National AIDS Control Programme

by Thulaja, Naidu Ratnala

The National AIDS Control Programme is an action plan for protecting against and preventing the spread of HIV (human immunodeficiency virus) infection and AIDS (acquired immunodeficiency syndrome) in Singapore. It was formulated by the Advisory Committee on AIDS formed by the Ministry of Health (MOH) in 1985, soon after the first reported case of AIDS in Singapore.1 The activities of the programme include educating and counselling the general public about the deadly disease, protecting the nation’s blood supply through stringent screening, introducing legislation to help control and prevent HIV infection, treating HIV and AIDS patients, organising community fundraising activities, and increasing awareness of AIDS through training and research.2

History of AIDS
AIDS is an infection caused by HIV. It weakens an infected person’s immune system, leading to the development of infections and cancers.3 HIV is passed from an infected person to another by the exchange of body fluids, such as blood, semen, vaginal fluid, breast milk and other fluids containing blood. Common modes of transmission are sexual contact, sharing or being pricked with an infected needle, transfusion of infected blood and perinatal transmission, namely mother-to-child transmission where babies born to HIV-infected mothers can be infected either in the womb, during childbirth or from breast-feeding.4


The term “acquired immunodeficiency syndrome” was first used in the United States in 1982 for infections affecting the immune system, such as Kaposi’s sarcoma and pneumocystis carinii pneumonia. The HIV virus was simultaneously isolated by doctors in the United States and France in 1983, and was initially named HTLV-III (human lymphotropic virus type III) or LAV (lymph adenopathy virus) by an international scientific committee. In 1986, HTLV-III was renamed HIV.5

Some of the symptoms displayed by AIDS patients are fatigue, weakness, fever, weight loss, loss of appetite, diarrhoea, swollen glands in the neck and armpit, night sweating, coughing, breathlessness and different infections, especially that of the lungs. AIDS is fatal and results in death. To date, there is no cure or vaccination available for AIDS or HIV.6

AIDS in Singapore
The first HIV-positive case in Singapore was reported in May 1985 and this patient was warded at Middle Road Hospital (today’s Communicable Diseases Centre, or CDC). Soon after, two more cases were reported. All the three cases were discovered by K. V. Ratnam, a dermato-immunologist at Middle Road Hospital.7

The government responded to these early HIV-positive cases by forming the Advisory Committee on AIDS in the same year. The committee launched the National AIDS Control Programme (NACP) to implement control measures for the prevention of HIV incidences in Singapore. The advisory committee was subsequently replaced by two boards in 1987: AIDS Task Force and National Advisory Committee on AIDS. The two bodies took on different tasks to help implement the action plan. The AIDS Task Force advised the MOH on scientific and medical matters pertaining to AIDS, while the National Advisory Committee on AIDS provided community feedback to MOH as well as advice on AIDS education to the public.8

HIV infection was deemed a notifiable disease by the Infectious Diseases Act in 1985; since then, it has been compulsory to notify MOH when a person tests positive for HIV infection. The law was later amended such that any action by an HIV-infected person that may result in the transmission of the infection becomes an offence. The first AIDS death in Singapore was reported in April 1987.9

Despite the government’s efforts, the number of HIV-positive cases in Singapore has been rising steadily. By June 1992, there were 124 HIV-positive people in Singapore, 27 of whom died.10 From 2002 to 2007, the number of new cases doubled.11 Many of the patients were warded and treated at the CDC.12

In 1988, the government provided around S$2 million for its anti-AIDS campaign, which included a S$400,000 educational blitz via radio and television advertisements.13 In January the same year, the government lifted its ban on condom advertisements.14 Charges for AIDS testing were reduced from S$20 to S$15, and testing centres were opened at the Bedok, Bukit Merah, Ang Mo Kio, Clementi and Kelantan Road polyclinics, as well as at the Kallang Outpatient Dispensary (OPD) and Maxwell Road OPD. In addition, an AIDS counselling centre was set up at Rochor OPD, and three AIDS helplines for information and counselling were opened.15

National AIDS Control Programme
The control measures implemented by the NACP included increasing public awareness on AIDS, educating the public on prevention methods, and counselling those in the high-risk category.16 The public were discouraged from having casual sex with strangers, engaging commercial sex workers and using injectable drugs such as heroin or cocaine. Instead, they were urged to maintain responsible sexual behaviour by remaining faithful to one partner.17

