Earliest cases of HIV/AIDS in Singapore

Earliest cases of HIV/AIDS in Singapore deals with the period from 1985 to 1990, beginning with the discovery of HIV infection in Singapore to the diagnosis of the first patient with AIDS, his subsequent death, the spread of the epidemic and its effects on society.

=Initial reports from USA=

In the first half of the 1980s, Singaporeans, especially the gay community, read with increasing disquiet the development of a new scourge called AIDS (acquired immune deficiency syndrome) which was first clinically observed in 1981 in the United States. The earliest cases were a cluster of injection drug users and gay men with no known cause of impaired immunity but who showed symptoms of Pneumocystis pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems. Soon thereafter, additional gay men developed a previously rare skin cancer called Kaposi's sarcoma (KS). Many more cases of PCP and KS emerged, alerting the US Centers for Disease Control and Prevention (CDC) which formed a task force to monitor the outbreak. The Singaporean gay community, already marginalised and discriminated against, was horrified that the mysterious malady was being referred to with negatively sensationalistic terms such as the "gay plague" and "gay cancer".

In the beginning, the US CDC did not have a definitive name for the malady, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the condition after which the discoverers of HIV originally named the entity. The general press coined the headline-grabbing term "GRID" which stood for gay-related immune deficiency. It came as some relief to some gay Singaporeans when the US CDC, in search of an official name and looking at the communities which had been infected, discovered that it not only afflicted the gay community but also heroin users, haemophiliacs, and Haitians. It was thus also dubbed the "4H" disease. However, after determining that the infection was not confined to homosexuals, it was realised that the term GRID was misleading and "AIDS" was introduced at a scientific meeting in July 1982. By September 1982 the US 'CDC had started officially using the name AIDS.

In 1983, two separate research groups led by Robert Gallo in America, and investigators Françoise Barré-Sinoussi and Luc Montagnier in France, independently declared that a novel retrovirus may have been infecting AIDS patients. They published their findings in the same issue of the journal Science. Gallo claimed that a virus his group had isolated from a person with AIDS was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) his team had been the first to identify. Gallo's group called their newly-discovered virus HTLV-III. At the same time, Montagnier's group isolated a virus from a patient presenting with swelling of the lymph nodes of the neck and physical weakness, two classic symptoms of primary HIV infection. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV). As these two viruses were later found to be the same, in 1986 LAV and HTLV-III were renamed HIV.

=First local newspaper article on AIDS=
 * Main article: Archive of "Aids - deadly disease of the 80s", The Straits Times, 23 April 1983

Even though AIDS had been reported in the American press since 1981, the first article on the disease to appear in a local newspaper was only published on Saturday, 23 April 1983 in The Straits Times. It described the "mysterious new illness" which was "incurable" and how its victims, the new "lepers", were shunned even by doctors and nurses. Another section on the same page talked about Haitian medical researchers investigating the link between the affliction and Haiti. 

=Calm before the storm=
 * See also: Archive of "Tight lid on Aids problem here, says doctor", The Straits Times, 9 December 1984

Even though Singaporeans were alarmed at the scale and speed with which the AIDS epidemic was growing in America, it seemed remote because the country was half a world away. There was a sense of complacency and smugness in some quarters of society that the possibility of the dreaded disease reaching the island republic's shores was highly unlikely. During an episode of Talking Point, a prime time Channel 5 televised forum devoted to the issue, a member of parliament from the ruling party who was invited to speak even quipped that Singaporeans were protected from AIDS by their "Asian values".

This view seemed to be affirmed when Dr K V Ratnam, a registrar at the Middle Road Hospital, announced on Friday, 8 December 1984 that unlike Western countries, Singapore had a "tight lid" on the AIDS problem. He said that Singapore did have some AIDS-linked factors, such as drug abuse and homosexuality but these were "under control". Speaking on the topic of "AIDS and Homosexuality" at a Rotary Club of Singapore East gathering, Ratnam said the number of homosexuals in Singapore was small compared to the United States. The 120 homosexual male prostitutes here were given blood and skin tests and thorough check-ups regularly.

Dr Ratnam explained that homosexuals risked getting AIDS because some of them practised "extreme sexual acts". Prolonged exposure and close contact helped to spread the disease. AIDS, which broke down the body’s immunity system and normally caused death, could be transmitted through blood transfusions. But Singapore's blood donation system was another defence against AIDS. Singapore depended on voluntary blood donations, which allowed donors to be screened. Drug abusers were a high-risk group because drugs further depressed the body's immune system. But there were very few hard drugs on the streets here, Dr Ratnam noted. His comments, published in The Straits Times the following morning, Saturday, 9 December 1984, assuaged the fears of the general public.

=Three in S'pore found with AIDS-linked virus=
 * See also: Archive of "Ministry issues Aids pamphlet", The Straits Times, 25 March 1985
 * See also: Archive of "Three in S’pore found with Aids-linked virus", The Straits Times, 10 April 1985

It therefore came as a profound shock to everyone when news broke in the press on Wednesday, 10 April 1985 that three men in Singapore had been found to harbour the virus believed to cause AIDS. A Ministry of Health statement the previous day said the men, all homosexuals, had "positive screening tests for antibodies to HTLV-III virus" which were detected during a study of high-risk groups. (Note: In 1985, the nomenclature of the AIDS virus had not yet been internationally standardised as "HIV" (human immunodeficiency virus) and it was still being referred to in the local press as HTLV-III or human T-cell lymphotropic virus type III. The Singaporean media only started calling the virus "HIV" in 1987).

The ministry said that, clinically, the men did not have AIDS but they were “under medical evaluation and close surveillance". Their blood samples were sent to the United States to verify the presence of the virus. The patients, apparently Singaporeans, were attending the Sexually Transmitted Diseases Clinic at Middle Road Hospital, but it was understood that they might be warded at the Communicable Disease Centre (CDC; the former Middleton Hospital) the following day, Thursday, 11 April 1985. Medical staff at the CDC had been alerted the previous week to receive the patients. It seems uncanny that barely two weeks before the public announcement of the discovery of the first cases, the MOH had presciently published a pamphlet describing the signs and symptoms of AIDS as a measure to prevent the local spread of the disease. It urged all prospective blood donors to read it before donating blood. The pamphlet became available from Friday, 22 March 1985 at the Blood Transfusion Centre along Outram Road and at all mobile blood donation stations. A spokesman from the Blood Transfusion Centre clarified: “This pamphlet is really because of AIDS.” Because laboratory tests for HIV were not available yet, the information in the publication aimed to allow prospective blood donors with the disease to exclude themselves. About 70,000 pamphlets were available in English and about 40,000 in Mandarin. The Health Ministry had also recently set up an advisory committee on AIDS which would look into ways of preventing and controlling the disease. In retrospect, it is reasonable to speculate that before the announcement of the first three cases of HIV infection in Singapore, the ministry had already known for some time about their existence and had instituted precautionary measures to safeguard Singapore's supply of donated blood. 

=Public education=
 * See also: Archive of "Pamphlet soon on how to avoid Aids", The Straits Times, 11 April 1985

There was some apprehension among the CDC’s staff about having to deal with the HIV patients. They approached their union for help in obtaining the ministry’s assurances that all precautions would be taken. The ministry advised the public that AIDS was not spread by ordinary social contact. Its statement assured: “AIDS is spread by close intimate sexual contact. It is not spread in ordinary activities of school, employment, public transport or places of entertainment.” On 11 April 1985, a Health Ministry spokesman said that a pamphlet to inform the public about AIDS and how to avoid it would be released soon. To protect doctors, nurses and other staff at hospitals and private clinics, the ministry sent out stringent guidelines on the handling of suspected AIDS cases. Medical personnel were advised to take "extraordinary care" in dealing with them. Among other things, staff should wear gloves and gowns when in contact with blood-soiled items, secretions, body fluids and excretions from these patients.

