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Your Ideas Please – Elderly HIV Prevention

Hi Forum,

I am starting a series called ‘Your Ideas Please’. This is really to listen to different ideas and get everyone more involved in medical issues that affect our lives.

At intervals we will have different topics and I really hope you can contribute your ideas and opinions. I am also looking forward to a lively debate on various topics. No flaming please; everyone is entitled to their point of view.

Off to Batam

Let’s kick things off with a particularly thorny issue that was raised in one of my meeting with our health authorities on HIV prevention.

There is one particular group of people that is very difficult to target in terms of HIV education and prevention.

This is the group of men in their 50’s to 60’s often of a low education level. They do not have any dependents and are working as drivers or equivalent jobs. They often go to Batam where commercial sex is cheap. They never use a condom and have the idea that ‘so what if I have HIV? I don’t have many years to live anyway. I do not have any sex with my wife. So if I catch HIV I’ll just die and won’t hurt anyone.’

So anyone has any good ideas on how to reach out to them to start using condoms and go for HIV testing? Or do you think their logic makes sense?

Please leave your comments in the section below.

About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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15 Comments

  1. Hi doctor,

    Thanks for the reply. I agree wholeheartedly on your views and I think you bring up very valid points. I agree that my friend is being selfish for not trying to prevent the spread of HIV (if he has already been infected) and it’s unwise to wait until he develops full-blown AIDS before he decides to seek treatment.

    I think his reluctance to get tested for HIV has everything to do with the fear of the unknown. He was probably in his late twenties / early thirties when HIV was first discovered. During those years, there was a lot of social stigma associated with the disease because it was most certainly a death sentence back then. There was also rampant chain letters being circulated that claimed people were getting AIDS and dying after sitting on toilet bowls and cinema seats… A lot of misinformation over the unknown certainly fueled greater shunning of HIV testing for people like my friend.

    Of course, HIV is now a controllable disease and no longer has to be a death sentence these days. However, for someone like my friend who is still stuck in the 80s and 90s mindset (lack of information and avenues to educate himself), he’s probably still out of date in regards to current help available for HIV patients. All he knows to be true is: “There was no cure for HIV back then, and there is still no cure now. Nothing has really changed and I’ll only get tested once a cure has been found.”

    I think educating people like him would be the best solution. Anonymous testing is a great implementation, but more can be done to help people in the same group. Such people have no one “in the know” to turn to (they’re a generation who trusts friends wholeheartedly and are word-of-mouth believers.) The problem with that is when a bunch of ill-informed people get together, more misinformation is spread amongst them. I think if people like him won’t step into clinics for anonymous HIV testing, we should instead bring the service to them (knock on doors, give out pamphlets, etc.) — let them know the options available to them and slowly but surely eradicate the misinformation out there.

    • Dear Chan,

      Great ideas! Information dissemination and ease of access to medical services are definitely the way forward. Although I think as a nation, we are some way away from accepting door to door HIV testing, one day this may be the norm. For now, let’s do our best to include people like Mr X into the discussion. Perhaps you can refer him to resources like our website to help him acquire more information and clarify his doubts and misconceptions.

      Meanwhile, we’d love more suggestions to help improve the awareness and empower people like Mr X who have been kept in the dark. Let’s dispel the fear and stigma surrounding HIV once and for all!

  2. Hi doctor,

    I have a friend who is in his mid-forties. He is not highly educated and has no dependents; an honest man who works hard for a day’s wages, he does not indulge in alcohol nor gambling. His only vices are the occasional cigarettes and paid sex.

    I think people like him don’t want to get tested for HIV for a couple of reasons. Yes, you’re right when you say they are unaware of the help available if they’re diagnosed with HIV. However, for people like him, that doesn’t make much of a difference in the grand scheme of things.

    He’s a simple man who leads a simple life, doing no harm to others and if he discovers he’s HIV positive one day, the only joys in his life (a puff and sex) would be denied to him for the rest of his life. These are people who know they’ve passed their prime, and they don’t have many goals or ambitions in life. They just live for a day and I’m unsure if we’d ever get people like him to go get tested.

