On June 7, 2022, a 48-year-old man was sentenced to a year’s imprisonment for not telling his sexual partner that he has HIV. Diagnosed as being HIV-positive in July 2017 and interviewed by an official from the National Centre for Infectious Disease, who ordered him to inform his sexual partners of risk of infection despite his viral load.
Prior to this sentencing, an anonymous informant reported to officials that the man had assaulted the victim after he offered him a ride home on 23 April 2021 from work in a private-hire vehicle the offender booked. En route, they decided to go to the offender’s place where the two engaged in unprotected sex in spite of the victim initially being against the idea. Before the act, the offender did not notify the victim of his HIV-positive status and the risk of contracting HIV from him. He also did not secure the victim’s voluntary agreement to take the risk. At the time the offense came to light, the man had also been under suspicion for committing the same wrongdoing in October 2019.
According to the man’s test records, the man’s viral load has always been consistently undetectable since November 2017 until January 2021. There was no record of his viral load for April 2021 and his test in July 2021 stated that his viral load as being ‘borderline’ with less than 20 copies per milliliter. A doctor from the National University Doctor claimed that ‘not detected’ and ‘borderline’ are the same and that no risk of transmission is present when a person’s viral load is undetectable.
HIV and The Infectious Disease Act
There is specific law in Singapore that regulates HIV known as the Infectious Disease Act which declares that every HIV-positive person is required to participate in counseling at a government-suggested institution where they have to adhere to specific precautions and safety measures. The legal framework also governs that sex should not be performed by HIV-positive people who are aware of their status unless their sexual partners are informed of the risk of infection and voluntarily agree to take the risk. On the other hand, the same policy applies if a person is not aware of their HIV status but believes that there is a chance for exposure. Those in this situation should prove themselves to be HIV-negative prior to engaging in sexual activities or take the necessary steps to lessen the chance of transmission.
HIV No Longer A Death Sentence
HIV is no longer a death sentence and besides enforcing law, access to antiretroviral therapy (ART) for those living with HIV helps prevent AIDS. HIV-positive people taking ART as prescribed can lead quality and satisfying lives. Nowadays, with sufficient access to ART, HIV-positive people are similar to people living with chronic diseases such as diabetes. Although HIV is a lifelong condition that cannot be fully eliminated like several other STDs, ART can prevent the disease’s progression to AIDS, the disease’s most severe stage. Successful treatment also means that an HIV-positive person cannot transmit the virus to their sexual partners. This paradigm is referred to as ‘Undetectable = Untransmissible’ or ‘U=U’. According to Dr Leong Hoe Nam, an expert specializing in infectious diseases at Mount Elizabeth Novena Hospital, when a person living with HIV has viral load under 40 copies per milliliter of blood, there is no risk for transference of the virus to others.
Assisting HIV-positive people with the needed treatment, erasing HIV stigma and discrimination around them and restoring equality and fairness to HIV-positive people are some goals of Singapore’s National HIV Programme (NHIVP). What is more, NHIVP believes that HIV prevention is of the utmost importance to completely eradicate HIV in Singapore.
More than two dozen antiretroviral drugs have been approved by the United States Food and Drug Administration (FDA) to treat HIV. These drugs are often classified into 6 groups due to them working in different ways. The six distinct classes are as follows:
- Nucleoside-analog reverse transcriptase inhibitors (NNRTIs): NNRTIs work by binding to and blocking HIV reverse transcriptase so that the HIV virus will not replicate or make copies of itself. Some examples of NNRTIs are nevirapine, delavirdine and efavirenz.
- Nucleoside reverse transcriptase inhibitors (NRTIs): This antiretroviral drug pushes the virus to utilize the faulty versions of building blocks so that infected cells cannot replicate. Several well-known NRTIs are abacavir, didanosine, and zidovudine.
- Integrase inhibitors: These inhibitors stop the virus from developing in number by blocking an important protein which permits the virus to insert its DNA in a person’s healthy cells’ DNA. Some examples of integrase inhibitors are raltegravir and elvitegravir.
- Protease inhibitors (PIs): This type of drug obstructs a protein which is needed by infected cells to form new HIV virus particles. Protease inhibitors take the form of nelfinavir, darunavir and saquinavir.
- Fusion inhibitors: Different from the four drug types mentioned above, fusion inhibitors do not work on infected cells, but rather block the virus from getting inside the healthy cells.
- CCR5 antagonist: Similar to fusion inhibitors, Maraviroc and Selzentry are two forms of CCR5 which also stop HIV from getting inside healthy cells.
Doctors usually prescribe ART by combining at least two types of HIV medications. Successful HIV treatment means HIV-positive people have to take the medications without missing a single dose. Missing too many doses may lead to the body resisting the drugs.
Preventing the Transmission of HIV
- HIV PEP: Post-exposure prophylaxis (PEP) may reduce the risk of infection after a person is exposed to HIV (through unprotected sex or condom breaks). This prevention method is best taken within 72 hours after exposure
- HIV PrEP: Unlike HIV PEP, PrEP means Pre-exposure prophylaxis which means that this prevention method is taken by people at risk for being exposed to HIV. If HIV PEP is taken within 72 hours after exposure, PrEP involves daily consumption of 2 combinations of HIV medications in one pill. If taken as prescribed, this drug has an effectiveness of 99% reducing infection risks.