Middle Road Hospital announced it would be holding a series of talks on AIDS for doctors of outpatient clinics and for general practitioners. Studies at the time had shown that only about 10% of homosexual men with the virus went on to develop AIDS within 2 to 5 years. Others in the high-risk groups were heterosexual men with multiple partners, drug addicts who injected themselves, and haemophiliacs. Screening tests for these groups were soon to be available at Middle Road Hospital. The hospital also offered AIDS and STI counselling service.

=Dr K V Ratnam, discoverer of HIV in S'pore=
 * See also: Archive of "Aids virus: Doctor who 'found it'", The Sunday Times, 14 April 1985

On 14 April 1985, the press announced that Dr K V Ratnam, a Middle Road Hospital dermato-immunologist, was the man behind the discovery of Singapore's first 3 cases of HIV infection. Ratnam had started his research in May 1984, a pilot project involving the screening of 100 transvestites with skin and saliva tests, blood analyses and delving into their backgrounds and lifestyles. It was a two-man show with just Ratnam and laboratory technician K Ali doing the blood tests. But other medical practitioners laughed at him and felt that he was wasting his time because they said AIDS could not hit a society like Singapore's. As it turned out, Ratnam had the last laugh as his research paid off.

Initially the transvestites from Bugis Street, Johore Road and Claymore Hill were reluctant to speak up, but when they realised the benefits of the study, they responded. Word got around and soon Ratnam had more than enough cases to test. It is believed Ratnam first saw AIDS patients (who were referred to as "AIDS victims" at the time) when he was studying immunology at Stanford University in California. In December 1984, Ratnam discovered one case which showed positive signs of "early AIDS". A total of 53 blood samples were immediately sent to Dr Robert Gallo, the American scientist who discovered the deadly AIDS virus. Tests were further carried out at the National Cancer Institute at Bethesda in the United States and they proved positive. Middle Road Hospital was informed of the results by Gallo in early April 1985. Blood tests for AIDS were then halted at the hospital until the laboratory technicians could be convinced that all was well and they were out of danger. About 80% of the 150 transvestites had already been screened for HIV.

1 of the 3 who had the AIDS virus was said to be in "a more advanced stage". His friend, a fellow transvestite, said: "He knows he will die and has told the doctor if that must happen, so be it because he can only work as a prostitute for a living." He added that another transvestite, who had the virus but no symptoms yet, had decided to end his promiscuous ways and become a bus driver. The third had yet to decide what steps to take. But all 3 were scared. The danger was that the 2 who had not shown any symptoms (it could take up to 4 years for the symptoms to surface) could still continue their promiscuous behaviour. "They can go to Bugis Street, eat, have fun and who's to say that some other person cannot pick up the virus if they eat off the same plate or drink out of the same glass which may not be properly washed."

The news affected conversations at Bugis Street and the talk was no longer who had had an operation to join the transvestite fraternity but the in vogue subject had become AIDS instead. And the habitues were going to great lengths to make sure that those who had not been cleared by Middle Road Hospital stayed out of the territory. On Thursday, 11 April 1985, a day after news of Singapore's HIV victims broke, one transvestite in Bugis Street said: "Some of our sisters (a term used to describe fellow transvestites) are moonlighting in our area. We don't mind, but we know they have not had the AIDS test. We don't need them here to infect our partners and ruin business for all of us." After more than two hours of arguing in the wee hours of the morning, the moonlighting "sisters" were seen leaving. A doctor at Middle Road Hospital said they had received many calls after the news appeared in the newspapers. "Many were anxious callers who wanted to know more about how screening was done. We have yet to see them at the hospital. I think they are shy." 

=Nurses seek transfer=
 * See also: Archive of "Aids: Nurses seek transfer", The Straits Times, 15 April 1985

On 15 April 1985, it was reported in the press that about 26 nurses had asked to be transferred out of the CDC because they were afraid of dealing with AIDS patients. Two doctors even resigned. The nurses' union, the Amalgamated Union of Public Employees (ACPE), wanted the Health Ministry to delay admitting patients until the centre was equipped to have them.

ACPE General Secretary G Kandasamy said the day before that if the men needed hospitalisation, they should be quarantined somewhere else and not at the CDC in Tan Tock Seng Hospital. "They should not be in the hospital where there are patients with other illnesses and who have relatives visiting them," he elaborated. The union was concerned about whether it was in the public interest to let the three men move about freely. "AIDS is an infectious disease and it is incurable," Kandasamy stressed.

In a letter to the ministry dated 10 April 1985, the union said that staff at the centre had not been briefed on procedures in handling AIDS patients. The union was worried that the ward earmarked for them, Ward 76, was not adequately equipped with staff safety in mind. Among other things, the union pointed out that the nurses’ station and the patient care area were not clearly set apart. It suggested that only staff who volunteered should be made to work in Ward 76. The union also called for a compensation scheme to be worked out for staff who may get the AIDS virus during their work.

Kandasamy reported that he had not yet received a reply from the ministry. A source at the CDC said there was some panic among the nurses, who were not mentally prepared for the patients. The source said that the centre had only a few days' notice that the men may be hospitalised but preparations had been made to receive them. The nurses had been assured that they would not be asked to take blood samples from these patients, thus reducing the risk of their getting infected with HIV if they accidentally pricked themselves while withdrawing blood.

=Iris Verghese=
 * Main article: Iris Verghese

One exceptional health worker at the CDC who did not shy away from dealing with AIDS patients was Iris Verghese. She even offered them comfort and a shoulder to cry on. She recollects: "The humiliation connected to the disease was horrible. People did not want to come close to them, let alone touch them." Verghese went on to dedicate much of her life to helping people living with HIV/AIDS. In the ensuing three decades, she would go on to counsel countless patients and their families, as well as raised funds for HIV prevention. In 2019, in honour of her bravery and compassion, Verghese was featured in a short film called Plague, directed by Boo Junfeng with script by Ash Lim, which was dedicated to an Action for AIDS charity. The film was part of the National Volunteer and Philanthropy Centre's 15 Shorts project, which featured 15 Singaporeans who went to extraordinary lengths to help others.

 

=MOH: Don't panic=
 * See also: Archive of "Don’t panic over Aids - ministry", The Straits Times, 16 April 1985

On Monday, 15 April 1985, the Health Ministry advised the public not to panic following the growing concern over the discovery of the AIDS virus locally. Dr Kwa Soon Bee, Permanent Secretary (Health) and Director of Medical Services, told a press conference at the Ministry of Health that people who were not promiscuous should not worry about getting AIDS as it was contracted through intimate sexual contact. "Avoid promiscuity," he advised. The ministry's disclosure the previous week that three men were found to have HIV touched off a scare despite a ministry statement that day which said that AIDS was not spread through contact at work, places of entertainment and public transport. Dr Kwa called the press conference to repeat this assurance, respond to press reports on AIDS, and elaborate further on the condition of the three men. He also gave an assurance that steps had been taken to ensure the safety of medical staff who would have to deal with cases of AIDS.

He said that there had been no substantiated study that AIDS could be contracted through the sharing of food or ordinary social contact. He added that the infectiousness was not like the flu and one did not get AIDS just by sitting next to a patient or a carrier. He informed the press that the ministry was still trying to trace the contacts of the three men. There were no other known carriers of the virus to date apart from the three men. And he stressed that there was no known case of "clinical AIDS” in Singapore.

The three men did not have clinical AIDS, although one of them had slight weight loss and fever, which were some symptoms of the disease. The other two did not have any AIDS symptoms. When asked what steps were being taken to stop these men from spreading the HIV virus, Dr Kwa replied: “We can only counsel them not to be so promiscuous. If that’s their way of life (homosexual prostitution), there’s little we can do about it." The men had been told to report for weekly check-ups. Dr Kwa said a checkup once a week was adequate because “it is not likely that they will develop Aids suddenly*'.

