World Aids Day 2014

Early HIV detection vital: Experts

By Nadia Jansen, Channel NewsAsia, 29 Nov 2014

Over 450 people, including local and foreign HIV experts, gathered for the 9th Singapore AIDS Conference on Saturday (Nov 29) to share their knowledge on combating HIV-AIDS.

Organised to commemorate World AIDS Day on Dec 1, participants at the conference stressed that early detection continues to play a vital role in fighting the disease. The Health Ministry says 49 per cent of new HIV cases from the first half of this year are already at a late stage - up from last year's 41 per cent.



Among the attendees at the conference was Avin Tan, who was diagnosed with HIV five years ago. But he's one of the few people open about his condition.

"A lot of the stigma and discrimination stems from misinformation or this irrational fear of how HIV could even spread through central air-con systems or sharing food with someone,” said Tan, who is a manager at Action for AIDS Singapore. “So these are the misconceptions that cause unnecessary fears."

Another issue with stigma is that it stops people from getting tested early. "We have to do away with the stigma,” said Prof Leo Yee Sin, Director, Institute of Infectious Diseases & Epidemiology, Tan Tock Seng Hospital. “That would encourage people who perceive themselves at risk to go for the tests and the treatment."

In the first half of 2014, Singapore had 155 new cases of HIV. This was a decrease from the 198 in 2013. But 49 per cent of the cases were already at a late stage - up from last year's 41 per cent.

"Early detection and treatment benefit both persons living with HIV (PLHIV) and their partners,” said Dr Amy Khor, Senior Minister of State for Health. “Studies have shown that treatment involving anti-retroviral (ARV) drugs not only allow PLHIV to lead productive lives, but also decreases the amount of HIV in their body, making them much less likely to pass the virus to others."

Three new anonymous HIV testing clinics were rolled out in 2014, to meet a growing demand. The total number of anonymous tests more than doubled - from about 5,500 in 2005 to almost 14,000 in 2013.

And rapid HIV tests are now offered by more than 60 GP clinics. So if people are ready to be open, there are options available to get tested early, to prevent the virus from taking its toll.

New HIV cases fall in first half of year
Govt offering drug subsidies for first time to encourage testing, treatment: Amy Khor
By Lim Yi Han, The Sunday Times, 30 Nov 2014

New cases of HIV continued to show an encouraging fall in the first half of this year, but Singapore has to remain on guard.

In an effort to encourage more people to go for testing and seek treatment, Senior Minister of State for Health Amy Khor revealed yesterday that the Government is providing subsidies for HIV medication for the first time.

They are being made available to patients at public hospitals and health-care institutions. Around 40 patients have benefited from the subsidies since they were introduced in September.

The move has made anti-retroviral drugs - which help to decrease levels of the virus in patients' bodies - more affordable. The drugs cost between $300 and $800 a month.

HIV patients with a per capita monthly household income of not more than $1,800 can get up to 75 per cent off the price of anti-retroviral medication.

Those with a per capita monthly household income of more than $1,800 can get up to 50 per cent in subsidies, depending on their financial status.

For the most needy patients, financial aid scheme Medifund will help to cover the cost of treatment.

Speaking at the biennial Singapore Aids Conference organised by Action for Aids (AFA) and Tan Tock Seng Hospital yesterday, Dr Khor said: "We hope that this will address affordability concerns that may be preventing them from coming forward to be tested for HIV early and to start treatment early."

There were 155 new HIV cases reported among Singapore residents in the first half of this year - down from 198 in the same six-month period last year and 215 in 2012, according to the Ministry of Health.

But worryingly, nearly half already had late-stage HIV infection when they were diagnosed.

Two groups remain particularly "at risk" - heterosexual men who have casual and commercial sex and homosexual men.

Dr Khor said: "We must work harder to improve this situation. This is why the Government will maintain, and expand where feasible, the accessibility of HIV testing in Singapore."

The human immunodeficiency virus attacks the body's immune system and is transmitted mainly through sexual intercourse, although it can spread in other ways such as sharing contaminated needles or receiving a transfusion of infected blood.

Acquired immune deficiency syndrome (Aids) is the disease caused by HIV.

Dr Khor, chairman of the National HIV/Aids Policy Committee, said cost and stigma are among the reasons that put people off going for HIV tests.

She noted: "We will continue to work with stakeholders such as community organisations, companies and other agencies in the public sector on HIV-related issues."

