The city-cum-state of Singapore is to implement an opt-out screening for HIV in its public hospitals. So far so good. Early detection means a better follow up, an early initiation of treatment, an opportunity to reduce further transmission, and an extended life expectancy.

“Cracked” Tan Ngiap Heng

Many studies have found that VCT (Voluntary Counselling and Testing) is an effective strategy for facilitating the behaviour-changes necessary to an effective HIV prevention and for providing early access to care and support. But VCT is not very useful without access to treatment. This may explain why 7 out of 10 people who participated in the pilot programme opted out of the screening.

The pilot conducted at the Changi hospital identified 50 HIV positive people out of 3,000 tested, which is in sharp contrast with the 0.3 % estimated HIV prevalence in Singapore (UNFPA) but after all, people attend hospital because their health bring them there.

For the Senior Minister of State For Foreign Affairs, Dr Balaji Sadisivan. “Whatever the reasons for failing to diagnose HIV may be, this is not something our hospitals can be proud of.” Strangely enough, Dr Balaji do not seem to think that the lack of access to treatment was a sign of failure.

As Roy Chan, president of Action For AIDS, observed: “You have to give people a reason why they want to get tested….(screening)… that is not the end of the story, you still have to provide support services.”

Interestingly, Richard Bellamy, specialist registrar in infectious diseases and general internal medicine, who spent 16th months in Singapor noted that,

“The Singapore health service has a limited list of drugs which patients can be prescribed at subsidised rates. Antiretrovirals are not included, so patients must meet the full costs. Initially, I thought this burden was a sign of a cruel and insensitive government. After a few months in Singapore, however, I realised that local people place greater value on support from their families than from the State. It was wrong to judge the system with my Western values; Singaporeans would be just as shocked by many aspects of British society, such as our system of caring for elderly people. People with HIV and AIDS in Singapore accept that it is their responsibility to pay for their treatment and they constantly impressed me with their determination to do so.”

In 2005 the same Dr Balaji announced that the Health Ministry will be raising fund to help women and children infected with HIV. Another example where money is raised and assigned to intervention against evidences: HIV Prevalence amongst women is three time lower than amongst men in Singapore and in 2007, according to the Singapore Ministry of Health there was 392 HIV infected men (most ageing one) for 31 HIV-infected women. So much for the women and child.

As previously observed, we should not pit “Western Truth against Native Error”; but that should not stop us pitting native truth against native error.

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