INFECTIOUS DISEASES(AMENDMENT) BILL

[Mr Speaker in the Chair]

Order for Second Reading read.

The Minister for Health (Mr Yeo Cheow Tong): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Infectious Diseases Act was enacted in 1976 to prevent the introduction and spread of infectious diseases into Singapore. In the late seventies, doctors in the USA encountered a new and deadly infectious disease amongst their patients. In 1981, the disease was identified, and given the name "Acquired Immunodeficiency Syndrome", or AIDS. Scientists also discovered that AIDS was caused by the Human Immunodeficiency Virus, or HIV.

AIDS has spread very rapidly since then. In the short period of 10 years, it has become a pandemic, affecting millions of men, women and children on all continents. The World Health Organisation (WHO) estimates that about 12 million adults and children are today infected with HIV. What is frightening is that WHO projects that this number will increase further to 30 to 40 million by the year 2000.

What about the AIDS situation in Singapore? In Singapore, we found our first HIV-infected person in 1985. Following this discovery, my Ministry gazetted HIV infection and AIDS as notifiable diseases. Up to the end of January this year, 111 Singaporeans were found to be infected with HIV. What is worrying is that the rate of infection is increasing. We had 10 new HIV-positive cases in 1989, increasing to 17 in 1990. Last year, the number of new cases shot up to 42. We expect the number of infected persons this year to be even higher.

The pattern of infection has also changed. Initially, homosexuals and intravenous drug addicts were the main groups at risk. Now heterosexuals form the majority of those newly infected. This change has significant importance and implications for all Singaporeans. Measures for the control of AIDS must now be targeted at all sectors of the population.

Sir, my Ministry firmly believes that education is the key to preventing the spread of AIDS. This is because anyone can easily avoid being infected by the HIV. All he has to do is to be sensible, and avoid high-risk activities. The HIV is normally transmitted through two main ways: either sexual intercourse with an infected person or through the blood, for example, sharing injection needles with an infected person.

We will therefore step up our educational efforts to remind Singaporeans about the danger of AIDS, and how the disease is transmitted. Our health education programme is conducted through talks, exhibitions, pamphlets, posters and the mass media. An AIDS telephone Helpline has been in operation since 1988 to provide anonymous counselling for members2 of the public. Personal counselling is also provided to persons with high-risk behaviour.

We will continue to follow up on HIV-infected persons. Specially trained doctors and staff will continue to counsel and encourage them to take the necessary precautions so that they will not infect others. Contact tracing is also carried out so as to prevent the further spread of the disease.

We will also continue to protect our national blood supply. In 1989, we incorporated a declaration in the questionnaire which all potential blood donors have to answer before they are allowed to donate their blood. It requires potential blood donors to declare the truth about their HIV status and risk behaviour. Donors who made a false declaration are liable for prosecution under the Penal Code. This helps to ensure that persons engaging in high-risk activities are excluded from donating blood. All blood donations are also screened for HIV to ensure that only uninfected blood is used.

With greater awareness of AIDS, I hope Singaporeans will avoid high-risk activities that put not just themselves, but also their family and loved ones, in grave danger. But the Government alone cannot contain the further spread of AIDS amongst Singaporeans. We can only succeed if everybody joins in this fight against AIDS. Singaporeans can greatly help by advising and persuading their friends not to indulge in high-risk activities, in Singapore as well as when they travel abroad.

My Ministry will closely monitor the disease and we will undertake all the necessary measures to prevent the spread of AIDS.

However, there is the risk that some of those who are already HIV-infected will continue to be irresponsible in their behaviour. We need to strengthen the existing legislation to deter such irresponsible and dangerous behaviour. We need to give the legal backing to our AIDS counselling and educational efforts. We need to protect the safety of our blood supply. The proposed amendments will help us to achieve these important objectives.

Sir, I will now deal with the six major provisions of the Bill.

Clause 3 empowers the Ministry to undertake epidemiological investigations of other infectious diseases which have not been made notifiable under the law. Examples of these are Legionellosis and Hand, Foot and Mouth Disease.