    • Hi,

      I emphathize with your view. While I can see from Mr X’s viewpoint there are a few things from the opposite side of the fence we have to consider:

      1. Mr X, should he get infected can and will serve as an infectious vector and spread the disease to other sex workers and customers.

      2. HIV is not a quick disease. If you see patients with AIDS you will understand how many of them suffer for years, even decades with complications such as Kaposi’s sarcoma, lymphomas and other debilitating infections before they pass on.

      3. Complications and infections from unmanaged HIV/AIDS will mean that Mr X will have to take more days off work. Additionally, more money will be spent on healthcare, meaning less cash to spend on his indulgences.

      Even if he does not wish to see it as a civic responsibility to get tested and minimize disease spread, if Mr X should get HIV and succumb to unmanaged disease, he will suffer for a long time and find himself losing his good health and hard earned money. In this light, management of HIV is very similar to management of diabetes or hypertension. It’s a lot easier to monitor and manage disease when it is detected early and no complications have set in. The only major difference is that Mr X, knowingly or unknowingly, can pass on his disease to others and harm them too.

      What do you think? How do we reach out to people like Mr X and make him see our viewpoint, or at least use condoms to minimize the risk of contracting disease?

  3. Fairul Ignatius

    Dear Dr Tan,

    I applaud the activists; most claim to have an urge to save humanity through social change. It is unavoidable that whatever a country’s leadership does has to first face criticism from this group. Activists fight for many things, including things that may be good for delinquent individuals but bad for the masses in a society. Amnesty International for instance, is doing a great job in fighting for human rights, but I disagree with one of their ongoing fights i.e. their tooth-and-nail fight for the total global eradication of the death penalty. In fact many believe that such a penalty is the only effective deterrent for gruesome crimes against humanity. Where AIDS and HIV sufferers are concerned, you must agree that these can be divided into two categories: those who contract the virus through no fault of theirs (the born-with-its, blood transfusion victims, innocent wives, etc), and the incorrigible, drug and sex addicts who simply beg for the virus and who keep on with their activities till they contaminate as many of their fellow human beings as they can lay their hands on. My earlier post focuses more on the latter group. I’m glad to hear from you that our government makes HIV preNS and PostNS checks compulsory. This is probably to make sure that pre-enlistees do not contaminate the whole SAF, and ORD personnel start their working lives as ‘clean’ members of society. Hopefully this system can one day be extended to other members of society especially the categories I have mentioned. Thanks for your timely response and wise input.

    Fairul

  4. Fairul Ignatius

    Dear Dr Tan,

    Batam is not the only problem, the category of men you mention, with their don’t-care-less attitude will get sex anywhere they can find it.

    I am not aware of the law in Singapore, but I find it peculiar that men who are tested positive for HIV are allowed to roam the streets. Shouldn’t they either be placed somewhere, where they can be less of a menace to society? I remember when I was warded in CDC for a bad skin ailment,a nurse there once told me of a 14-year-old who contracted AIDS from just attending his first wild party. The poor boy was never discharged from CDC until he eventually died there.

    We know that people under DRC probation are made to wear a device on their ankles which signals the authorities if they go beyond the limits of their reported locations. Why? Obviously to keep them from causing mischief in society. But HIV positive patients? No indication whatsoever – not even a tattoo to show that they should be avoided sexually. Aren’t they a greater danger to society vis-a-vis the drug delinquents?

    But how would anyone know about their condition if they don’t get a medical check-up? Here, the onus is on the government to make it compulsory for free yearly HIV checks starting with those in the risk category (compulsory immunisation is regularly done on children, so this is not something that should raise eyebrows).

    As an extension to this protect-society idea of mine, marrying couples should also be made (by law) to test for HIV before the knot is tied. I know our government want us to have more babies…..but HIV positive ones?? Children should never be the innocent victims of irresponsible parents.

    This section is a great initiative on your part, doctor. It shows clearly your commitment to the medical profession and society at large.

