SECTION_NAME:ORAL ANSWERS TO QUESTIONS

[Mr Speaker in the Chair]

ORAL ANSWERS TO QUESTIONS:

* 1. *Assoc. Prof. Ngiam Tee Liang asked the Minister for Health what is the Government's policy regarding the promotion of HIV-AIDS public education campaigns by (i) his Ministry, (ii) the Communicable Disease Centre (CDC), and (iii) the people sector.

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The Senior Minister of State for Health (Dr Balaji Sadasivan) (for the Minister for Health): Mr Speaker, Sir, my Ministry implements the AIDS Education Programme through the Health Promotion Board (HPB) to educate Singaporeans on how HIV infection is transmitted and its consequences.

The HPB conducts year-long education using both the mass media and face-to-face activities to reach the general public, the high risk groups, foreign workers and the youths. Awareness activities include talks, interactive workshops, mobile exhibitions, video screening and distribution of educational materials. In addition, a month-long AIDS awareness campaign is held in conjunction with World AIDS Day on 1st December.

As it is important to educate our youths, the AIDS Education Programme also aims to raise awareness of AIDS and other sexually transmitted infections among students in secondary schools, junior colleges, institutes of technical education, polytechnics and universities.

As community involvement is an important aspect of the Programme, my Ministry and the Health Promotion Board collaborate with various businesses through their workplace health promotion programmes as well as voluntary organisations in our fight against AIDS.

The Communicable Disease Centre (CDC) plays an important role in the education of patients with HIV infection or AIDS and their family members. Patients seen at the CDC are carefully counselled and given information on the disease, its mode of transmission and how it can be prevented, as well as the risk that they pose to their sexual partners, and how they can care for themselves. These patients are also informed that it is an offence if they carried out activities that will put others at-risk of the infection.

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The AIDS prevention message is summarised in the ABC Approach: (a) Abstinence from sex with multiple partners and sex workers; (b) Being faithful to one partner; and (c) Condom use.

Singapore's HIV/AIDS rate is much lower than many Asian countries and is within the range found in developed countries. So, our AIDS prevention programme works as well as that in many developed countries. However, if we consider the relentless progressive rise in new HIV/AIDS cases in Singapore, with an expected record of more than 300 new cases this year, we clearly need to do more if we are to stem the rise.

We need to get across four public health messages: First, do not be promiscuous. HIV is a sexually transmitted disease and if all individuals lived an upright and moral life, there will be no HIV/AIDS problem. HIV spread is related to promiscuity. The greater the prevalence of promiscuity in a society, the greater the risk of HIV spread. So we must reduce promiscuity. Second, if an individual is having casual sex, a condom should be used. It will provide significant protection against catching HIV/AIDS. Third, if an individual has casual unprotected sex, that person is at risk of catching HIV and we recommend HIV testing. If HIV is detected early, treatment can be started early. Fourth, if a person is HIV positive, it is an offence to have sex without informing the partner of the HIV status.

The first message will be targetted at the general public, and the second, third and fourth messages will be targetted at the high-risk groups, like gays and those having casual sex.

Assoc. Prof. Ngiam Tee Liang (Nominated Member): I thank the Minister for the comprehensive reply. As the Health Promotion Board supposedly would

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be the lead agency, what are the coordination mechanics and system at work to bring in the people sector, organisations like AFA and others, so that we can do a better job at public education?

Dr Balaji Sadasivan: The Health Promotion Board and the Ministry of Health have frequent dialogue sessions with the community groups, including AFA. In fact, last week, there was one such session and all the groups from the community agree on the four messages, although there was no total agreement on how much emphasis should be given to each individual message.

Dr Lily Neo (Jalan Besar): Mr Speaker, Sir, may I ask the Minister whether he will consider reviewing the signed consent for HIV blood test, especially for antenatal HIV screening, in order to better protect the unborn babies? Is it not correct that those who refuse HIV screening are the ones that doctors are most concerned about but cannot do anything due to the required signed consent? On another question: will the Minister consider helping those afflicted patients who cannot afford HIV drugs because they are very expensive?

Dr Balaji Sadasivan: With regard to the first question, my Ministry is reviewing this question of screening of mothers with HIV, especially since if we treat a mother who has HIV with medication, the child can be born without HIV. The risk of HIV transmission is reduced from 25% to 2%, and that is a significant drop in the risk. So the Ministry is currently reviewing this and will announce changes shortly.

With regard to the second question on helping HIV patients, currently, we treat HIV patients in our hospitals like all other patients. We should not discriminate against HIV patients either positively or negatively. So HIV patients are entitled to

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the same subsidies as patients who suffer from other illness. Like other patients, if they have financial difficulty, they can apply to the medical social worker for help.

Mdm Halimah Yacob (Jurong): Sir, I have three supplementary questions. My first question to the Senior Minister of State is: what is his evaluation of his public education campaigns? How effective are they, in particular, in terms of targetting the sex tourists, either those from Singapore or those who transit through Singapore, who go to places primarily for such activities? Can the messages be more focused and targetted in order to help prevent communication of such diseases?

My second question is that the Minister has mentioned earlier about targetting campaigns at the workplace. There is a guideline on handling HIV cases at the workplace. Will the Ministry be able to provide a lot more support, in terms of promoting that guideline? This is the joint tripartite guidelines actually.

My third question is: are there sufficient resources allocated to the prevention of communicable diseases, such as HIV? Are enough resources allocated, including the recruitment of specialists, to deal with such diseases?

Dr Balaji Sadasivan: The first issue of sex tourists is a very complicated issue. We do not know why they choose to go to Batam and have unsafe sex. If the issue is one of not being educated about the precaution that they can take, then this is something that the Ministry can try and correct. Pamphlets have now been distributed to these travellers about AIDS prevention. But there has been another feedback that we have got from members of the community. It is hard to verify how true this is. It is that most of the people who get HIV/AIDS, whether they are gays or heterosexual men who are

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having casual sex, know there is a risk of HIV and they know what they need to do to protect themselves. But they think that it will not be them who are going to get the disease. They always think it is someone else. The reason for this may be that, so far, the incidence of HIV has been quite low and they have not seen their friends, colleagues and partners die of HIV. So there is still this denial that it is a problem that is going to affect them and that is why they are not taking the necessary precaution. It is very hard to understand what goes on in the minds of these people. Nevertheless, my Ministry will try our best to reach out to these people and get this message across to them that they have to protect themselves. My Ministry will work with the unions and others in the tripartite partnership and businesses, and to further our education efforts in the business community. We hope the unions will also work with us in getting this message across.

With regard to resources, currently, 95% of the resources given to CDC is used on the clinical side, that is, looking after patients who have got HIV/AIDS, and only 5% of the resources of the budget is being used in public health measures in trying to control AIDS. We are going to give more resources to build the public health arm. With that, I think they will be more effective in contact tracing and doing all the other things that are necessary to try and reduce the number of new HIV cases.