarly for the case of HIV infection, we have to look at the local context, what the local statistics are and what the risk factors for our population are. As I have previously stated, our local statistics and those of the US show that the group with the highest risk of being infected by the HIV virus is that of individuals who indulge in anal intercourse.

Currently anal intercourse is a criminal offence. The argument put forward that decriminalisation will make it easier to educate those who engage in such practices and lower the risk of HIV needs to be examined carefully.

As a doctor I wrote in to highlight the public health issues involved in this matter. As for public policy issues, this is not an appropriate forum. Parliament will consider all these issues in due course.

Dr Alan Chin Yew Liang