He called on the media and public to see the three men’s plight “in perspective”. There was a big jump from carrying the HIV virus to contracting AIDS. It was not necessary to ostracise or incarcerate the men in a camp, he said. The ministry had no intention of ostracising everyone who had a positive blood reaction to the test for HIV, he added. But any case of clinical AIDS would immediately be hospitalised at the Communicable Disease Centre, Tan Tock Seng Hospital, which was fully prepared to handle infectious diseases including Aids, he explained. Dr Kwa said that the ministry was gathering more information before coming up with a "master plan" to deal with the disease. It was gathering data on how many people in the "high risk groups" such as male homosexual prostitutes had the virus and whether female prostitutes had it too. This could be tested when more detection kits for HIV arrived.

Dr Kwa disputed a press report that an Aids scare had caused staff at Middle Road hospital to “revolt”. The report implied that two doctors had resigned rather than deal with AIDS patients and that 26 nurses had asked for transfers. He said the resignations had nothing to do with AIDS and that the nurses, 25 in all, from the Communicable Disease Centre at Tan Tock Seng Hospital, were believed to have been “pressured” into asking for transfers. He did not say by whom. Two or three of the nurses had already withdrawn their letters. He said that when and if clinical Aids surfaced, anyone who asked for a transfer would have his request considered. 

=HIV/AIDS put on notifiable disease list=
 * See also: Archive of "Aids on ‘must report’ list", The Straits Times, 17 April 1985

On Monday, 15 Aril 1985, Dr Kwa Soon Bee announced that the Ministry of Health would make HIV infection and AIDS notifiable diseases within the next few days, just as was the case for yellow fever, malaria and viral hepatitis. The move would give the ministry extensive powers to monitor the spread of the disease and tackle it more effectively. Once HIV/AIDS was included in the schedules of diseases listed in the Infectious Diseases Act, the ministry would be able, among other things, to:
 * Require doctors by law to notify the MOH of any case of HIV/AIDS among their patients
 * Quarantine anyone suspected of having the disease
 * Order people to undergo blood tests or any examination to determine if they had HIV/AIDS
 * Question the public in order to trace the spread of the disease among the contacts of a carrier
 * Order post-mortems in deaths due to AIDS or suspected of having been caused by AIDS.

Dr Kwa said that doctors at Middle Road Hospital, where cases of sexually transmitted infections were referred to, had been on the lookout for signs of HIV/AIDS since 1981 when the disease first hit the headlines. He disclosed that the ministry had zeroed in on male homosexual prostitutes, considered a high risk group, since March 1984 following the increase in reports of the incidence of AIDS around the world. The ministry also began to look into the possibility of blood tests to detect the presence of HIV. He said that the tests were only recently found reliable, which is why they were not used earlier. The Elisa test for HIV had just become available in Singapore. But blood samples with the virus would still be sent to the US for confirmation by the special Western Blot test not currently available locally.

Meanwhile, Dr Ong Yong Wan, head of the Advisory Committee on Aids, was in Atlanta attending the world's first major conference on AIDS. She was among 2,000 participants from 30 countries who had registered for the three-day gathering. The public would be able to get snapshot answers about the disease in a week or two when a Health Ministry pamphlet, entitled What You Should Know About Aids, was printed. Yeo Cheow Tong, Minister of State (Health and Foreign Affairs), would visit Tan Tock Seng Hospital on Friday, 19 April 2019, planned some time ago as part of a routine programme of visits for him.

=Letters to press decrying sensationalism=
 * See also: Archive of "Fair reports on subject show paper is credible", The Straits Times, 20 April 1985

On 20 April 2019, a particularly woke reader of The Straits Times wrote in to commend the paper for its fair and informed reporting on the subject of AIDS. He said that the Straits Times' strict adherence to facts, avoidance of emotive language, and choice of educational as opposed to exciting news angles showed that the paper was responsible and credible. He slammed another newspaper, most probably the tabloid of the day, which in contrast was a disappointment to him. The Straits Times' headlines, "No danger from social contact" and "Don't panic over Aids" reflected the facts but he took issue with the other paper which preferred headlines with commercial appeal. Its reporting served only to cause panic among some members of the public.

The Straits Times not only refuted the other paper’s report that the AIDS scare had caused two doctors to resign and the staff of Middleton Hospital to “revolt", but that the Ministry of Health also reiterated the facts about HIV/AIDS to counter the damaging rippling effect of misinformed journalism. The reader lamented the unfortunate situation that there was a tendency to associate homosexuals or homosexuality with AIDS as the link was understandable as a high proportion of those afflicted were homosexuals. But he stressed that the truth was that homosexuality per se did not bring about AIDS. It was promiscuity which increased the risk of  contracting HIV infection. He also pointed out the tendency to confuse homosexuals with transsexuals and transvestites. The public now knew from the interview with Dr K V Ratnam that the three "homosexual prostitutes" afflicted were actually transsexuals. He cautioned that readers should not be led to believe that sexuality per se or a particular group was responsible for AIDS because that could start a witch-hunt when moral panic gripped society.

Another reader wrote in to say that although HIV could be transmitted through blood transfusions, that is by receiving blood, it was not possible to contract the virus through blood donations. He cautioned that this point could be misinterpreted by the public and lead to the blood bank running dry as had happened in Australia.

=New CDC set up to treat AIDS=
 * See also: Archive of "New centre to be set up to treat Aids", The Straits Times, 20 April 1985

Just after completing a three-hour tour of Tan Tock Seng Hospital on 19 April 2019, ending at Ward 76 which was reserved for AIDS patients, Yeo Cheow Tong, Minister of State for Health and Foreign Affairs said that a new Communicable Disease Centre (CDC) to treat AIDS and other infectious diseases would be set up at the hospital. The 200-bed centre with special facilities to deal with AIDS would replace the present 160-bed CDC. To be built under Phase II of the Redevelopment Plan for Tan Tock Seng Hospital, it would be on a site between Jalan Tan Tock Seng and Mandalay Road, opposite the existing CDC.

Yeo said there were no details on the special facilities or number of beds for AIDS patients at the moment as the plan was at a conceptual stage. But the ministry would send a proposal for redeveloping the hospital to the Finance Ministry for approval as soon as possible. Since AIDS involved a malfunctioning of the body’s immune system, the ministry’s decision to develop clinical immunology, a medical speciality, at the hospital was seen as a welcome move. Yeo explained that his tour was part of a programme of visits to major government hospitals to give him an overall appreciation of hospitals. He said steps to contain the disease included stepping up blood tests for blood donors and high-risk groups, such as male and female prostitutes. At least 15,000 people would have their blood screened for HIV with the ELISA test over the next three months or so. The ministry also planned to bring from the US the confirmatory Western Blot test in about three months. Yeo added that the ministry would send more doctors overseas to keep up with the latest developments on dealing with the disease. Dr Ong Yong Wan, Director, Blood Transfusion Services, Head of the Haematology Department,. Ministry of Health, and Chairman of the Advisory Committee on Aids, was the first Singapore doctor sent. She had just attended the world's first major conference on AIDS in Atlanta, US, which ended on Wednesday, 17 April 2019.

A ministry spokesman said tender documents were being prepared to further upgrade Ward 76 facilities. The ward would have six individual patient rooms and two intensive care units. The individual rooms were to reduce infection risks for AIDS patients because even simple infections could be fatal for them due to a breakdown of their immune system. Ward 76, where Aids patients would stay, had acquired two new machines - the bedpan steriliser costing more than $10,000 and the $10,000 autoclave machine to sterilise articles such as nurses’ gowns. Notification forms for HIV/AIDS could be obtained from the Medical Director, Middle Road Hospital, or the Head, CDC, Tan Tock Seng Hospital.

Dr Kwa Soon Bee said the day before that the Western Blot test would be conducted in the pathology laboratory. A Health Ministry spokesman explained that the ELISA test was a more general test to detect the presence of HIV and the Western Blot test was a double check to weed out "false positives". On the same day, a Tan Tock Seng Hospital official said that 23 of the 25 nurses at the CDC had withdrawn their requests for transfers. The other two were considering whether they too should withdraw their requests.

