ST: Most with AIDS virus don't know they have it - Balaji off to Australia with Fridae.com and OC

July 18, 2007
Most with Aids virus don't know they have it
By Judith Tan

THIS is the bad news in Singapore's fight against Aids: Most adults who are infected do not know it, and some are being treated wrongly in hospitals.
A study of more than 3,000 leftover blood samples from public hospital patients early this year showed that one in 350 was infected with the human immunodeficiency virus (HIV) which causes Aids.

This is consistent with a UNAids estimate that 0.3 per cent of Singapore's adult population is infected with the Aids virus.

If accurate, this would mean that Singapore has about 9,000 infected adults, much more than the official figure of 2,852 people, including 25 children, who are HIV-positive, and 1,547 with Aids.
But worryingly, neither the patients in the study nor their doctors were aware. Infected men outnumbered women 15 to one and all were being treated for other medical conditions.
As the study was done anonymously, none of the infected patients was traced and all will remain undiagnosed unless they undergo a HIV test.

Revealing this yesterday, Senior Minister of State (Foreign Affairs and Information, Communications and the Arts) Balaji Sadasivan called it a serious problem with implications for patients, healthcare workers and hospitals.
He described three kinds of patients who may be undergoing treatment while unaware of their HIV status.

The least serious: a patient who seeks treatment for myopia or short-sightedness and has Lasik treatment which does not have an impact on his condition. His health does not suffer directly from the missed diagnosis, but he has lost an opportunity to be treated early for HIV infection.
More serious: in treating a patient's symptoms, doctors may unknowingly prescribe drugs that worsen his ability to fight disease.

For example, the patient may be given steroids, which reduce his immunity to disease and could trigger HIV-related infections.

Then, there are the patients whose symptoms may be totally HIV-related. But because they have been misdiagnosed, they receive the wrong treatment.

Dr Balaji cited the example of a HIV-infected person who falls ill with chronic diarrhoea and weight loss.

If his status is not known, he might end up having many expensive and unnecessary investigations like MRI scans and colonoscopy, and a wrong diagnosis could still be made.

A simple HIV test would have allowed the patient to be treated correctly, he said.

But many of those at risk refuse to get tested for HIV, fearing the stigma associated with Aids.
Doctors are also not allowed to conduct HIV tests on patients without their consent.

Dr Balaji stressed that he was not pushing for mandatory testing, but urged those at risk to get themselves tested.

Speaking at the launch of Art Revelations, a workplace HIV/Aids education programme, he called the blood sample study a milestone in Singapore's fight against Aids.

He said hospitals and the medical establishment should reflect on the implications and come up with new ways of caring for patients with HIV.

The medical fraternity should worry about the current situation, because misdiagnosis might well lead to complaints of professional failure against doctors and hospitals.

But rather than compel patients to get tested, he said doctors should explain and tell them why they would be better off knowing if they have HIV so that they could be treated.

Dr Balaji is off to Sydney today to learn more about Australian best practices in fighting HIV and Aids.

He is leading a Ministry of Health study team which includes ministry experts as well as members of activist groups Action for Aids, Fridae.com. and Oogacharga.