Cablegate: Singapore Considers Tougher Hiv Legislation

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A


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

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

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.


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