Meanwhile, there had been no discernible drop so far in the number of blood donors following reports that three people in Singapore have contracted HIV. This was apparent from an analysis of the amount of blood donated. It had not varied since the first report of HIV cases on Wednesday, 10 April 1985. Figures from the Blood Transfusion Service for the past three months showed that on average more than 1,000 units of blood had been collected each week. For the week beginning from Monday, 8 April 1985 to Sunday, 14 April 1985, 1,184 units were collected. The number of units of blood collected in the previous few days were: Monday, 154 units; Tuesday, 115 units; Wednesday, 169 units and Thursday, 163 units. This was close to the daily average of about 140 units. A Health Ministry spokesman said that regular blood donors were well informed about AIDS, as more than a month ago, they were issued with a pamphlet explaining that the disease could not be contracted through blood donation. He said: “This s because when someone gives blood, we use a new, sterile, disposable needle to collect the blood. The needle is discarded after each use.”

=Medical undergrads taught about HIV/AIDS=
 * See also: Archive of "Undergrads to be taught about Aids", The Straits Times, 21 April 1885

On Saturday, 20 April 1985, Professor Edward Tock, Dean of the Faculty of Medicine, National University of Singapore said that medical students would soon be taught about AIDS, Professor Edward P C Tock said yesterday. As doctors would be asked many questions on AIDS, medical students would have to be made aware of the latest developments in the disease. Tock was speaking at a symposium on Training of Our Future Doctors, which was organised by the Singapore Medical Association. The symposium, held at the Hyatt Regency Hotel, was part of a four-day SMA Silver Jubilee National Medical Convention. Today is the last day of the convention. Tock said AIDS would be taught under immunology and infectious diseases, two subjects in the five-year medical course. As there was as yet no cure for the disease, students would be taught prevention. This would include patient education and the study of the effects of HIV.

=Four screened as AIDS clinic opens=
 * See also: Archive of "Four screened as Aids clinic opens", The Straits Times, 26 April 1985
 * See also: Archive of "Aids: Empat lelaki diperiksa di klinik", Berita Harian, 26 April 1985

The AIDS Screening Clinic at Middle Road Hospital started work on Thursday, 25 April 1985 and four men were screened for HIV infection. Dr K V Ratnam, the immunologist at the hospital who discovered Singapore's first three cases HIV infection said the day before that since the announcement of the three carriers, more than 50 men had been to the hospital worried that they might have the virus. He revealed: "Because of the publicity and education through the media in exposing the three cases, a lot more people have come forward and can now be diagnosed.” But he added that "a lot of them have a guilt complex more than anything else." For example, one of the men who had been to the clinic had intercourse with a male homosexual about 10 years ago. The clinic would screen people mainly from the high-risk groups every Thursday from 8:30 am to 12:30 pm and follow up on those with AIDS and counsel them.

Ratnam, who was speaking at the Rotary Club of Marina City luncheon, said that studies of cases in the United States had shown that between 60 and 70% of people with the virus were "healthy carriers". About 10 to 90% had non-clinical AIDS and only 5 to 10% would have the "full blown symptoms which would show itself within two years." Of the three people who had HIV in Singapore, two of them had non-clinical AIDS and one was a healthy carrier. But anyone with the virus, whether a healthy carrier, or non-clinical or clinical AIDS patient, would be spreading it through sexual intercourse.

He added: "We cannot lock them up. But what we can do is to advise them to use condoms if they want to have sex. Though it is still being studied whether using condoms would prevent the virus spreading, I think the chances are slim." They would also he advised not to donate blood. Ratnam explained: "AIDS used to be known as the gay plague. It’s now no more so." Of the 7,886 cases of AIDS reported in the US between 1 June 1980 and 21 January 1985, 465 patients were not homosexuals, bisexuals, haemophiliacs, intravenous drug abusers or Haitian immigrants. The study showed that 66% of the 465 patients had no identified risk. The others contracted the virus through heterosexual contact (13%) and blood transfusions (21%). In the US, AIDS had been more or less linked with four "high risk groups". These were known as the "four Hs": homosexual men, heroin addicts (and other intravenous drug abusers), haemophiliacs and recent Haitian immigrants. Ratnam said the AIDS Screening Clinic would be collating data on the prevalence of HIV infection in Singapore.

=16 more may be carriers of HIV=
 * See also: Archive of "16 more may be carriers of Aids virus", The Straits Times, 30 April 1985

On Monday, 29 April 1985, in a statement to give an update on its monitoring programme on AIDS, the Ministry of Health reported that sixteen more people in Singapore were suspected of being HIV carriers. They had shown positive results to the screening ELISA test. But pending more tests, the ministry was unable to say whether the 16 were carriers of HIV. It added that the three confirmed carriers of the HIV "remain clinically well". They were being followed up regularly at Middle Road Hospital. "The majority of the 16 showed only weak positive results. The significance of the weak positive tests is unclear and false positives due to serological abnormalities are possible," the ministry said.

AIDS Advisory Committee Chairman Dr Ong Yong Wan said the same day: "Initial positive results from laboratory tests may not mean the individual has been exposed to or is carrying the virus." Dr Ong said the ELISA test was used as a screen for antibodies or protein substances to HIV. There could be other proteins in the blood unrelated to the virus, giving a positive test result. All blood samples found positive have been sent to Reference Laboratories in the United States and Australia for the confirmatory Western Blot test. None of the results were yet available. Thirteen of the suspected cases were from the high risk group of haemophiliacs, homosexuals and prostitutes. So far 2,058 people from the high risk group had been screened. Three others were discovered through screening tests done by the Blood Transfusion Service, which tested specimens from 4,723 blood donors.

Dr Ong said that, eventually, about 20,000 people would be screened - about 5,000 in the high risk group and 15,000 blood donors. The 16 suspected cases, screened under the ministry's AIDS monitoring programme, included a man who was discharged from Alexandra Hospital on Saturday, 27 April 1985. The ministry assured the public that during the patient's brief hospitalisation, all necessary precautions were taken to safeguard the public and hospital staff. AIDS could he transmitted through sperm, but a ministry spokesman said that there was no move to ban artificial insemination because of little such activity in Singapore. “The Sperm Bank is dry because people are afraid to donate sperm," she added.

=Special lab set up for HIV diagnostic tests=
 * See also: Archive of "Special lab to do Aids tests soon", The Straits Times, 18 May 1985

Dr K V Ratnam, a Registrar at Middle Road Hospital and the discoverer of HIV in Singapore, was sent to Atlanta and Washington in February 1985 to learn the latest techniques on confirmatory tests for the as-yet incurable disease. At the Atlanta Centre for Disease Control, he attended a four-day intensive training course on the Western Blot test. He was the only overseas participant in a group of about 30 doctors. The Western Blot test was employed after another test has been made. This first test, called the ELISA test, was used to screen the presence of certain antibodies which might indicate whether the person had been exposed to HIV. Once the ELISA test identified someone as having these antibodies, the Western Blot test was then employed to determine if this person had been actually exposed to HIV virus or was carrying it.

The Western Blot test which Singapore intended to use would be enzyme-linked and was called the ELISA-Western Blot test. It was different from the Western Blot test employing radioactive materials in use in the laboratory of Dr Robert Gallo, the American doctor who discovered HIV. Ratnam said both were just as accurate but the ELISA-Western Blot test was more convenient to use and did not pose the problem of radioactive waste disposal. He added that both Western Blot tests were not commercially available yet. Ratnam had spent a week at Robert Gallo's laboratory in Washington to see the work done there.

Ratnam said the laboratory in Singapore would be operational by July 1985. It would be situated in the Pathology Department of the Singapore General Hospital. He said all precautions would be taken to ensure the safety of the staff, including the proper sterilisation of equipment and proper disposal of materials. Having learnt how to use and interpret the Western Blot test at Atlanta, Ratnam would be responsible for the work in the special SGH laboratory. He said he would divide his time between Middle Road Hospital and the laboratory. He would train two laboratory technicians to help him. Later he would also train some doctors to interpret the results.

The Ministry of Health said that a man was now under observation at Middle Road Hospital for suspected Kaposi's Sarcoma, a skin cancer that was one of the clinical manifestations of AIDS. It added: “So far, all tests carried out have been negative. The patient is still under investigation.” Meanwhile, the three men identified as carriers HIV were well, said Dr Tulip Tan, the Medical Director of Middle Road Hospital. She added that their condition remained unchanged and they were reporting for the weekly check-ups at the hospital. Dr Ratnam said one of them had weight loss and swollen lymph nodes while another had swollen lymph nodes.