Reducing costs and the stigma associated with HIV is crucial in managing the spread of Aids, according to Mr Michael Loh, executive director of the Catholic Aids Response Effort, which runs a shelter for people living with the virus.

He said: "It's a good move on the part of the Government to make the drugs more accessible. The drugs are not cheap, so this will definitely help those who cannot afford it.

"The disease does carry with it a very strong stigma, but we must all realise that these are people who did not choose to have this illness, so instead of condemning them, we should treat them with compassion."

Professor Leo Yee Sin, director of the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital, added: "There is still quite a significant element of fear among the community and public towards HIV. In the past, we viewed it as a deadly disease. Today, we know it is a chronic disease which can be treated."

At the conference, Professor Leo, AFA president Roy Chan, National University of Singapore Associate Professor Wong Mee Lian and the DSC (Department of Sexually Transmitted Infections Control) Clinic were given the Red Ribbon awards for their efforts in HIV care and prevention.

Pill for those at risk available
By Lim Yi Han, The Sunday Times, 30 Nov 2014

There is a morning-after medication that can help reduce the risk of HIV infection, and Action for Aids (AFA) wants people at risk to know about it and use it.

Called the post-exposure prophylaxis, the drug must be taken over 28 days, starting from within 72 hours of a risky sexual exposure, said AFA president Roy Chan.

AFA wants those who think they are at risk of contracting HIV to come forward so that they can be offered the option of taking the drug.

"We have decided that for those under 25, we will pay 50 per cent (of the cost of the drugs)," he said.

AFA is targeting younger people who might not come forward because they think the medicine is expensive, and delaying may mean missing the window period.

AFA is working with the DSC (Department of Sexually Transmitted Infections Control) Clinic to provide medical checks and to offer the medication at about $200.

According to Professor Chan, the medication was introduced here in 2004, and is believed to cost at least $2,000 at private clinics. He also stressed that those who engage in risky sexual activity ought to use condoms.

He said: "Somewhere along the way, people think it's not important any more. I think that the message has to be loud and clear - condom use is so important, especially for men who have sex with men."

He also urged people infected with HIV to not keep their status a secret. "A person living with HIV should not live in a shell. If they don't discuss it or talk about it with family and friends, people would not know that HIV exists in the community," he said.

AT THE FRONT LINE
Promoting condom use among sex workers
By Wong Kim Hoh, Senior Writer, The Sunday Times, 30 Nov 2014

Associate Professor Wong Mee Lian is warm, maternal and a tad bashful, not quite the type one imagines in the company of sex workers, brothel owners and their clients.

But for more than 20 years, the 62-year-old has been involved in several ground-breaking projects to promote condom use among those in the sex trade.

As her work has helped to bring down the number of sexually transmitted infections (STI) - including HIV - among sex workers and their clients in Singapore, she received a Red Ribbon award at the Singapore Aids Conference yesterday. The award by Action For Aids honours those who have made significant contributions in the fight against HIV.

Prof Wong was the principal investigator of a multi-disciplinary team which worked with several agencies, including the Department of STI Control, to research the prevention and control of sexual infections among brothel-based workers in 1990.

Her team surveyed more than 800 brothel-based sex workers and found that although 90 per cent knew about the consequences of HIV infection and that condoms help prevent the spread, only 40 per cent had clients using condoms.

Prof Wong spoke in depth with 30 women who succeeded in getting their clients to use condoms, and their tips were turned into a video which was used in a programme to promote condom negotiation skills and condom use in 1994.

She recalled a woman who knew how to deal with men who refused to use condoms and said they were old and not afraid of dying. "She would tell them, 'But you don't just die. You will suffer many pains and disabilities before you do. And what about your grandchildren, what would they think?"

The woman also shared how she helped the men put on the condom.

"We showed the video to other sex workers and told them, 'If your peers can do it, so can you,'" said Prof Wong.

Sponsored by Action For Aids, the intervention programme included measures such as closing down brothels which had more than 5 per cent of sex workers with STIs. It led to an increase in consistent condom use for vaginal sex, from less than 45 per cent before the programme to more than 90 per cent. Last year, consistent condom use for vaginal sex was 97 per cent.

Increased condom use was accompanied by a sharp decline in new cases of STIs, such as gonorrhoea, among sex workers. Before the programme, about 40 per cent of sex workers contracted cervical gonorrhoea in a year. Last year, less than 1 per cent had gonorrhoea.

Since 2003, there has been only one case of HIV infection reported among brothel-based sex workers.