    Fairul

    • Hi Fairul Ignatius,

      Thank you for your very well-thought out comments. I can definitely see how our society can benefit from your ideas. However, I think the human rights activists will have something to say about the ‘HIV colony’ idea as well as the ‘tag-HIV-patients’ idea. You are right that there is no intiative for compulsory HIV testing in Singapore. What we have is HIV testing for all during NS enlistment and ORD. We also have a opt-out HIV testing scheme for pregnant women. In South Africa, people who do not go for annual HIV testing are not allowed to renew their health insurance plans. As an enforcement tool to your ‘compulsory testing’ idea, perhaps we can enforce a similar strategy with our Medi-Fund program. Some would still find this too punitive. Thank you again for you ideas. Please continue to contribute.

      rgds

      Dr Tan

  5. Hi Dr Tan,

    sorry the test taken is Elecsys Combi test 8 weeks PE.(post Exposure)

    Is this accurate?

    Thanks.
    China

    • Hi China,

      I am not familiar with the Elecsys test so am unable to comment on its accuracy.

      rgds

      Dr Tan

      • Hi Dr Tan,

        Thank you for your reply.

        Well, most people are afraid of testing because it is uknown or to afraid to know. Perhaps, in your website you could post some updates on latest medicines or research on cures currently on the way though the disclaimer still apply.

        As most people live longer and life expectancy is also better due to increased medications.

        Bumrungrad hospital is one of the best hospital who has specialists to handle patients well and I guess in Singapore it is difficult to educate as most people are stress out or the discrimination still very strong.

        Anyway, Happy new year and Gong Xi Fa Cai.

        Regards,
        China

        • Hi China,

          That you for your inputs. That is very helpful and insightful.

          rgds

          Dr Tan

  6. hi Dr Tan,

    I am base in China.

    I did a test on Roche combi (p24 & antibody) post exposure 8weeks.

    Is this test accurate at this time?

    Thanks,
    China

    • Hi China,

      No it is not. Repeat a HIV antibody test at 3 months post exposure.

      rgds

      Dr Tan

  7. Hi Dr. Tan,

    You are right Dr.

    They really don’t care much if they are really infected by the virus and nobody will know if they do have it.

    Another issue is Singapore Government has no control over Batam as there is belong to Indonesia. Singapore Government probably can consider to work together with local government in Batam to create HIV awareness and giving out free condom.

    I believe everyone has a weakness and there must be one thing they care the most. Singapore government really has to put more effort to find out what can motivate them to use Condom voluntarily. The promotion message must target to them which will leave significant impact.

    My idea is not something new, hope i answer your question. Happy New Year 2012!

  8. Hi Dr Tan,
    经过这次教训后,我再也不敢交男朋友,更怕结婚,我真的好害怕我的伴侣今天跟我做sex明天跟别人。不是每个男人都要use condom.的。如果我叫他做hiv testing他也有可能在window period。现在要交男朋友真难。不结婚又会被人叫老处女。真的好烦。我现在不感提起HIV或者是爱滋病这个字了。好怕!昨天我有找hiv specialist医生,他再次跟我拿血post exposure 5 week了。您告诉我不用在TEST ANTIBODY ,但是我还是怀疑我的TEST跟你讲的不一样HIV P24 ANTIGEN而你的是P24 AG/AB COMBINATION TEST..但我也做antibody tested Hiv 1 and 2 ab/ag menthod ECLIA post exposure 3 week.您说得没错,我必须找个proper Dr,我也明白您当时不肯回答我的问题了原因了,所以我鼓起很大的勇气见专科医生。我也把我发生一切告诉他,很丢脸,我认识他的,但没办法,因为我真的没办法入睡。。我也希望我的报告会是好的,很期待。但很怕。但如果真的有这种病,我接受事实了,我想应该没得医只有控制。我真的好希望全世界的人都知道婚前或婚外情的人性行为的危险性是会传染到HIV..也非常希望在各报刊都刊登这样新闻,鼓励人用安全套。现在要婚前做验血是没什么意义了,结婚后也一样搞婚外情,把这些病传染给夫或妻。我觉得最好的办法是在马路的招牌多贴一点关于hiv。这样每个人去上学,下学,上班或下班都会看到这些关于爱滋病。这样才会让那些乱性的人感到害怕而自然而然会戴上安全套。

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