HIV in Singapore

This plot was generated from data on the Singapore Ministry of Health website. It shows the rising number of HIV cases since 2002. As pointed out in the earlier post, HIV testing moved to an opt-out process in 2008.

Clearly as the graphs show, despite HIV being most common among heterosexuals, the incidence is rising most rapidly for homosexuals and bisexuals.

Why the difference between HIV and H1N1? Exceptionalism?

The coincidence of the reports on our first H1N1 related death and the guy who came out with respect to his HIV, gave me cause to think about how the world treats these two pandemics.

It is becoming increasingly clear that the mortality related to H1N1 is nowhere as high as was initially estimated. A recent article in Eurosurveillance by two New Zealand public heath experts reviewed the methods for estimating the case fatality ratios (CFRs) for the H1N1 flu and concluded that the current methods overestimated the CFRs. They present possible alternative methods, which despite their limitations, all produce much lower CFRs (0.06% - 0.0004%) compared to the original estimates of 0.4%.

By contrast also, the HIV CFR has an almost surreal air to it. Nobody talks about HIV related deaths in the same way as for H1N1. For example, a heart attack patient with positive H1N1 would be an H1N1 related death, but an HIV patient dying of a heart attack would not be a HIV related death. Even so, the very crude estimates of HIV CFR is in a totally different ball park from H1N1. In 2007 WHO reported a global incidence of 33 million cases of HIV. Over the same period 2 million AIDS deaths were reported. This allows us to make a very rough estimate that HIV related deaths could be at least 6%, 10 x the worst estimated CFR for H1N1.

Yet we run around panic stricken, whacking at the H1N1 flu with fancy words like containment, mitigation - quarantines, contact tracing etc etc.....while treating HIV almost with kid gloves.

The word that epidemiologists use for this is - 'exceptionalism'.

HIV is probably one of the most destructive pandemics in human history. Since 1981 when it was first discovered it has been estimated to have killed 25 million world wide. Yet we are afraid to manage it in the same scientifically rational way we manage all other epidemics. Activists and lobbyists have managed to persuade the global community that to do otherwise is a human rights offense.

So we have been powerless to deal with this pandemic in the correct way.

But things seem to be swinging away from that falsehood as people come to terms with the destructive nature of the pandemic. In 2007, the US CDC and and WHO/UNAIDS finally got the courage to recommend that testing for HIV be part of routine clinical testing. This is 26 years too late if you ask me.....but at least it is now being done.

Singapore followed suit with Changi General Hospital taking the lead. Senior Minister of State Ministry of Foreign Affairs, Dr Balaji, reported (Nov 2008), "... Changi General Hospital was the first hospital in Singapore to pilot voluntary opt-out HIV screening for inpatients just under a year ago. They have shown that it can be done. More than 3,000 of their patients have been screened so far, and around 50 have been found to be HIV-positive. The Ministry of Health has asked other acute hospitals to implement a similar opt-out HIV screening programme for their adult inpatients, and it should be in place in all public sector hospitals by the end of the year. Private hospitals should also study how they can implement opt out testing as this becomes the standard of care."

Let's do away with exceptionalism once and for all, and deal with a pandemic the way pandemics ought to be dealt with. Scientifically, rationally and truthfully.

Read "Changing the Paradigm for HIV Testing — The End of Exceptionalism" in the New England Journal of Medicine.

So we won't repeal Section 377A?

Is it a cause for celebration? Not really.

The inconsistency in the law is not something we can be proud of. And I am saying this even though I do not agree with the homosexuality arguments.

But Minister Shanmugam's position is a pragmatic one. And for that I respect him, and the government he represents, that they can be mature enough in his/their thinking not to be too fixated on a course of action that is inflexibly bound with ideological correctness. He is right in stating the obvious, that ..."We, sometimes in these things, have to accept a bit of messiness."

Yep. Applies to both sides of the argument.

Marriage and alimony - Dr Soin's fallacy

Andy Ho wrote a half decent commentary of Kanwaljit Soin's recent rant to grant alimony for men. Not so sure I agree with him though. And certainly not with her that men and women are equal and that 'In this era, maintenance should be on the basis of need and not on the basis of sex.' (I think she meant gender.)

It is an important discussion, because it will help us come to terms with what the institution of marriage really is. This does have repercussions for the future, because the earning power of men and women will become less (although I think not for a long time more), and also when the same sex marriage people start pushing their agenda. Actually I am not to sure how much Dr Soin's push for 'gender equality' comes from her close association with AWARE and her ideas of a genderless marriage. This is certainly not advancing the cause of women, but reducing the approriate consideration of the gender based disadvantage that women have in the marriage relationship.

