Singapore had its first human immunodeficiency virus (HIV) case reported in 1985, and experts across Singapore are now aiming for the nation to see its last case no further beyond 2030.
Describing advances in medicine as providing the “most opportune time” to end HIV transmission and acquired immune deficiency syndrome (AIDS) in Singapore, a community blueprint unveiled by non-profit group Action for AIDS (AFA) Singapore on Saturday (Nov 23) said that there are more than half a million people at risk of acquiring HIV in Singapore.
Of the people most at risk, the majority are heterosexual males and men who have sex with other men, it said.
Covering areas such as prevention testing, treatment and outreach to reduce stigma, AFA said that 60 experts from 30 organisations had helped in the formulation of the blueprint, which aims to be a starting point for a national plan to end HIV in Singapore.
Stigma and discrimination need to be addressed
According to the blueprint, key areas in ending HIV include the tackling of HIV-related stigma and discrimination, and the normalisation and scaling of Pre-Exposure Prophylaxis (PrEP).
PrEP is a daily course of antiretroviral drugs taken by high-risk HIV persons to protect themselves from infection, according to Avert, a UK-based HIV charity. According to the US Centers for Disease Control and Prevention, PrEP reduces the risk of getting HIV from sex by about 99 per cent when taken daily. Among people who inject drugs, PrEP can reduce the risk by at least 74 per cent.
A 2018 study published in the US National Institutes of Health’s National Library of Medicine revealed that persons living with HIV who perceive high levels of HIV-related stigma are 2.4 times more likely to delay treatment until they are very ill.
In addition, the fear of stigma and discrimination has been shown to discourage HIV-infected persons from disclosing their status even to family.
In order to reduce stigma, the blueprint proposed a few measures such as the promotion of HIV testing as part of regular health screenings and the development of large-scale campaigns to raise awareness and drive acceptance of HIV-infected people among the general population.
In regards to the normalisation and scaling of PrEP, the document said that it can be a powerful tool for reducing HIV transmission rates.
However, there are limited PrEP options in Singapore as it is currently only available at the National University Hospital, Tan Tock Seng Hospital, DSC Clinic and some general practitioner (GP) clinics.
Another barrier to PrEP normalisation is its price, as Truvuda – a brand of PrEP medication – costs about S$15 per tablet in restructured hospitals, AFA said.
Thus, the blueprint proposed that the government make more efforts to engage private GPs in providing PrEP services, and to explore registration of generic PrEP medications in order to scale up the program.
Other areas include expanding the HIV community-based medical workforce and the monitoring and evaluation of HIV prevention programmes.
Another country with similar plans is Australia, where the Australian Federation of Aids Organisations announced a blueprint in 2017 that sought to end HIV by 2020.
More than 70 cities around the world have also signed the Paris Declaration as Fast-Track Cities with the target of eliminating all new HIV infections and AIDS-related deaths.
At the end of 2018, the Ministry of Health (MOH) said that there had so far been 8,295 HIV-infected Singapore residents, of whom 2,034 had passed away. In addition, there were 400 to 500 new HIV cases detected among Singapore residents each year from 2007 to 2017.
There is no known cure for the disease. But effective antiretroviral drugs can control the virus and help prevent transmission.