The proposed new section 20A empowers the Director of Medical Services to require any person who has been diagnosed as having AIDS or as having been infected with the HIV to undergo counselling and to comply with all the safety measures which may be specified by the Director.

The proposed new section 20B makes it an offence for any person who knows that he has been infected with the HIV, to have sexual intercourse with another person unless before the sexual intercourse takes place, the partner has been informed of the risk of contracting the HIV infection from him, and has voluntarily agreed to accept the risk.

The proposed new section 20C makes it an offence for any person who knows that he is infected with the HIV to donate blood at any blood bank in Singapore, and to commit any act which is likely to transmit AIDS to another person.

Any person who commits an offence under these three new sections will be liable to a fine of up to $10,000 or imprisonment for a term not exceeding two years, or both.

The Bill also protects the identity of any person who has been diagnosed to be infected with the HIV except in certain circumstances specified by the Bill.

The Bill provides for an increase in the penalties for certain offences under the Act from $2,000 and $5,000 for the first and subsequent convictions, to $5,000 and $10,000 respectively.

Sir, the proposed amendments to the Infectious Diseases Act will enable my Ministry to have a better control over AIDS and other infectious diseases in Singapore. It will help to deter HIV-infected persons from activities that are likely to spread the disease. It will further enhance the safety of Singapore's blood supply.

Sir, I beg to move.

Question proposed.

Mr Loh Meng See (Kampong Glam GRC): Mr Speaker, Sir, I rise to support the Amendment Bill.

Sir, in the case of AIDS, prevention is the only way as there is no cure. In Singapore we cannot afford to be complacent because the numbers have been increasing by geometric proportions. And at the rate that it is going, the numbers can only continue to increase.

I read with concern, when the Ministry of Health launched the public education campaign and through the press reports, that among Singaporeans who take short trips to neighbouring countries some believe that they are not likely to be struck down with AIDS because they think that they are not so unlucky, in the sense that they are not lucky enough to strike lotteries and it is not likely that they will be caught with AIDS.

I think we have to understand what the Thai Minister Meechai said recently on the dangers of AIDS, how he himself described the very extensive numbers among the Thai people being caught with this disease, and how he claimed that his own daughter is not likely to be able to marry a Thai man free from AIDS. I am very pleased that the Ministry of Health is taking very early action in this regard.

Sir, I would like to just ask the Minister a few questions for clarification. First, Sir, we know that Magic Johnson has been treated with a drug called AZT, which is approved by the Food and Drug Administration (FDA), and it is purported that this particular drug can slow down the affliction to full-blown AIDS. I wonder if the Ministry is able to help make it easier for the HIV-positive infected patients to be able to use their Medisave to buy such drugs. If not for anything, we can help them to provide the relief through the use of this drug.

Second, Sir, the Minister mentioned about the questionnaire that potential blood donors have to fill in. It is in fact a very lengthy questionnaire of 15 questions that they have to answer each time. And of course some prospective blood donors think that it is an intrusion of their privacy. We also know that it is important for the blood bank to keep the integrity of the blood supply to protect innocent lives, the very people who needed the blood donation. I am wondering whether the Ministry of Health can differentiate between the first-time donors and the regular donors. Is there a possibility of making it easier for regular donors to have a different set of forms so that we can facilitate the regular blood donors to continue to provide the generous donation of blood to save lives?

The other question, Sir, is whether the Ministry of Health can actually work with travel agents to provide information leaflets to Singaporeans travelling abroad to heighten their awareness with regard to this very serious disease. Because if they could be alerted prior to their departure, most probably we can help save some from getting into their high-risk behaviour.

Finally, Sir, we do have cases of Sin-gaporeans seeking surgery abroad, and we have learned of cases whereby through such surgery some of the Singaporeans have been infected with HIV. I wonder whether some procedures could be worked out so that such patients could seek counselling and consultation with the Singaporean doctors before they proceed overseas.

Mr Peh Chin Hua (Jalan Besar GRC): ( In Mandarin): Mr Speaker, Sir, I rise in support of this Amendment Bill.