Marriage to my mind is, and will remain an equal partnership where the partners bring different assets and resources into the relationship and are intrinsically unequal. This cannot be denied. On one hand, women tend to marry up (yes, yes, there are exceptions, I know), they bring their womb and eggs and commit to being a mother (and yes, of course there are exceptions!) and by and large, they tend to step down their ambitions and career advancements to look after the home. To this end they become more of a dependent than a provider. This is a reality, and in her push to advance the idea that women are as masculine as men, Dr Soin should not forget this.

But having come into the partnership as non-equals, marriage is an equalizer, and the partnership becomes an equal partnersip, where both have equal responsibilities for the family and child rearing (should there be children). Best of all, family wealth become equally shared.

Within the institution of marriage, there are three recognizable elements should a marriage dissolve:

a] sharing of conjugal property
b] mainenance of the wife as a dependent (in recognition of her dependent status during marriage)
c] continued shouldering of the parental roles, fiscally and functionally.

These are not gender equal, and it is right that the Women's Charter continue to protect the rights of women with respect to these issues. It is true that in some isolated situations, the roles may somehow be reversed, in part of in whole, and the courts should have some leeway in determining how to vary the outcomes accordingly. But these would be by far, the exception than the rule.

Dr Soin, in her attempt to be progressive should not quickly barter these away. Marriage is an equal partnership, but needs to recognize that the individual partners are not true equals.

Above all marriage is not genderless.

Origins of homosexuality?

Just as a distraction from the media obsession about H1N1, here is an interesting report from TIME about the origins of homosexuality.

The article is called "Why Some People Are Gay: Notes (and Clues) from the Animal Kingdom". Only some excerpts are reproduced here. You can read more from the original article.


"We have known for at least a decade that hundreds of animal species — including birds, reptiles, mollusks and, of course, humans — engage in same-gender sexual acts. But no one is quite sure why. After all, same-sex couplings don't usually result in offspring. (I say usually because when male marine snails pair with other males, one partner conveniently changes sex, allowing for reproduction.) Evolutionarily speaking, homosexuality should have disappeared long ago.

A yearlong study just completed at the University of California at Riverside offers several fascinating competing theories about why same-gender sexual behavior has endured. And although it's gay-pride month — and the 40th anniversary of the Stonewall riots that sparked the gay-rights movement — not all the theories will give same-gender-loving humans a reason to celebrate.

What all these theories have in common is that same-sex sexual activity is either an accident or a quirky genetic method of helping males impregnate females. Which raises the evolutionary question of why men and women who are exclusive gay and lesbian exist. One answer is that exclusive gays and lesbians are a relatively new creation: the concept of exclusive homosexuality barely existed before modernity; even a century ago, most same-sex-attracted men and women got married and had kids."

Government, homosexuality and AWARE

So the government has broken its silence on the issue. There's fairly wide coverage of this in the Straits Times today, so go read.

Whatever we may often criticise the gahment for, I must admit that at the crucial moments, they have been able to step in and provide the calming leadership that is required. This has been one such occasion. So I applaud the government for the very even handed way that they have now dealt with this issue. There have been a couple of slaps on the wrists where they have been needed, but I don't think anyone would dispute that they were justified. I don't think anyone would be shouting 'referee kelong'.

But here's a thought worth pondering....I think.

We don't really want religious groups muscling into what we perceive as public space, and imposing their views on a secular activity (really? how about schools and hospitals? But I digress....). The public reaction against the perceived Christian takeover of AWARE was very clear even though it was really not a church-backed 'takeover', rather one that was coordinated by a group of like-minded people from the same church. But the message was unmistakable. But how about if so-called secular groups like AWARE were taken over by a group of like-minded activists of LBGT leanings? Shouldn't we be equally concerned?

Shouldn't we?

MOE suspends Aware's programme for schools - 'nuff said!

Breaking news from Asia1
(snipped and pasted from Asia1)

MOE has examined AWARE's "Comprehensive Sexuality Education: Basic Instructor Guide". The Guide contains some positive aspects, like the accurate information provided on STIs/HIV and role-play practice for students to say no to sex.

However, MOE's assessment is that in some other aspects, the Guide does not conform to MOE's guidelines. In particular, some suggested responses in the instructor guide are explicit and inappropriate, and convey messages which could promote homosexuality or suggest approval of pre-marital sex.

In view of this, AWARE's programmes in schools will be suspended and subjected to the new vetting processes.