US embassy cable - 05SINGAPORE2584

UNCLAS SECTION 01 OF 02 SINGAPORE 002584 
 
SIPDIS 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: KHIV, TBIO, PHUM, ECON, SN 
SUBJECT: SINGAPORE CONSIDERS TOUGHER HIV LEGISLATION 
 
REF: A. 04 SINGAPORE 395 
     B. SINGAPORE 1839 
 
1. (U) SUMMARY:  Singapore is considering legislative 
changes that put the onus on individuals to be aware of 
their HIV status and responsible for protecting others from 
infection.  This comes on the heels of Singapore's increase 
in HIV cases in 2004 from 1,192 to 1,503 infections among 
the country's 4.2 million people.  Most experts here believe 
that another 2,000-3,000 HIV cases remain undiagnosed.  END 
SUMMARY. 
 
New HIV Infections are Few, but the Number is Increasing 
--------------------------------------------- ----------- 
 
2. (U) Singapore reported a 28% increase in newly diagnosed 
HIV infections with 311 cases in 2004, compared to 242 new 
cases diagnosed in 2003, bringing the official total of HIV- 
positive individuals in Singapore to 1,503.  Experts 
estimate the actual number of HIV cases is between 3,000 and 
5,000.  Even using unofficial estimates, less than 0.12% of 
Singapore's population has HIV; however, if this trend 
continues, there could be more than 15,000 HIV-infected 
individuals in Singapore by 2010. 
 
3. (U) The most at-risk population group for HIV is 
heterosexual, single males, aged 30-49, (206, or 66%, of 
last year's new cases).  Among these, 171 individuals had 
sex with prostitutes or engaged in casual sex.  Further 
analysis of Singapore's HIV statistics is available on the 
Ministry of Health website at www.moh.gov.sg. 
 
GOS Considers Tougher Legislation 
--------------------------------- 
 
4. (SBU) The Government of Singapore (GOS) is considering 
legislation to put the onus on HIV-positive individuals to 
not spread the disease to others.  Key proposals include: 
 
-- Mandatory Pre-Natal Testing: Since November 2004, doctors 
must offer optional HIV tests to pregnant women; 98% opt to 
have the test.  New legislation would make the pre-natal HIV 
test mandatory. 
 
-- Mandatory Pre-Marital Testing: Over half of HIV-positive 
women are married and experts here believe most contracted 
the disease from their husbands.  New legislation would 
require an HIV test before marriage. 
 
-- Relaxation of Doctor-Patient Confidentiality: As of July 
2005, Health workers must inform the spouses of patients 
with HIV regardless of whether the infected person agrees. 
The GOS is considering legislation to compel patients to 
disclose further information on sexual history so that 
doctors can inform other sexual partners. 
 
-- Criminalizing "Reckless Transmission":  It is illegal for 
diagnosed HIV-positive individuals to have sex with a person 
who is unaware their status.  MOH is considering legislation 
to make individuals criminally liable even if they 
unknowingly transmit the virus.  MOH Deputy Director of 
Epidemiology and Disease Control Dr. Jeffrey Cutter told 
EconOff that strong public opposition has made this 
legislation highly unlikely. 
 
Educational Efforts Expanding 
----------------------------- 
 
5. (U) The MOH collaborates with outside organizations, 
including the American Chamber of Commerce, to educate on 
HIV prevention through its statutory arm the Health 
Promotion Board (HPB).  HPB is the main driver for national 
health promotion and disease prevention programs. 
 
6. (SBU) Senior Minister of State for Health Balaji 
Sadasivan announced formation of a Singapore "AIDS Alliance" 
at an American Chamber of Commerce meeting on August 25. 
The AIDS Alliance will coordinate the efforts of government, 
business, health workers, and community organizations to 
promote AIDS education and end discrimination against HIV- 
positive individuals. 
 
7. (SBU) The vast majority of Singaporeans contract HIV 
through sexual means.  Still, concerns about negative public 
reaction prevent MOH from undertaking safe sex education 
promoting condom use; MOH opts instead to promote abstinence 
and monogamous sexual activity as prevention methods.  Some 
activists here argue that educational programs directed at 
condom usage could decrease the infection rate more 
effectively than this or legislation aimed at already 
infected individuals. 
 
-- HIV infections are not high among youths (age 10-19) but 
incidence of other sexually transmitted infections 
(including gonorrhea and syphilis) has upsurged, a sign of 
increased unsafe sexual activity. 
 
-- A 2004 National University of Singapore study found that 
while "almost all" Singapore men use a condom when engaging 
in casual sex in Singapore, only about half will use a 
condom when abroad. Singaporean men do engage in sex 
tourism; the nearby Indonesian island of Batam, for example, 
is a popular destination for Singapore men seeking 
inexpensive prostitutes, and has a higher rate of HIV 
infections than Singapore. 
 
Singapore Actions to Stem Spread Have Economic Impact 
--------------------------------------------- -------- 
 
8. (U) The Singapore economy has benefited from homosexual- 
oriented consumerism, despite the illegality of homosexual 
acts.  However, the GOS has recently cancelled gay parties 
and concerts on the grounds that reported sexual activity at 
earlier homosexual gatherings contributed to the HIV 
infection rate.  (NOTE: The Nation Party, a popular gay and 
lesbian festival held annually in Singapore since 2000, 
hosted 8,000 people and generated an estimated S$6 million 
(US$3.63 million) in tourism revenue in 2003.  END NOTE.) 
 
9. (SBU) COMMENT: Authorities are worried about the 
increased rate of HIV, and are responding by trying to 
legislate responsible behavior, even if some civil liberties 
like personal privacy are encroached upon in the process. 
While it is too early to speculate whether new infections in 
2005 will be higher or lower than 2004 numbers, more 
individuals are taking HIV tests, an indication that 
government efforts to increase HIV awareness among the 
population is working.  END COMMENT. 
 
 
Lavin