The pilot study and blood tests on 20,000 people in the high-risk groups such as prostitutes and haemophiliacs had begun, said AIDS Advisory Committee Chairman Dr Ong Yong Wan. She stressed that there was still no case of AIDS in Singapore. The pilot study should be completed in about three months, she added.

=Man with HIV hospitalised and then discharged=
 * See also: Archive of "Man with Aids related virus in hospital", The Straits Times, 21 July 1985
 * See also: Archive of "Aids carrier leaves hospital", The Straits Times, 28 July 1985

On 20 July 1985, a Health Ministry spokesman said that a man who was exposed to HIV had been admitted to Alexandra Hospital. Apparently, he was admitted for severe depression. Screening tests showed the man had the antibodies to the virus but he did not have AIDS or its symptoms. Samples of his blood had been sent to the United States for tests and the ministry was awaiting the results. Until laboratory facilities for the confirmatory Western Blot test were ready locally, blood samples would continue to be sent to the US. Alternatively, some samples might be sent to Australia. Laboratory equipment for the test have been ordered for the Pathology Department of the Singapore General Hospital. The man, admitted the previous week, was not one of the three men identified earlier as carriers of the virus. He was also not the man who reportedly was suspected to have Kaposi's Sarcoma. The spokesman said that all necessary precautions to safeguard hospital and laboratory staff and patients from accidental infection had been taken. These included the isolation of the patient in a room, proper disposal of medical supplies, wearing of gloves and a gown over the uniform, sterilisation of articles such as the gowns, and the wearing of masks.

On 27 July 1985, the man was discharged from Alexandra Hospital. A Health Ministry spokesman said the man was discharged because he was "all right” and did not have AIDS. He had also seen a psychiatrist. The man, a homosexual, was attending counselling sessions at Middle Road Hospital like the other three men who were identified earlier as HIV carriers. It was learnt that more people might be HIV carriers. These probable new cases were people whose blood tests showed they had the antibodies to the virus.

=MOH steps us anti-AIDS drive=
 * See also: Archive of "Talks on plan to deal with Aids", The Straits Times, 6 August 1985
 * See also: Archive of "Ministry steps up Aids drive", The Straits Times, 5 September 1985

In early August 1985, Health Ministry officials and the Aids Advisory Committee, made up of government doctors, held high-level discussions on a comprehensive plan to deal HIV/AIDS. The plan covered "the total works" from stepped-up public education on the disease to monitoring and tests for the presence of antibodies to HIV. The Health Ministry headquarters had a position paper on the plan which would cover not just the current year or the next, but a much longer term. Health and Finance Minister Dr Richard Hu and the Minister of State for Health and Foreign Affairs, Yeo Cheow Tong, were expected to see the paper before the meeting.

The plan's strategies would most likely include the training of doctors, nurses and laboratory staff, more public education, and perhaps, even the setting up of more laboratories to do the necessary tests. The ELISA screening test for detecting antibodies to HIV was currently done manually and the few laboratory technicians doing the test were hard-pressed. The plan was expected to provide for the training of more staff and even getting equipment which would partially, if not fully, automate such tests. Doctors would, however, still interpret the results.

ELISA tests were done at a Pathology Department laboratory in the Singapore General Hospital for the high-risk groups of haemophiliacs, homosexuals and prostitutes. Tests for blood donors were done at a Blood Transfusion Service laboratory in the SGH. The special laboratory for the confirmatory Western Blot test now done overseas was being set up at the SGH’s Pathology Department. An AIDS Advisory Committee spokesman expected the laboratory to be operational before the end of 1985. The plan was subject to fine tuning and changes. It contained a budget but no details were available. Meanwhile, a ministry statement issued the previous week said that the three confirmed carriers of the virus identified in April 1985 were clinically well. The Western Blot test results for another 16 suspected carriers were still not available.

100,000 copies of a newsletter, devoted specially to the prevention of AIDS, would be distributed later in August 1985. The 60,000 English and 40,000 Chinese editions would be sent to voluntary organisations, welfare homes, hospitals and all general practitioners. Educational institutions, factories, companies, government departments, statutory boards and members of the public on the Health Ministry's mailing list would also receive it. The ministry was additionally working on a publication for the high-risk groups such as haemophiliacs, homosexuals and prostitutes. These moves were part of the ministry's stepped-up efforts to educate the public. Other plans included public talks and the publication of a a new booklet on safety precautions especially for nurses and laboratory technicians.

The training and health education department of the ministry was preparing the special issue of its newsletter, The Health Educator. On 4 September 1985, the department's medical director, Dr Luisa Lee, said: "The article is written to suit the general public and will be illustrated with drawings. The aim is prevention of AIDS. But before you can prevent, you have to help people understand what AIDS is, how it is spread, the symptoms and so on." Later that month, the department would start its series of talks for the public. The talks would be given to those who asked, said Lee.

=S'pore-Stanford research tie-up=
 * See also: Archive of "S’pore-Stanford research tie-up bid", The Straits Times, 10 October 1985

On 9 October 1985, Associate Prof Oon Chong Jin, chairman of the National Scientific Committee on Hepatitis and Related Disorders, announced that Singapore was working towards a research collaboration with Stanford University in California and the use of antiviral drugs for hepatitis B and AIDS. The affiliation might come about in January 1986 and would involve leading authorities on antiviral drugs, such as Prof Tom Merigan of Stanford University. Arrangements for the tie-up were being handled by the Health Ministry.

Oon said that the antiviral drugs would include “new generation interferon". The successful use of antiviral drugs could help stem the spread of hepatitis B infection and the number of carriers by at least two-thirds. Trials on the use of an antiviral drug on hepatitis B will begin soon at the Singapore General Hospital. There was as yet no cure or even a vaccine for AIDS. Various drugs were used in trials overseas to fight the disease. Some were antiviral drugs and others were drugs which helped to stimulate the patient’s natural defence mechanism.

Oon said that there were contingency plans in Singapore to deal with AIDS should there be a need. Groundwork for the plans were laid some time ago. Singapore had the capacity to screen for exposure to HIV because of the anti-Hepatitis B programme. He explained that hospital staff, such as laboratory technicians who had been trained to do hepatitis B screening, could use those methods in screening for exposure to HIV. Prof Oon, of the National University of Singapore's Department of Medicine, said that AIDS and hepatitis B had similar modes of transmission. He stressed that sexual promiscuity was mainly responsible for the spread of both diseases. Surveys showed that male and female prostitutes in Singapore had high rates of hepatitis B infection - 88% in the male group and 64% in the female group. Oon was an adviser to the World Health Organisation regional seminar on cancer, then on at the Regional Language Centre.

=20,000 cleared of having HIV=
 * See also: Archive of "Aids: 20,000 cleared", The Straits Times, 29 November 1985

On 28 November 1985, Dr Ong Yong Wan, Chairman of the AIDS Advisory Committee, announced that more than 20,000 people in Singapore had been screened and all had been found to be free of HIV infection. Those who had their blood tested under the Health Ministry’s screening programme included blood donors and 2,500 prostitutes. The result was described as miraculous by Professor Jean-Claude Chermann, one of the scientists who discovered the AIDS virus.

Dr Ong said Singapore had the advantage of learning about the disease from countries such as the United States and France. She added that the ministry had taken all measures to prevent the spread of the disease. There were only five carriers and all were still all right. With a safe blood supply due 100% screening of donor blood, there was no longer a threat of infection through blood transfusions, Dr Ong remarked.

This left sexual contact with infected people as the main way by which HIV could be spread. So the Health Ministry would focus on public education regarding the risks of promiscuity through talks, posters and publications, Dr Ong announced. The screening of blood donors was an ongoing exercise and the ministry would keep a close watch on the situation where high-risk groups, such as homosexuals and prostitutes, were concerned. Anyone who requested tests would be obliged.