The NACP is also responsible for protecting the nation’s blood supply. It undertakes the routine screening of blood and blood products for HIV, syphilis and Hepatitis B. Blood donors are filtered with a specially designed questionnaire on their health status and activities associated with HIV infection. Potential candidates are required to declare that their statements are true. Those who make false declarations may be prosecuted by MOH. The programme also monitors the spread of the infection by initiating contact tracing, performing routine screening of sex workers, monitoring the results of voluntary blood donors and those of serological testing in patients with sexually transmitted diseases. It is also responsible for notifying MOH of any new AIDS case, and collating results and statistics for the ministry. HIV-infected persons are treated using approved drugs and undergo counselling regularly.18

The NACP trains medical personnel, healthcare workers, paramedical personnel, counsellors, drug rehabilitation officers, teachers and anyone who might come in contact with HIV-infected or AIDS persons, by organising workshops on AIDS prevention and control. It also undertakes research projects and studies to evaluate existing programmes, conducts surveys, studies sexual behaviour and conducts clinical epidemiological studies on HIV infection in Singapore. The government works closely with other ASEAN countries to monitor the spread of AIDS in Southeast Asia. It also collaborates with the World Health Organisation and the United Nations Development Programme in AIDS prevention and control.19

Action for AIDS
Formed in 1988, Action for AIDS (AFA) is a non-governmental organisation dedicated to fighting AIDS and HIV infection in Singapore.20 It works closely with the government to prevent the spread of AIDS in Singapore. In 1991, it organised an AIDS candlelight memorial, a pop concert by entertainer Boy George, and an orientation programme for freshmen at the National University of Singapore.21 In 1996, AFA organised the Art Against AIDS exhibition, which was held at The Substation, Suntec City and Parco Bugis Junction to raise awareness of AIDS.22

The biennial Singapore AIDS Conference was first held in 1998. The conference invites healthcare professionals, public health experts, community partners, policymakers, key populations and affected communities to discuss and share new information regarding care and support for AIDS patients, how to fight HIV-related stigma and discrimination and ways to stop the spread of HIV.23

In 2012, AFA presented its inaugural Red Ribbon Awards to five recipients – one individual and four organisations – for helping to raise public awareness of HIV and AIDS in Singapore.24


The AFA partnered with diversity and inclusive advocates Be-Inclusive in 2019 after private and confidential information of 14,200 persons diagnosed in Singapore with HIV were leaked online. This is to promote the Employer’s Pledge on HIV in the Workplace Initiative, with over 100 companies pledging to not discriminate any of their employees on the basis of the HIV status, promote workplace education on HIV-related stigma and discrimination, and provide support to employees suffering from HIV-related stigma and discrimination.25

In 2020, AFA announced the launch of the AFA Fund for the Arts, an initiative to target stigma and discrimination faced by the HIV-positive community. AFA awards grants of up to S$20,000 per project to participants with projects that have a strong focus on ending HIV-related stigma and discrimination.26



Authors

Naidu Ratnala Thulaja & Zoe Yeo



References
1. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 3–4, 7. (Call no.: RSING 614.5993 AID)

2. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author. (Call no.: RSING 614.5993 AID)
3. About HIV and Aids. (2005, November 26). The Straits Times, p. 10. Retrieved from NewspaperSG.
4. Aids: What’s safe, what’s not. (1988, November 28). The Straits Times, p. 3; Koh, N. (1985, April 15). If Aids strikes SingaporeThe Straits Times, p. 1; Aids can be passed onto babies through breast milk. (1991, August 31). The Straits Times, p. 6. Retrieved from NewspaperSG.
5. Aids: What’s safe, what’s not. (1988, November 28). The Straits Times, p. 3. Retrieved from NewspaperSG.
6. Koh, N. (1985, April 15). If Aids strikes SingaporeThe Straits Times, p. 1. Retrieved from NewspaperSG.
7. Kong, S. C. (1985, May 18). Special lab to do Aids tests soon. The Straits Times, p. 15; Tang, K. F. (1988, March 6). AIDS hits homeThe Straits Times, p. 1. Retrieved from NewspaperSG.
8. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 2, 10. (Call no.: RSING 614.5993 AID)
9. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 2, 10. (Call no.: RSING 614.5993 AID); First Aids death in S’pore. (1987, April 8). The Business Times, p. 3. Retrieved from NewspaperSG.
10. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, p. 1. (Call no.: RSING 614.5993 AID)
11. Action for Aids Singapore. (2008). 20 years of education, care and advocacy: Action for Aids Singapore. Singapore: Author, p. 6. (Call no.: RSING 616.97920095957 TWE)
12. John, A. (2003, May 18). Heroes toil quietly in the humblest of hospitalsThe Straits Times, p. 23. Retrieved from NewspaperSG.
13. Ministry to spend $2m on Aids campaign. (1988, November 25). The Straits Times, p. 1. Retrieved from NewspaperSG.
14. Prema, L. E. (1988, January 3). Ban on condom ads lifted to fight AidsThe Straits Times, p. 1. Retrieved from NewspaperSG.
15. Ministry to spend $2m on Aids campaign. (1988, November 25). The Straits Times, p. 1. Retrieved from NewspaperSG.
16. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 3–4, 7. (Call no.: RSING 614.5993 AID)
17. Lim, A. (1995, November 29). 82 HIV cases so far this yearThe Straits Times, p. 1. Retrieved from NewspaperSG.
18. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 2, 4–7. (Call no.: RSING 614.5993 AID)
19. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 5–6, 9, 11. (Call no.: RSING 614.5993 AID)
20. Toh, S. (1988, December 1). Professionals set up society to fight Aids. The Straits Times, p. 16. Retrieved from NewspaperSG; Action for AIDS Singapore. (2020). About us. Retrieved from Action for AIDS Singapore website: http://afa.org.sg/aboutus/
21. Ministry of Information and the Arts. (1992). AIDS: Singapore acts. Singapore: Author, pp. 7–8. (Call no.: RSING 614.5993 AID)
22. Action for Aids Singapore. (1996). Art against AIDS: The Singapore Red Ribbon Awards. Singapore: Author. (Call no.: RSING 704.949362196972 ART); Art against AIDS: The Singapore Red Ribbon Awards [Brochure]. (1996). (Call no.: EV13 V1.7)
23. Action for AIDS Singapore. (2020). SAC: 12th Singapore AIDS Conference. Retrieved 2020, December 5 from Action for AIDS Singapore website: https://afa.org.sg/whatwedo/advocate/sac-12th-2020/
24. Goh, S. T. (2012, December 9). Straits Times' HIV reporting lauded. The Straits Times, p. 22. Retrieved from NewspaperSG.
25. Action for AIDS Singapore. (2020). Press release – Fund for the Arts. Retrieved from Action for AIDS Singapore website: https://afa.org.sg/portfolio-item/press-release-fund-for-the-arts/; Chang, A. L., Koh, F., & Khalik, S. (2019, January 30). Data of 14,200 people with HIV leaked online by US fraudster who was deported from Singapore. The Straits Times. Retrieved from The Straits Times website: https://straitstimes.com/singapore/data-of-14200-singapore-patients-with-hiv-leaked-online-by-american-fraudster-who-was
26. Action for AIDS Singapore. (2020). Press release – Fund for the Arts. Retrieved from Action for AIDS Singapore website: https://afa.org.sg/portfolio-item/press-release-fund-for-the-arts/



Further resources
Action for Aids. (1991). The Act: An AFA publication. Singapore: Author.
(Call no.: RSING 362.1969792005 A)

Anti-Aids campaign focuses on teens. (1988, December 5). The Straits Times, p. 21. Retrieved from NewspaperSG.

Khoo, V. (1991, December 1). Aids fighters shift into top gearThe Straits Times, p. 3. Retrieved from NewspaperSG.

Ministry of Health. (1991). Handbook on prevention of HIV transmission in the health care setting. Singapore: Author.
(Call no.: RCLOS 614.5993 HAN)

Toh, S. (1989, August 16). Group to hold fortnight on Aids and safer sexThe Straits Times, p. 22. Retrieved from NewspaperSG.

Training & Health Education Department. (1991). We have AIDS. Singapore: Author.
(Call no.: RSING 616.979200222 WE)

Wing, C. (1991). A family guide to HIV & AIDS in Malaysia and Singapore. Penang, Malaysia: Southbound Sendirian Berhad in association with Malaysian Council of Non-Government Organisations for AIDS, and Action for AIDS Singapore.
(Call no.: RSING 616.9792 WIN)



The information in this article is valid as at December 2020 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

Subject
Health and medicine>>Diseases>>Immune system diseases>>AIDS/HIV
Health education--Singapore
Public health
Politics and Government>>Health
National campaigns
Events>>National Campaigns
AIDS (Disease)--Singapore