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)
11 Comments:
I agree with your prediction that the social stigma against HIV will be significantly reduced when we have an effective cure or vaccine for the disease.
Having said that, it is my view that the ministry of health had by continuing to moralise the issue done more to add to the stigma of HIV thatn it has to reduce it.
As for mandatory HIV-testing for the whole nation, my first thought is that it will be impractical or at best expensive and logistically difficult.
Even if it can be done, it will not be as 'universal' as the blogger thinks it is since new cases can always be imported from overseas; add to that the phenomenon of the 'window period', and it means we need to conduct the test every few months, and indefinitely unless we close our borders.
Finally, for mandatory testing to be effective in reducing HIV prevalance, we must ensure that those who test positive are given effective treatment for the disease, and modify their behaviour so that they do not spread the virus to other people. It is in this last link that I think we are failing.
Currently HIV (specifically non-standard anti-retroviral) treatment is expensive and (as far as I know) unsubsidised. While the cost of subsidising this treatment can be high, I suspect the cost of not ensuring affordable treatment to patients will be higher in the long-term. The decision to not subsidise HIV treatment may or may not have be due to the social stigma against HIV, but it certainly adds to it.
Scientifically, we have come a long way in understanding HIV/AIDS and treating it. We have the tools and resources to detect and treat HIV. However, we are hampered in our efforts by a government that choses to pander to the "sensibilities" of the public, continues to moralise the issue, and refuses to repeal laws that by further stigmatising the disease make it harder to educate people about HIV/AIDS while passing more laws to stigmatise the disease.
I believe this refusal to go all-out to fight the disease stem partly from the mentality that only *they* get the disease while moral folks like ourselves will never catch it. The laws certainly reinforce this view. As I mentioned in a previous blog entry, we as a society managed to fight tuberculosis effectively by recognising that it is a problem for the whole nation and not just the few - why won't we do the same against HIV?
Hi Angry Doc, thanks for stopping by and expressing your views on this matter.
Even if it can be done, it will not be as 'universal' as the blogger thinks it is since new cases can always be imported from overseas; add to that the phenomenon of the 'window period', and it means we need to conduct the test every few months, and indefinitely unless we close our borders.
You've made a good observation: the blogger's suggestion was to conduct the HIV testing yearly, but that may be too infrequent to make a significant difference.
Finally, for mandatory testing to be effective in reducing HIV prevalance, we must ensure that those who test positive are given effective treatment for the disease, and modify their behaviour so that they do not spread the virus to other people. It is in this last link that I think we are failing.
I think that in order to address the increasing HIV rates, it's important to find out the details of why this is occurring. The AAMS review did not investigate the causal factors for this, and thus cannot rule out the possibility that the perceived increase could be just due to increased case detection due to wider public awareness.
It would be rather odd that more people are engaging in risky sexual behaviour despite knowing better. If this is really the case then we need to find out the root cause of this.
I think that the best way one can deal with the problem of moralising the issue is to have a public education campaign focused on the facts of HIV infection and various ways of countering it. Blantant sex imagery might just catch people's eyeballs but will do nothing for the infected HIV patients. This approach has been taken by the pro-abstinence camp and as you have previously mentioned, abstinence education without contraceptive education has done nothing for teenage pregnancies and will indeed do little for the prevention of HIV infection.
Angry doc hit it right on about the impracticality of HIV testing due to the window period, varying latency periods and so on. A better solution would be targeted HIV screening for high risk patients but then we will again face the problem of denial or refusal on various grounds.
hey there,
thank you for coming and it was great to see you there! pity that i didn't have a chance to talk more with you, and sorry to keep you waiting while gathering the other bloggers. hope to see you at future events okay!
huiwen of nuffnang
Edgar says:
"Blantant sex imagery might just catch people's eyeballs but will do nothing for the infected HIV patients. This approach has been taken by the pro-abstinence camp and as you have previously mentioned, abstinence education without contraceptive education has done nothing for teenage pregnancies and will indeed do little for the prevention of HIV infection."
Yes, that is a good suggestion - focus on the facts and avoid sexual imagery during the publicity effort. I do see a trend in that direction, especially in the photo competition where only a small proportion of photos have sexual imagery.
To Davienne:
Welcome to Fresh Brainz! Thanks for organizing the blogger forum, it was a great event. If there are more such interesting events I'll be there. See you then!
Actually with some genetic research in an European country there are new methods being developed to render the Human Immunodeficiency Virus ineffective. No idea on the progress.
But the virus itself(purportedly) spread from West Africa through zoonosis.(Avian flu is the same thing except it is spread by consumption just like Sars of civet cats)
So that's why more precaution should be exercise While handling infected vectors in controlled lab enviornment. well that's what BSL are for.
The Acquired ImmunoDeficiency Syndrome can be detected through certain syndrome but by that time the person would have been infected and when the person display the syndrome.
The virus can also be spread by MTCT, infected needle, Breast Milk and blood transfusion.
Stigmata aside the spread of the disease is due to lack of transparency and responsibility on the part of the infected person who could be denial of the infection or fear of rejections.
To do that mandatory (compulsory) testing in hospital can be considered.
But a more viable method is to make a commercial Testing Kit that use saliva to detect antibodies....
that is cheap due to mass production.
To Apostle:
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