NEARLY 30 years of public health efforts have succeeded in halting the global Aids epidemic, UNAids reported in its annual round-up published on World Aids Day this week. The rate of new HIV infections in Singapore, however, has not quite gone down. The Health Ministry said this week that 273 people became infected in the first half of this year and projects that the total for the whole year will come close to last year’s 463 cases. Between 1985 and the end of June, 4,573 people have been infected with HIV, of whom 1,356 have died. The threat remains. Although the infection rate – 124 per million last year – remains quite low, Singapore has not reversed the trend.
By contrast, according to UNAids, 56 countries have either stabilised or reduced incidence rates significantly, although from a far higher level than in Singapore. Worldwide, new infections have fallen by nearly 20 per cent in the last decade, Aids-related deaths are down by almost 20 per cent in the last five years, and the number of people living with the virus is stabilising. So there is good news in the fight against HIV/Aids, with headway being made in public awareness, prevention, testing and treatment. But to reduce incidence rates even further, the authorities will have to pay attention to trends that have become obvious over time.
In Singapore, one disquieting development is the increase in the number of older people, mostly men, becoming HIV positive. There were 60 new such cases last year among those above 59 years old, nearly twice as many as in 2005, according to Health Ministry data. To make matters worse, many of them were diagnosed at a later stage, implying greater risk of transmission to sex partners. Late detection also means that treatment is less effective in assuring quality of life, especially since these older patients have other illnesses such as hypertension and diabetes. Why do they put themselves and their spouses at risk? Why do some of them think they are less vulnerable to infection than younger and healthier individuals?
Public health officials need to study these questions. Ignorance, fear and stigma still work against early detection and treatment. Compulsory screening in prisons and drug rehabilitation centres contributed to a 10 per cent increase in HIV tests in the past year. Instead of continuing to be in denial, those engaged in risky behaviour, including older men, should respond more readily to the ministry’s call for voluntary testing. With early and effective treatment, a positive diagnosis may no longer be a death sentence. The world has made progress in containing HIV/Aids, but the fight is far from won, here or elsewhere.