Dr Jimmy Sng, a member of the committee and who was with the Pathology Department of the ministry, said that in early 1986, the confirmation test for exposure to HIV, the Western Blot test which was then done overseas, would be carried out in Singapore. Equipment for the Western Blot test laboratory of the department had been set up and staff trained to do the test. The test kits from Australia would arrive early in 1986.

Dr Flossie Wong-Staal of the US National Cancer Institute said that the situation in Singapore was under control and would not reach the proportions in the United States. Prof Chermann and Dr Wong-Staal were interviewed after they met the AIDS Advisory Committee at the Singapore General Hospital. Prof Chermann was head of the viral oncology laboratory of Institut Pasteur in Paris and Dr Wong-Staal was head of the molecular biology section of the NCI.

=Screening test likely to uncover more HIV carriers=
 * See also: Archive of "Screening tests likely to uncover more Aids carriers", The Straits Times, 1 May 1986

While presenting a paper on the control of sexually-transmitted infections at a World Health Organization (WHO) seminar being held at Novotel Orchid Inn on 1 May 1986, Dr Tulip Tan, Medical Director of Middle Road Hospital, predicted that more carriers of the AIDS virus were likely to be uncovered in Singapore through the Health Ministry's screening programme.

The Health Ministry expected to conduct 60,000 to 70,000 screening tests a year, a target it considered adequate for Singapore. A ministry spokesman said there was still no case of AIDS in Singapore although there were five carriers of HIV locally. All five were homosexuals and their conditions were being monitored by Middle Road Hospital. The ministry had three screening programmes - for the public, blood donors and high-risk groups such as prostitutes and homosexuals. Screening tests were available at five polyclinics - Ang Mo Kio, Bedok, Bukit Merah, Clementi and Kelantan Road. The fee per test was $30 for citizens and permanent residents and $36 for others.

Donor blood obtained by the Blood Bank was also screened before use. Since August 1985, 28,500 units of blood had been screened. Sex with infected partners, contaminated blood and blood products and intravenous drug abuse were major means of HIV transmission. This had been the experience of countries such as the United States, where AIDS was a major problem. High-risk groups such as prostitutes and homosexuals were initially screened at the Middle Road Hospital. The confirmatory Western Blot tests were done at the Pathology Department of the Singapore General Hospital. More than 100 of these tests had been done since late 1985, said Dr Jimmy Sng Ewe Hui, Head of the Pathology Department. The department expected to carry out 700 to 800 Western Blot tests a year. Further medical tests were needed before doctors could tell for sure whether a person was either a carrier or had AIDS, an AIDS Advisory Committee member said.

Dr Chew Chin Hin, the ministry's Deputy Director of Medical Services (Hospitals), said when he opened the seminar on Monday, 28 April 1986, that AIDS had added a "fearsome dimension" to the problem of sexually transmitted infections. The closed-door regional seminar, which attracted 20 participants from 18 countries, together with experts from Switzerland, Australia, Japan and the US, ended on Saturday, 3 May 1986.

=First AIDS case diagnosed=
 * See also: Archive of "First Aids case discovered in Singapore", The Straits Times, 27 September 1986

On Friday, 26 September 1986, Dr Chew Chin Hin, acting Permanent Secretary (Health), told a press conference that the first case of AIDS had been discovered in Singapore. The patient, "a Singapore man who has travelled widely", was being treated for gut and chest infections at the Communicable Disease Centre at Tan Took Seng Hospital. It was confirmed the day before that he had clinical AIDS, which meant his immune system was damaged, and his body was defenceless against infections. HIV carriers had been found in Singapore but their condition was different from this man's as they had been exposed to the AIDS virus, but did not have symptoms of the disease. Statistics from abroad indicated that about 10% of carriers eventually got the disease.

The man had not been told he was suffering from the disease "following requests from his family and relatives who were calm and at the same time anxious about publicity when the news was first broken to them", said Dr Chew. "But we want to discuss it with the family again because we feel the man, who has lost 10 kg in the past few months, ought to know of his condition," he added. The ministry did not believe he fell into any of the high-risk groups, namely haemophiliacs, homosexuals, prostitutes and intravenous drug users. But he had a history of blood transfusions during an operation abroad. "The man is not quite clear when, as it was done many years ago," reported Dr Chew.

AIDS was a disease with a long incubation period and it was "very difficult sometimes to pinpoint the source of infection. But it was likely he contracted the infection overseas through blood transfusions," said Dr Ong Yong Wan, chairman of the AIDS advisory committee and director of the Blood Transfusion Services. The man was admitted to a government hospital for chest infection and bacterial diarrhoea and was transferred to the Communicable Disease Centre when he did not respond to treatment. There had been no outcry from the staff, unlike when the first HIV carriers were discovered in April 1985. This time, medical staff had been briefed on precautions to take when handling him. They also had to be extra careful in prominently labelling bottles with his blood samples as "bio-hazard", said Dr Jennifer Lee, director of the ministry's management services and administrative division. "We are trying our treat his condition, but as far as curing his AIDS is concerned, that's a different matter, said Dr Ong. The man was responding to the potent antibiotics being given to him and his gut infection was clearing, though his chest infection was still not completely clear.

Dr Chew stressed that the disease could not be contracted by such things as breathing the same air as the man or putting an arm around him. HIV was passed on through sexual contact, blood transfusion, via open cuts, or infected hypodermic needles whether shared by patients in a hospital or between one drug user with Aids and his fellow drug users. Another three men had been found to have the AIDS virus, bringing the number of HIV carriers to eight. The new carriers - all men below the age of 40 - were discovered after a year's screening of some 20,000 blood donors. It was not clear whether they fell into the high-risk groups as they were not very forthcoming in the interviews, said Dr Ong.

=First AIDS death=
 * See also: Archive of "Aids claims first victim here", The Straits Times, 11 April 1987

On Tuesday, 7 April 1987, a statement from the Ministry of Health informed the public that AIDS had claimed its first victim in Singapore. The patient was a 55-year-old Chinese man. He died of complications following pneumonia brought on by (AIDS) over the weekend. The ministry did not identify the man. It said the body was cremated after the necessary precautions were taken so there was no danger of the killer disease spreading.

The man was not believed to be in one of the high-risk groups, i.e., haemophiliacs, homosexuals, prostitutes and intravenous drug users. He was said to have travelled widely and was thought to have contracted the infection after receiving blood transfusions during an operation overseas many years before. The victim's AIDS diagnosis was confirmed in September 1986 when he was admitted to the Communicable Disease Centre at Tan Tock Seng Hospital. He had earlier gone to a government hospital with chest and gut infections but was transferred to the centre when he did not respond to treatment. At the CDC, he was treated in isolation in one of the wards in the sprawling grounds off Moulmein Road.

Initially, he responded to potent antibiotics and was discharged. He then went for regular follow-up checks. But he was back at the hospital following chest infections and died in the hospital over the weekend, the ministry spokesman said. To prevent transmission of the disease, his body was wrapped in a plastic bag and chemically sealed in a wooden coffin at the hospital's mortuary. The man's family were advised to cremate the body and they agreed. Sources said that his body was taken to the crematorium from the hospital and Environment Ministry officials accompanied the hearse. The patient was the only one known to have the disease in Singapore, although nine people had been identified as HIV carriers. They were being monitored.

=AIDS fear boosts condom sales=
 * See also: Archive of "Fear of Aids pushes up condom sales", The Straits Times, 19 April 1987

In the same month following the first reported AIDS death in Singapore, some condom distributors experienced a dramatic increase in sales of their products which they attributed to fear of the deadly Aids disease. "Contraception can only account for a small part of the growth in sales," said the spokesman for a company which was the sole agent for a leading Japanese brand of condom. "It s the fear of Aids that is the real booster." He said sales of condoms at supermarkets, pharmacies, Chinese medical halls and street-comer stalls he supplied had doubled since HIV cases were first identified locally in 1985. His company also sold to Malaysia and Brunei, where sales were similarly buoyant, mainly because people there were worried about picking up HIV or other infections, he said.

