Wednesday, December 22, 2004

*HIV/AIDS in Singapore*

I think it is safe to say that AIDS is a problem of sufficient magnitude that we need to do something about it. Granting of course that some would consider other issues as more pressing etc.

What I want to do is to focus this issue in Singapore for a couple of reasons: 1. It's my homeland after all 2. While no longer in its nascent stage, it's not as widespread as certain parts of Sub-Saharan Africa 3. Whatever policy considered has a fair chance of actually working considering the strong Executive/Legislature and the relative small size of this sunny island. 4. The worthy luminaries can worry about the rest of the world

Before I begin, let me state what this problem is not. 1. Cost, Singapore does subsidise AIDS drugs if I'm not wrong. 2. Distribution, small island, literate population. If it works in Uganda, it's bound to work here. 3. Acknowledgement of problem. We realise we have a problem...I think... 4. Blood. It's almost entirely about sex. We screen our blood, we don't have the sale of blood/blood bank scandals like in China.

So, the basic problem in Singapore is fundamentally one of education. See the whole debate on whether Condoms work or do not work...I blame Focus on the Family for their ideological stance getting in the way of proper sex education and their infantile idea that an abstinence only policy works. But others would claim either the moral degeneration of aping Western Liberal Ideas, promiscuity, the homosexual community etc. And with all the ideological egos at stake we could have a serious problem here. But ultimately, I suppose we're all on the same side so to speak.

The more pressing issue is the extent to which certain civil liberties, particularly those of privacy, should be infringed. Theoratically, we could institute mandatory AIDS testing and let nature run its course and theoratically it would 'burn out' by itself. Of course, practically speaking it (being Murphy's Law) would ensure that this would never happen but we've already taken the first step of screening mothers for AIDS with the provision of antenatal drugs to prevent transmission of the virus.

But even if we do a full blown mandatory testing, of which the next step would be to test the yearly intake of NSF regularly and then extending to the rest of the population etc., it then arises the question of whether the test results ought to be made know in a public fashion. On one hand, you've got the public good. On the other, do we trust our society to be mature enough not to discriminate and abuse such people? After all, while there are those who voluntarily took the risk, others had the risk forced upon them e.g. spouses.

However, while keeping the data private (or on a need to know basis) would protect the privacy of patients, it would require people with knowledge of their condition not to willfully infect others (see the recent Thai case). With the stakes so high, can we afford the risk?



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