Prof Wong has been involved in other research projects and studies involving freelance sex workers, sexually active adolescents, HIV- positive women and heterosexual males who engage sex services online or in brothels and other establishments.

Married with three adult children, she said: "I want to be an advocate for people who cannot advocate for themselves. My work is not to judge but to ensure that health is a basic right and that everyone has access to good health."

HIV & STIGMA
A 14-year secret for fear of being judged
By Lim Yi Han, The Sunday Times, 30 Nov 2014

He has been living with HIV for 14 years, but the 50-year-old has not told anyone beyond his immediate family, for fear of being judged.

The odd-job worker who declined to be named said: "I don't want my relatives or friends to think negatively of me."

He was diagnosed with HIV in 2000, after his wife tested positive. She was pregnant at that time and their daughter was born with the virus.

"My wife had a fever for two months and they found out she had HIV," he said. "I had to go for a test, and when the doctor said I had it too, I couldn't believe it. But what to do?

"At first I was afraid, but there was nothing I could do. I just had to follow through with my medication. The social workers have been helpful too, and I pray about it."

He now takes about seven pills each day. When asked if he questioned his wife about how she got infected with the virus that passes mainly through sexual activity, he would say only that it was from her past. He was with her until she died in 2010.

He is most upset that their daughter, a teenager now, is also infected. "She gets very tired of taking the medicine because it's hard to swallow. I'm worried because sometimes she refuses to take the medicine and ends up in hospital," he said.

He earns about $1,500 a month but often has to be away from work to visit his daughter because he did not want others to know about their situation. He declined to let his daughter be interviewed, saying she was moody and emotional.

"I hope people can be more accepting," he said. "Some people are scared they get infected by us through a handshake but that is not true."

15 years with HIV, life goes on for John
By Lim Yi Han, The Sunday Times, 30 Nov 2014

When John first found out he was HIV-positive in 1999, he did not think twice about telling his immediate family and friends.

The 55-year-old administration worker, who gave only his first name, said: "They already knew about my sexual orientation. And I'm glad I told them. Without their support, I definitely wouldn't be here today."

He is homosexual and contracted the virus from a gay partner.

"I was diagnosed at a late stage, so for the first two years, I spent a lot of time in and out of hospital and the intensive care unit."

It turned out that HIV infection did not lead to death and he has survived 15 years with treatment and the support of his loved ones and his employers.

"They have all been super supportive. When I told them, of course they were shocked and sad but that motivated me to get better, so they didn't have to worry so much," he said.

"People have this deep fear that they will be discriminated against. But having supportive people around you is very important. They can help you learn how to take care of yourself, reminding you to take your pills."

But he said he did not tell his other relatives about his disease in order to avoid gossip and misunderstanding.

His condition improved in 2001, and in the following year he became a volunteer with Action for Aids. Despite having to take medicine every day, life has gone on without a hitch, he said.

"There's been too much negativity surrounding HIV, but it's not a death sentence.

"It's not like my life is all good but I hope people know there are always two sides to a coin. HIV people do get on with their lives and it's not all doom and gloom."

Closing the gap in HIV response
The focus of this year's World Aids Day is better access to services.
By Poonam Khetrapal Singh And Shin Young-soo, Published The Straits Times, 1 Dec 2014

THE vast majority of new HIV infections in the Asia-Pacific region are occurring among populations most vulnerable to HIV: men who have sex with men (MSM), transgender people, people who inject drugs, sex workers, as well as people in prisons and other closed settings.

Nearly five million people were living with HIV in the Asia-Pacific region in 2013 - about one-sixth of the global total. There were an estimated 350,000 new HIV infections in the region in 2013 - the second-highest regional HIV figure after sub-Saharan Africa.

Partnerships between health systems and communities in the region have improved access to life-saving treatment, increased domestic resources for HIV/Aids programmes and reduced stigmatisation and discrimination. For example:

- Community organisations have helped formulate, implement and scale up the evidence-based recommendations in the consolidated guidelines of the World Health Organisation (WHO) on HIV prevention, diagnosis, treatment and care for key populations.

- India's Avahan HIV programme helped strengthen community-based organisations, leading to a sharp fall in the epidemic in several high-prevalence states. The lessons learnt are being incorporated in the national response, helping to ensure sustainability.

- In China, the government is increasingly engaging with civil society organisations. Non-governmental organisations such as Aids Care China are providing a key bridge between government HIV programmes and key populations.

- The governments of Thailand and the Philippines, two of many countries where the MSM HIV epidemic is surging alarmingly, are working actively with MSM organisations that connect communities with HIV services.