Others involved in selling contraceptives said that the condom was a continual good seller. A distributor and retailer of a brand of condom that contained a sperm-killing agent said sales of that product took off in the past few months. The company which was the sole agent for a British brand of condom with spermicide said its overall sales were up and that demand was particularly strong for the spermicidal condom. "It's moving so fast we have run out of stocks. But we have placed orders for more," the company spokesman said the previous week. She said buyers were attracted by the extra precaution afforded by the spermicide. The transmission of AIDS had been linked to infected body fluids, including sperm. A spokesman for Guardian Pharmacy said recently that sales of condoms at its retail outlets were good and that the condom with spermicide was among the fastest sellers with sales up by 50%. When the AIDS virus was first identified here Guardian decided to increase its condom stocks by 20%.

Dr K. V. Ratnam, a senior registrar at Middle Road Hospital who was conducting a study of 100 transsexuals said the transgender sex workers had become aware of the dangers of contracting the deadly disease after being told by doctors at the hospital. He said the week before that many of them were now insisting that their clients, who are men, used condoms. They had been told to avoid exchanging semen or blood, which had been associated with HIV infection. Some were doing this. However, Dr Ratnam noted that a few had resisted it because of what he termed their "fatalistic attitude". "They felt that since death was inevitable, they were prepared to get AIDS and were not prepared to adopt any precautionary measures." Others had the misconception that their risk of contracting HIV was negligible since they were going to the hospital for regular check-ups. Dr Ratnam said this belief stemmed from the false notion that AIDS was similar to gonorrhoea and syphilis and could be cured with antibiotics.

The sex workers were men between 19 and 55 years old when the study began in 1984. More than half had little or no education. They were selected from a hospital register for the study. The findings of the study entitled, Awareness of Aids Among Transsexual Prostitutes in Singapore, was published in the December 1986 issue of the Singapore Medical Journal. Working with them, Dr Ratnam, who was in his 30s, discovered the first three HIV carriers in Singapore. He said the carriers' condition was unchanged, that is, they had not developed AIDS. Between August 1984 and February 1985, Dr Ratnam interviewed 100 transsexual sex workers to find out how many knew about AIDS. He found that only 58 out of 100 knew what AIDS was. And of these 58, only about half had taken precautions against getting HIV from clients. But the picture has since changed, Dr Ratnam said. Last year, far more of the prostitutes said they were aware of the disease and taking measures to protect themselves. He was studying another 20 to 30 transsexual sex workers, who were younger, to find out how they compared with the original 100.

=Second AIDS case detected=
 * See also: Archive of "Second Aids case detected here", The Straits Times, 25 July 1987

On Acting Health Minister Yeo Cheow Tong's return from Sydney on the night of 24 July 1987, he revealed that a second AIDS case had been discovered - a male in the high risk group who was believed to have contracted the disease abroad. Yeo had been attending a four-day World Health Organisation/Australian Ministerial Meeting on AIDS. He said the Health Ministry was moving to strengthen the committee that was set up to advise the Government on how to prevent and control the disease. The second case had not been hospitalised "but has been in and out of hospital". A woman, the wife of one of the carriers, was among the nine Singaporeans who had been identified as carriers of HIV.

During the Sydney conference, other countries with many AIDS cases revealed that for every "full-blown" case of the disease, there were at least fifty to 100 other people in the society who were affected with the virus. "Going by their experience we must assume that here there are about 100 with the AIDS virus," said Yeo. He said the Advisory Committee on AIDS, whose members were mainly medical professionals, would be broadened into a National AIDS Committee. This would draft people from other professions too, for example, from the media. One of their tasks would be to help shift the focus of the present public-education programme on AIDS. The campaign warned those in the high-risk groups, for example, homosexuals and bisexual men with multiple partners, of the possibility they could contract the disease.

He said that "many of Singapore's nine carriers fall into the high-risk group". Now, the campaign would include warnings to people who indulged in "high-risk behaviour” by having multiple partners. It would also stress that AIDS could be contracted in heterosexual relationships as men could pick up the virus from women. "We need to educate our men on this, because they travel abroad quite often,” said Yeo. There are plans to ask those who have engaged in "unsafe sexual acts to please come forward to be tested for the Aids virus", he added.

He had a message for Singaporeans: "Over three million tourists come in every year. Many Singaporeans travel abroad every year for business or pleasure. Therefore, they must be very careful." The Philippines appeared to have a larger number of AIDS cases than any of the other ASEAN countries. It had 50 carriers, 47 of whom were women. Thailand had four full-blown cases of AIDS. Three others had died from the disease earlier. Malaysia and Brunei had a "couple of cases”, while Indonesia had only one, an expatriate who had been sent home.

=Govt dental clinics phase out boiling=
 * See also: Archive of "Govt dental clinics phasing out boiling", The Straits Times, 1 October 1987

At a meeting of dental surgeons over the weekend commencing on 26 September 1987, Dr Myra Elliot, said during her talk that it was believed that almost half of all dental surgeons still boiled their instruments. More government and school dental clinics were sterilising instruments with high-pressure steam, chemicals or hot-air ovens instead of with boiling water. The change had been taking place daring the past year under a Health Ministry programme to ensure that dental instruments were totally germ tree. The programme was expected to be completed soon. The dental clinic at the National University Hospital had already fully converted to autoclaving and the hot air method. As a further precaution against infection, many disposable items were used, like needles, cups, salivary ejectors (to drain out saliva during treatment), and suction tips.

Private dental clinics, on the other hand, had been slow to change. The risk in not autoclaving, or using hot air ovens with temperatures up to 180 degrees Celsius, was that some hepatitis B or AIDS viruses might not be destroyed. Some spores were resistant to heat and sometimes boiling did not destroy them. With about 140,000 hepatitis B carriers in Singapore, or 5.5% of the population, dentists could become agents of infection if they used poorly sterilised instruments. Private dentists who were slow to change cited two reasons - practicality and cost.

A dentist in private practice said: "In autoclaving, or sterilising with high-pressure steam, the instruments must be able to withstand the pressure and temperature. Over time, these could damage the delicate hand pieces. It is also difficult to recover the cost spent on these units because we want to keep our fees low." Another said: "Boiling of instruments is still practical for non-surgical operations, such as filling teeth, where the likelihood of contamination is not great. But when it comes to surgeries, the instruments will have to be 100 per cent sterile." Two others said the switch to autoclaving could be done overnight because of the cost. However, one dental surgeon with a clinic in town felt that in terms of hygiene for himself and his patients, buying an autoclave and hot air oven was worthwhile. He bought them a few years ago for about $4,500 but then had to raise his fees by between 2 and 5%.

=Goh Choo San dies of AIDS-related illness in New York=
 * See also: Archive of "Choreographer Goh Choo San dies in New York", The Straits Times, 1 December 1987
 * See also: Archive of "The dance is over", The Straits Times, 1 December 1987

On 1 December 1987, it was reported in the press that talented, applauded and celebrated choreographer Goh Choo San, then 39, the brightest dance star Singapore had ever produced, died in his New York City home on the night of Saturday, 29 November 1987 of a viral infection apparently linked to AIDS. Goh was last in Singapore as a judge in the Miss Universe pageant held in May 1987 when this picture was taken. He had been seriously all for at least a month before be succumbed to viral colitis, a disease which the United Press International news agency said was linked to AIDS. The UPI report said he had been diagnosed as having AIDS in December 1986 but a family statement released on 30 November 1987 revealed only that he died “after complications due to viral colitis". Asked how Goh could have contracted AIDS, his ballet master, Janek Schergen said in a telephone interview on 30 November 1987 from New York: "I'm sorry. I couldn’t possibly tell you that."

