Worrying trend in HIV cases

The Straits Times, 22 Apr 2012

Singapore's Aids activists see reasons to worry in the picture of HIV infections here last year.

For the first time in two decades, men who have sex with men and men who have sex with both men and women accounted for most of the new infections detected in the first half of last year.

Out of 195 people infected through sexual activity, 88 were homosexual and 17 were bisexual. They added up to 54 per cent, a big change from 2000 when the two groups accounted for only 13 per cent of total infections detected.

From back in 1991, Singapore's HIV story was that the majority of those infected were heterosexual men who have sex with women only.

Activists who have been promoting safe sex and encouraging people at risk to get themselves tested for HIV told The Sunday Times there may be two main reasons why homosexuals and bisexuals overtook straight men last year.

First, gay men are more willing to get tested and that may be why more of them find out they have HIV.

Second, and this is what worries the activists, a younger generation of gay men may be less afraid of HIV because Aids is no longer the killer it was in the 1980s and 1990s.

Also, they say, younger homosexuals, including those in their teens, are finding it easier than ever to meet strangers for sex by going online or using smartphone applications.

They fear Aids less, and may be more reckless with multiple partners. 'Alarm bells should ring,' said veteran Aids activist Brenton Wong.

Surge in HIV infections among gays, bisexuals

Aids activists worry that younger gay men are less afraid of Aids, more reckless with sex

By Theresa Tan , Candice Neo, The Straits Times, 22 Apr 2012

For the first time since 1990, the number of homosexual and bisexual men diagnosed with HIV has overtaken that of heterosexual men.

In the first half of last year, homosexuals and bisexuals comprised 54 per cent of the 195 people found to have the human immunodeficiency virus which causes Aids. All were infected through sex. Heterosexuals made up the rest.

The change is significant, Aids activists told The Sunday Times, because for most of the past two decades, men who had sex with women were the majority of those diagnosed with HIV.

They said the rise in infections among men who have sex with men and those who have sex with both men and women points to two things: that gay men were more willing to get themselves tested for HIV and, worryingly, there may be a greater degree of sexual recklessness among this group.

The Internet has made it much easier for men to meet strangers for sex, they said, and a younger generation may be less fearful of Aids which is no longer viewed as the death sentence it used to be.

Mr Brenton Wong, former vice-president of Aids advocacy group Action for Aids, said of the surge in gay and bisexual infections: 'It's really a warning sign that something needs to be done now.'

Alarm bells should ring, he added, if those in this minority have overtaken the majority heterosexual population in infections.

The overwhelming proportion of those diagnosed last year - 95 per cent - were men.

Singapore's first HIV case was detected in 1985 and in the years that followed, most of those found with HIV were gay or bisexual.

However, from 1991, heterosexual men accounted for the majority of those found with HIV. That remained so until the mid-2000s, when the proportion of gay and bisexual men began rising.

Of those infected through sex, the main mode of transmission, gays and bisexuals accounted for 35 per cent in 2005, 43 per cent in 2008 and 47 per cent in 2010 before hitting 54 per cent in the first half of last year.

The full-year figures for last year will be released next month, the Health Ministry said.

A ministry spokesman told The Sunday Times that the exact reasons for the increased gay and bisexual diagnosis were 'not fully clear'.

Dr Sophia Archuleta, senior consultant at the National University Hospital's Infectious Diseases Division, said the statistics did not necessarily mean that more gay men were infected. She noted that gay men tended to be more aware of the risks of contracting HIV and more diligent in getting tested compared to heterosexual men.

Indeed, the ministry's data for last year showed that 27 per cent of homosexuals discovered they were HIV positive after getting tested voluntarily, compared to only 2 per cent for heterosexuals.

But Aids activists and members of the gay community tossed up several concerns that might explain the higher number of infections. They said it has become much easier to find multiple sexual partners not only over the Internet but also with some mobile phone applications.

Action for Aids executive director Donovan Lo said many gay men have become complacent about HIV and the acquired immune deficiency syndrome too.

'They can't relate to the seriousness of this silent epidemic,' he said. 'They don't know or see anyone with HIV. So they think their chances of getting it are very low, especially if they have tested negative before.'

Unlike older men who witnessed their friends or sex partners fall ill and die in the earlier years of Aids, younger people do not view HIV infection with the same degree of dread and horror.

Although there is still no cure for HIV, treatment available since the mid-1990s has made it possible for those infected to survive and live normal lives for many years.

Those interviewed said younger men who fear HIV and Aids less may not think twice before having sex with strangers.

Highlighting the prevalence of 'chemsex', Mr Wong noted that younger gay men who have sex while under the influence of party drugs such as Ecstasy and Ice may be less likely to use condoms to protect themselves.

Take for example, 25-year-old undergraduate Zack (not his real name) who is HIV positive. He started having sex at 16 and by the time he was diagnosed at 20, he had had sex with more than 100 men - many of them strangers he met online. Some of the sex happened while he was under the influence of drugs.

He said: 'There is this naivety and a couldn't-care-less attitude among some young gay boys. I felt I was invincible and that it (HIV infection) wouldn't happen to me.At my lowest point, I didn't care who I was sleeping with.'

More young men like Zack are being diagnosed with HIV. From January to June last year, 21 per cent of the men diagnosed were aged 29 and younger - up from 14 per cent in 2005.

Those interviewed said boys as young as 15 or 16 were having gay sex now, whereas in the past, gay youths began being sexually active in their late teens or early 20s.

To tackle this problem, Action for Aids and Oogachaga, which counsels gays and bisexuals, have started reaching out to gay teens and those in their 20s to educate them about HIV and safe sex.

On a wider front, the Health Ministry has also been working with activist groups to reach out to high-risk groups with HIV prevention programmes.

The ministry spokesman said: 'We are continuing our public education efforts to encourage all persons at risk of HIV infection to practise safer sex such as the consistent and correct use of condoms and to go for regular HIV testing.'