The Bill will ensure that there will be some form of control over the spread of AIDS so that innocent people will not contract AIDS unknowingly through sexual intercourse with those who are aware that they have been diagnosed to be HIV-positive, and thus getting themselves into grave trouble and misery. At the same time, the Bill will also ensure that those who are diagnosed to be HIV-positive will not be allowed to donate blood or do anything which is capable of transmitting AIDS to others.

According to figures provided by the World Health Organisation (WHO), nearly 10 million people in the world are suffering from AIDS or are HIV-positive. 10 million is an astonishing figure. If we do not have effective control over this disease today, the consequences will be disastrous. According to available information, among the 111 AIDS cases discovered in Singapore, 83% are homosexuals and heterosexuals and some 88.2% of the patients are below the age of 40 years. Two-thirds of them are professionals, executives and people in the service industry. This situation is very alarming indeed.

The Bill, I believe, will have a positive effect. Therefore, I urge all fellow Singaporeans who go overseas for vacation or business to avoid frequenting the "redlight area" to indulge themselves in women and song, so that they will not beget sorrow through extreme joy and ended up contracting AIDS, and even bring AIDS back to their spouses and children. That will be a great tragedy! Especially today, Sir, when we are developing the new Growth Triangle of Singapore, Johor and Batam, our businessmen should not use their investment as a pretext to deceive their family members by telling them that they are going on business trips or having seafood there, while in fact they are fooling around in the neighbouring countries. By so doing, they will not only do harm to themselves but to their family members as well. We must not forget that in Singapore, among the foreigners who suffer from AIDS, about 60.8% come from ASEAN countries. This percentage is very high indeed. In Thailand alone, there are 400,000 people who are known to be suffering from AIDS, accounting for 57% of the total number of cases in the whole of Asia. As such, when Singaporeans go overseas for vacation or business, they must make sure that they do not frequent the "redlight area" and run the risk of bringing AIDS back to their loved ones at home.

I would also urge the Ministry of Health to take more stringent measures to prevent people who have AIDS or are HIV-positive from committing the offence of rape, because they will harm their victims even more severely. As such, the Government should consider imposing more severe punishment, such as death penalty, etc, on this type of rapists, to serve as a deterrent. I hope the Minister for Health will consider this view.

Mr Yeo Cheow Tong: Mr Speaker, Sir, I would like thank my two colleagues who have spoken out in support of the amendments.

They have very correctly warned Singaporeans to be extremely careful so that they do not get infected with AIDS, especially when they travel abroad and indulge in sexual activities.

Sir, Mr Loh Meng See has asked whether we would be prepared to let patients with HIV infection to use Medisave for AZT treatment. The Ministry has been considering that and I am happy to inform him that we will allow HIV-positive persons to use their own Medisave to the extent of $12 per month to help pay for AZT treatment.

He has also asked whether we would be prepared to have two different questionnaires, one for new donors, and one for repeat blood donors. Sir, much as we would like to help repeat blood donors, unfortunately, the safety of our blood should be the main consideration. For repeat blood donors, the frequency of donation is normally about twice a year, and certain things can still happen in the six months between the donations. I am happy to say that since we introduced the questionnaire, we have had no drop in the number of repeat blood donors. They have been quite happy to answer the questionnaire because they already know what the questionnaire is all about. I also think they fully understand what is the purpose of this questionnaire, so most of them have been happy to answer all the questions.

As to his suggestion that we discuss with travel agents and get them to distribute AIDS pamphlets, I will get my officials to look into this. It is a good suggestion and we will explore it.

As to whether we can provide counselling for Singaporeans who are going abroad for surgery, if we are aware of these cases, we would definitely counsel them. Those who are going abroad can also come and seek assistance from the Ministry in terms of getting information about the places they are going to, and what sort of safeguards they should look into.

Mr Peh Chin Hua has also warned Singaporeans who are travelling abroad to be very careful. I agree with him. He has also asked that we must be very stringent on HIV-infected persons who are rapists. Sir, I would pass his suggestion on to my colleague, the Minister for Home Affairs, for consideration.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Yeo Cheow Tong].

Bill considered in Committee; reported without amendment; read a Third time and passed.