All of these examples fit the theme of World Aids Day 2014: Closing the Gap. This theme is about empowering all people to access the services they need.

Fewer than half of all HIV-positive people across the Asia-Pacific region are aware of their status. An estimated 1.5 million people in the region are receiving antiretroviral treatment - about one-third of the region's HIV-positive population.

This is a significant improvement compared with a few years ago, but the journey is less than half complete. WHO member states can do better. It is only by closing testing and treatment gaps and reaching all those in need that we can achieve our goal of ending Aids in Asia by 2030.

We need to overcome challenges. Key populations continue to face stigmatisation and discrimination, including punitive legislation. This must change.

WHO consolidated guidelines are guided by human rights principles. They call for governments to enforce protective laws to eliminate discrimination and violence.

Today, WHO has released a new update to recommend antiretrovirals as an emergency prevention intervention following possible HIV exposure for HIV-negative individuals, and to prevent and manage common opportunistic infections that affect many people living with HIV.

We need more resources and wiser investments to address the HIV crisis in key populations. A renewed focus on HIV response needs to be articulated in the post-2015 health and development agenda.

WHO works to improve the continuum of HIV prevention, treatment and care. We work hand in hand with key populations - with a range of civil society organisations like the Asia Pacific Coalition on Male Sexual Health - to help safeguard the health and well-being of millions of people.

Health is a human right. Creating an enabling environment ensures equity and respect for human rights, ensuring greater access to essential health services for all people.

The writers are the WHO regional directors for the South-east Asia Region and Western Pacific Region respectively.

'Tipping point reached in Aids fight but progress uneven'
The Straits Times, 2 Dec 2014

LONDON - The world has finally reached "the beginning of the end" of the Aids pandemic that has infected and killed millions in the past 30 years, according to a leading campaign group fighting HIV.

The number of people newly infected with HIV over the past year was lower than the number of HIV-positive people who joined those getting access to the medicine they need to take for life to keep the acquired immune deficiency syndrome (Aids) at bay.

But in a report to mark World Aids Day yesterday, the ONE campaign, an advocacy group working to end poverty and preventable disease in Africa, warned that reaching this milestone did not mean the end of Aids was around the corner. "We've passed the tipping point in the Aids fight at the global level, but not all countries are there yet, and the gains made can easily stall or unravel," said Ms Erin Hohlfelder, ONE's director of global health policy.

The human immunodeficiency virus (HIV) that causes Aids is spread via blood, semen and breast milk.

There is no cure for the infection, but Aids can be kept at bay for many years with cocktails of antiretroviral drugs.

United Nations data shows that last year, 35 million people were living with HIV, 2.1 million people were newly infected with the virus, and some 1.5 million people died of Aids.

By far the greatest part of the HIV/Aids burden is in sub-Saharan Africa.

The Aids pandemic began more than 30 years ago and has killed up to 40 million people worldwide.

The United Nations Aids agency, UNAids, said that by June this year, some 13.6 million people globally had access to Aids drugs, a dramatic improvement on the five million who were getting treatment in 2010.

"Despite the good news, we should not take a victory lap yet," said Ms Hohlfelder.

She highlighted threats to current progress, including a US$3 billion (S$3.9 billion) shortfall in the funds needed each year to control HIV around the world.

"We want to see bold new funding from a more diversified base, including more from African domestic budgets," she said.

ONE also noted that HIV is increasingly concentrated among hard-to-reach populations, such as injecting drug users, gay men and sex workers - groups who are often stigmatised and have trouble accessing treatment and prevention services.

Echoing these concerns, the World Health Organisation (WHO) issued a call to action to China over HIV/Aids as government figures showed that nearly half a million people are living with the disease, with hundreds of thousands more thought to be undiagnosed.

Dr Bernhard Schwartlander, the WHO's representative in China, wrote in an op-ed in the state-run China Daily newspaper that "there is much more China needs to do" to prevent infection and better help those living with HIV.

"Perhaps most importantly, we must eliminate stigma and discrimination towards people living with HIV, and at-risk populations such as men who have sex with men, sex workers, and injecting drug users," he wrote.

"I've seen some of my own colleagues in the medical profession turn patients away because they disapproved of the person's sexual orientation. That is simply unacceptable, and it has to stop," he added.

China's National Centre for Aids/STD Control and Prevention last year estimated that as many as 810,000 people were living with HIV/Aids in the country, including those who had not yet been diagnosed.

REUTERS, AGENCE FRANCE-PRESSE