Yesterday I attended the first blogger forum organized by the Health Promotion Board and Nuffnang Singapore, on the topic of AIDS.Actually, I haven't been paying much attention to the AIDS situation in Singapore. In 2005, the adult HIV prevalence in Singapore (PDF poster) was around 0.3%, which is among the lowest in the region and comparable to Western Europe (and lower than the USA).
Thus, I don't really have any strong opinions about this topic.
However, a recent review article (PDF file) has shown that HIV infection rates have been on the rise in the past few years. What is particularly worrying is the increasing incidence of sexually transmitted infections in young people between 10-19 years of age, and the gradual shift of primary contacts from sex workers to casual partners. So there is some cause for concern.
In addition, I am really curious to know what the other bloggers think.
So off I went!
Like many youth events nowadays, there must be music!
The organizers of the "Open Your Heart" campaign have invited some local musicians to perform as part of their activities. So I stood and heard them play while waiting for the other bloggers to arrive.
This rock group is called King Kong Jane. Pretty damned good actually.
And here is their resident drummer. There are two more guitarists in their group.
I especially liked their bemused expressions when a hot babe stopped and snapped a photo of them with her cell phone.
When the bloggers have fully assembled, it's time to check out the display booth. The booth was manned by many young volunteers. As you can see, there were more lady bloggers than men.
Once inside the booth, two video presentations were screened. The first one was a video interview with HIV-positive individuals, who discussed the social alienation they experienced. They appeared in silhouette to protect their identities.
The next video, shown above, was sort of a romantic short film about two people in love - one of them is HIV-positive. It is a well-made film, with an idealized narrative. From the feedback later in the forum, the lady bloggers seem to like it.
Personally, it didn't have a strong emotional impact on me. Perhaps it's because I am a geek.
Next, it was time to view the photo gallery. Each photograph was accompanied by a descriptive panel positioned below. Two of them captured my attention.
One of these was a photograph of the back profile of a woman scratched out by a pencil eraser. I think its caption accurately summarizes the main purpose of the campaign - to raise the awareness of the situation of people living with HIV.
Another striking photo featured a dead chicken trying to incubate an egg. The caption has a rather odd (possibly oxymoronic?) title, but reinforces the notion that HIV is not merely a personal issue, but has wider consequences for the family of the afflicted.
Time to head to the preview lounge for the blogger forum!
The forum was kicked off with two rounds of ice-breaker games. Next, there was an awkward moment of silence when the organizers try to encourage the bloggers to voice their opinions.
Eventually a keen-witted blogger brought up an interesting point: was the focus of this forum about reducing the social ostracism of people living with HIV, or was it about reducing the incidence of HIV infection by encouraging more people to go for HIV testing?
Based on the information in the display booth, it appeared that the emphasis was on the first issue, but during the forum the organizers often talked at length about the second issue.
Bloggers soon realized that these two goals may require contradictory approaches.
1. Reduce Social Stigma?
One member of the organizers contrasted the social discrimination that individuals living with HIV face in Singapore, compared to other industrialized nations. She felt that it was an "Asian" mentality to consider these individuals as morally indecent people.
Another blogger agreed, noting that any disease that is associated with sex carries a negative connotation.
I think to humanize the situation of HIV-positive people, the disease should not be moralized, and there should be greater emphasis on the fact that a HIV-positive diagnosis is not a death sentence.
Firstly, the latency prior to the onset of AIDS is ten years on average. Second, although there is still no cure for AIDS, current antiretroviral therapies (and new classes of medicines on the horizon) has prolonged the lives of numerous AIDS patients by many years.
As treatments improve, survival rates rise and prevalence drops further, the stigma of the public towards HIV-positive people will gradually fade.
I mentioned during the discussion that I believe in time AIDS will be considered no different from any other chronic infectious disease.
Take for example Hansen's Disease, better known as Leprosy.
Since ancient times, Hansen's disease sufferers have been subject to severe social ostracism, abuse and neglect. Due to their obvious and ugly sores, these people were considered by the public as "unclean" or "cursed by God". They were labelled as "lepers" and swept under the rug of society by housing them in "leper colonies".
It was not until the early 1980s that an effective multidrug treatment for the infection emerged, halting the disease progression and rapidly reducing its prevalence. Today, only two decades later, Hansen's disease has left the public consciousness in Singapore and nobody really bats an eyelid about "leprosy" any more.
Some bloggers also raised a point that stigma could result from the insecurity that many people feel when they meet people with HIV. Is it really safe to physically contact them? What if the both of you have open wounds?
I think these concerns can be alleviated with wider publicity of existing information about the modes of disease transmission. Here are some resources that address common misconception about HIV/AIDS:
Rumors, Myths and Hoaxes (CDC USA)
About AIDS - Myths and Misconceptions (HPB Singapore)
HIV and AIDS misconceptions (Wikipedia)
2. Reduce HIV prevalence?
On the other hand, emphasis on the treatability of AIDS and the normalcy of people living with HIV can be counterproductive in the efforts to discourage people from risky sexual behaviour.
Although the HIV infection rate is low, it is on an upward trend. In the review mentioned earlier, it is noted that only about 50% of sexually active adolescents were using barrier protection. Despite being aware of the potential for pregnancy and sexually transmitted infections, there are people who choose to disregard what they have learnt.
I think one way of discouraging such complacency is to use a shock effect, similar to the approach taken by the anti-smoking campaign. However, it is easy to see how this strategy could further alienate existing HIV-positive individuals from integrating with society.
One of the organizers described this as a difficult balancing act.
An outspoken blogger felt that all this talk is fruitless and proposed action: mandatory HIV testing for everyone in the country, similar to the approach for child vaccination. Since it will involve everyone, there will be no discrimination against any particular group.
Some of the bloggers and organizers are supportive of this idea. I have no strong views either way, though I remember that Angry Doc had written on this topic before - perhaps he may comment on it. Personally I'm not sure if the rise in infection rates is high enough to warrant island-wide mandatory testing, but I'll let the better informed experts weigh in on this.
After a lively discussion, it was time to have some light refreshments and mingle with the other bloggers. Overall it was a successful forum - many key issues were highlighted and the intellectual quality of the discussion was high.
Kudos to Ming, the co-founder of Nuffnang, his staff and the HPB team for organizing this interesting and thought-provoking forum for all of us.
*Update (03 Apr 08) - Here's a poem from the HPB regarding this topic:
“Why do you see me through tinted glasses?
It breaks my heart into a million pieces.
The day I knew I was positive,
all people around me turned negative.
Some of you think that I deserve it,
and so in your society I no longer fit.
But just like you I did not know,
so now my tears abundantly flow.
I had faith in my partner,
that he loved me and none other.
But the truth was revealed;
that one mistake and my fate’s been sealed.
Please don’t look at me through tinted glasses,
support me as I pick up my life’s broken pieces.
Anonymous”
Would you like to know more?
Recent reviews about the origins of HIV and new treatment for AIDS
- Origins of HIV and the Evolution of Resistance to AIDS (Science)
- HIV entry inhibitors (Lancet)
In our current world of ubiquitous high quality digital sound, it's hard to imagine that until about 150 years ago, there was absolutely no way that a person's voice could be captured, stored and replayed at a later time.
Coming from the old school of 35mm photography, I've never been a fan of post-processed photos.
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