When fear begets fear: Singapore’s deeply embedded aversion towards HIV

Some twenty years ago, Paddy Chew selflessly withstood a torrent of hate when he publicly came out as the first Singaporean HIV-positive individual. Amidst the cloud of uncertainty around the epidemiology of HIV back in 1998, Paddy implored his fellow Singaporeans to extend their compassion towards people living with HIV as he knew one thing for certain: “This disease does not discriminate – people discriminate.”

People dining outdoors in Singapore
“In 1997, a Straits Times reader wrote a letter to urge people living with HIV to “be hygienic when eating together”.”

In January 2019, Singapore’s Ministry of Health announced that an individual had gained unauthorised access to the personal information of 14,200 people living with HIV. It was the Ministry’s biggest breach of patient confidentiality to date. As of today, the person behind the leak remains uncooperative and has repeatedly threatened to leak the HIV registry to the public. There is a palpable sense of fear among one of Singapore’s most vulnerable communities as they agonize over his next move in his mental game of chess against the authorities.

If anything, this quagmire has exemplified how in the twenty years since Paddy came out, nothing much has changed in our national mindset. Myths over transmission have been debunked, pharmaceutical advances have substantially increased life expectancy and quality of life for people living with HIV, and pills that almost eliminate the risk of infection before intercourse (pre-exposure prophylaxis) are readily accessible. Yet, for most people living with HIV, the notion of being outed is unthinkable and they continue to harbour deep-seated fears of being stigmatised. This undergirds the fact that the fear between them and the wider general population is mutual; it runs in both infected and uninfected blood. *

The genesis of serophobia (the term that describes the irrational fear HIV-negative individuals have towards people living with HIV) in Singapore can be loosely dated back to April 1985 when The Straits Times, Singapore’s de facto national newspaper, reported that HIV had finally reached our shores and three Singaporeans were found to be HIV-positive. Back then, our fear of HIV stemmed primarily from lack of information. No one knew definitively what caused AIDS, how to identify people living with HIV or had clarity on the non-sexual modes of transmission.

This uncertainty stoked a sense of stigma against people living with HIV in Singapore. In 1997, a Straits Times reader wrote a letter to urge people living with HIV to “be hygienic when eating together”. Seven years later, another reader admonished barbers for failing to change razors between customers, thereby facilitating the transmission of HIV. The senselessness which mired Singapore was far from unique and many other nations similarly grappled with the deep dark unknown that was HIV. Across the Pacific Ocean, the New York Times mistook HIV for a type of cancer while the Daily Mail in the UK labelled it a “gay plague” in the 1980s.

But the lack of information is not enough to explain the serophobia that continues today in Singapore. After all, most epidemics emerge in the public eye with little information on how they originated or can be contained. If we move past the facile attribution of fear to lack of information, we find that HIV has all the cornerstones of a moral taboo. The good majority of Singaporeans who have never had to deal with the virus otherise people living with HIV for partaking in actions that might increase their likelihood of contracting the virus, and since these behaviours are predicated on moral grounds, the fear becomes legitimised.

The most classic wrong a person living with HIV can commit is to be gay. Throughout the years, Singaporean media has disproportionately associated HIV with male homosexuality. The media identified “being gay” as a key characteristic of the “most likely make-up of Singaporean Aids victim(s)”; magazines did a special feature on “Rebecca the transvestite” who had contracted the virus and approved a reader’s letter cautioning the general public against succumbing to the “high-risk ‘gay lifestyle’”. This rhetoric was similarly adopted by the government with then Senior Minister of Health Balaji Sadasivan stating that “the gays” were a bigger concern than heterosexual men who have casual sex. All this despite the chorus of voices from the medical community asserting that, contrary to popular belief, heterosexuals formed the overwhelming preponderance of people living with HIV in Singapore.

Furthermore, no constructive conversation about HIV can be made without recognising the venereal nature of the virus. As with all STIs, HIV is automatically associated with the vice of promiscuity. In 1991, then Minister for Health Yeo Cheow Tong likened those who had casual sex with prostitutes as gamblers who had put their lives at stake in return for an ephemeral pleasure. With the sanction of the government, Singapore entered an era of sanctimony against anyone who did not conform with societal norms of sex and/or sexuality. The average Singaporean in a long-term, monogamous relationships found that he/she could adopt the moral high ground requisite in otherising those who practised different lifestyle choices. Anyone who was gay, engaged in casual sex or worse, both, was made a pariah. *

Following the data leak in 2019, the Ministry of Health has provided psychological support for affected individuals. It is heartening to know that today’s government has moved past profiling people living with HIV, acknowledges the severe consequences of the leak and puts their mental health at the forefront. But that is not enough. We should be striving to free Singapore from serophobia as no one deserves to be discriminated against for being infected by a virus. 

Because societal attitudes are longstanding and difficult to change, the government must be proactive in tackling the fear that has allowed the general public to treat people living with HIV as sub-humans. This involves reviewing the institutional factors that generate serophobia. For a start, the government should incorporate protection clauses for employees who currently have no recourse if their employers dismiss them for their HIV-positive status, even if it is irrelevant to their quality of work. Next, they should review if the infamous Section 23 of the Infectious Disease Act (which mandates all at-risk individuals to declare their potential HIV-positive status to their sexual partners before intercourse) has had any effect on transmission rates, and consider less shameful alternatives, such as punishing only those who intentionally spread the virus. Beyond these two most salient issues, the government should review other policies such as the insurance void for people living with HIV whose status excludes them from coverage in most plans, the Immigration Act’s prevention of HIV-positive foreigners from working in Singapore, and the pricing mechanisms behind medication.

Public health is not simply a matter of physical health. It concerns mental health too. It is high time for the government to acknowledge their encouragement of the serophobia that persists till this day and to take action to better protect people living with HIV among us – be it through attitudinal shifts or more humane policymaking.

Michelle Wang Shuting is currently studying for a Master of Public Policy at the Blavatnik School of Government.

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