Goh had 36 ballets to his name, commissioned by "name” companies such as Alvin Ailey American Dance Theatre, Paris Opera Ballet and American Ballet Theatre, and had just received commissions for three new ballets the very morning of his death. "He's going to be missed by the entire dance world," Schergen said. Goh’s artistic achievements as resident choreographer at the Washington Ballet since 1976 and associate artistic director since 1984, brought him, and Singapore, international recognition unmatched by any other Singapore-born artist. "He really put the Washington Ballet on the map", said Kay Butler, a board member of the Washington Ballet who had known Goh for more than six years. "People held him in the utmost respect. They regarded him as a genius in terms of his choreography. Dancers in the company came to the Washington Ballet to be with him and learn from him," Butler said on 30 November 1987 in a telephone interview from Washington D. C.

Recognition at home took longer. Goh received long overdue honours in Singapore only in February 1987 as one of seven recipients of the Cultural Medallion, the country's highest honour for artistes. Goh was last in Singapore in May 1987 as one of the judges at the Miss Universe pageant. His eldest brother, Choo Chiat, who headed the Vancouver-based Goh Ballet Company, and sister Soo Khim, principal of the Singapore Ballet Academy went to New York to be with Goh last month. Also there were Goh's sister Soonee, the academy’s founder and then head of the dance department at the Vancouver Academy of Music, and Goh’s mother, Madam Ching Siew Han, who had been visiting Soonee. Ironically, after 17 years away from Singapore the youngest and most famous of the "Dancing Gohs" had been set to spend more time back home. He had promised to help Singapore Dance Theatre, the professional dance company just launched by Soo Khim and choreographer Anthony Then, on its feet. There would be a memorial service in New York today and later on in Washington D. C. Goh's body was to be cremated and his ashes would be flown home for a memorial service in Singapore later in December 1987 or in January 1988. 

=GE Life is first insurer with question on AIDS=
 * See also: Archive of "GE Life is first with question on Aids", 28 December 1987

On 28 December 1987, A Great Eastern Life Assurance spokeswoman said that the company recognised the existence of AIDS and so had included it in the list of ailments under the “Particulars of Health” section of its policy proposal form. “We also monitor the experience of insurers in other countries," she said. In GE Life's proposal forms, AIDS was covered by the question "Have you ever suffered from or received any treatment for:" followed by 12 groups of ailments. The killer disease came under item (i), which grouped "nephritis, kidney stones, tumour, albumin in urine or urinary tract abnormalities, gonorrhoea, syphilis or AIDS".

Other companies such as American International Assurance, Insurance Corporation of Singapore, NTUC Income and Prudential Assurance had not included questions on AIDS in their proposal form, but the situation might change. An Insurance Corporation of Singapore spokesman said: "We have taken a decision to incorporate questions on AIDS, and we are in the process of reviewing our application forms to see how we can Insert certain questions to elicit more information". NTUC Income was considering inserting questions on AIDS in its proposal form. Mr Tan Kin Lian, General Manager of NTUC Income, said AIDS in Singapore was a potential and not an immediate problem. "We have thought about it, but we want to get a better understanding of the problem before we make a decision," he said. An official at another company, where the question of AIDS had not been officially brought up yet, said: “AIDS is not that serious here. It has not created a problem so far and we are not paying close attention to it."

However, another insurer said his company was now paying even closer attention to singles taking out large policies - for sums more than the average $100,000 to $150,000; "We are more cautious of underwriting very large cases where there are no insurable needs, for example singles with no family or dependents who ask for exorbitant cover if they ask for $1 million or buy $100,000 from each company, bells start ringing." Additional questions relating to the applicant's lifestyle and occupation were asked, and AIDS-related blood tests were also ordered if necessary. "It is unfair, but single men would be asked more questions," he said.

Singapore's situation, with three AIDS-related deaths and 17 carriers, varied greatly from that in the US, Europe and Africa where mounting AIDS-related deaths had alarmed insurers. In the US, a study by the Society of Actuaries stated that insurers faced an estimated US$50 billion (S$100 billion) of AIDS-related life insurance claims for policies already in force. And death claims resulting from AIDS could exceed US$2 billion a year by the mid-1990s, or about 15 per cent of projected individual life insurance claims for all US companies. The worry was that heavy payouts by insurance companies, as AIDS-death claims swelled, would eventually be passed on in the form of more expensive premiums and smaller bonuses to those who bought policies that shared in the profits of the insurance companies, smaller dividends to shareholders in the companies, and might even bring some companies to financial ruin.

The potential severity of the AIDS problem prompted a US economist who recently visited Singapore to say that he was more concerned about the "AIDS effect" than the "stock market crash effect" on the world economy. Although there had only been three AIDS-related deaths in Singapore, local insurers nevertheless thought they should take precautions to avoid potential pitfalls. Most favoured more stringent selection at the application or proposal stage, rather than adjusting mortality tables - statistics on probable life spans and premiums to reflect possible AIDS-related deaths.

One insurer said: "If we select at this stage, we would not need to adjust mortality tables unless the claims situation gets very bad." Including questions on Aids in the proposal form would be one way to weed out the high-risk groups, he said. But he preferred indirect questions aimed at finding out the applicant's lifestyle and whether the applicant had ever taken a HIV test rather than direct questions. Another insurer said that as AIDS was, by law, a notifiable disease, a person who took out a policy without disclosing that he had the disease would be committing fraud. He said the policy would not pay if the company could prove that the insured knew of his disease before buying the policy. The GE Life proposal form already warned applicants: "You are to disclose... fully and faithfully all the facts which you know or ought to know, otherwise you may receive nothing from this policy."

=Effect of AIDS on society=


 * See also: Archive of "AIDS hits home", The Sunday Times, 6 March 1988

On 16 February 1988, the press reported that the Criminal Investigation Department (CID) had issued a warning to owners of nightspots to stop admitting homosexuals and transvestites into their establishments and cautioned that clubs flouting the regulation could end up losing their licences. Several dicos were also told to stop promotions of "macho nights" and all-male swimwear fashion shows. CID director Chua Cher Yak said it was for moral reasons that the action was taken: "We do not want to encourage such behaviour". However, it was widely thought that the clampdown was a reaction to the first reported AIDS death in April 1987 (see above). The following year, in 1989, the second incarnation of Niche disco in Chinatown had its liquor license withdrawn and was given only a week to close down. No reason was provided for the police action but a person, personally involved in the running of the disco, believed it was also a similar unwarranted response on the part of the authorities.

By March 1988, a hazy awareness of AIDS, perhaps the most feared and least understood four-letter English word of the day, was beginning to seep into Singaporeans' consciousness.Discos had been told to ban homosexuals from their establishments, people then thought twice about receiving food from a friend's chopsticks, employers were engaged in revising employment and recruitment policies just in case one of their workers was stricken with the disease. One dentist was so worried, she was considering, even though she was only in her mid-forties, giving up work for the calm of retirement, away from potential infection from her bleeding patients. The heightened consciousness was not anywhere as strong as the health authorities would have wished. But at least some people were beginning to be more careful about sexual relationships, though most still appeared to think that AIDS could not possibly happen to them. Dr K V Ratnam, the Middle Road Hospital dermato-immunologist who discovered the first three cases of Aids, said: "There are no high-risk groups anymore, just high-risk activities."

In April 1987, the first of four Singaporeans, all men, died of AIDS. The second died in October 1987, followed by two more in December 1987. All four died within a year of their diagnosis. The deaths left 16 known carriers of HIV, of whom two-thirds were male homosexuals who had had sexual encounters with foreigners either locally or abroad. The December deaths climaxed a year in which the collective Singaporean psyche seemed to take a leap in AIDS consciousness. Some 66,000 people, for instance, attended AIDS exhibitions at six shopping centres in October and November 1987. If there was any doubt that AIDS could strike somebody known to Singaporeans, the death of Singapore-born choreographer Goh Choo San removed all doubt. When he died from an Aids-related disease in New York late last year, it was a shock that jolted many out of their complacency. The death of a Singapore Airlines chief steward a little more than a week later brought it even closer to home.

The Government, realising the urgency, had set up an Aids Task Force and a National Advisory Committee on Aids to educate the public about the killer disease, for which there was yet no cure. The first world summit on AIDS, organised by the World Health Organisation (WHO), in London at the end of January 1988 issued a sombre yet optimistic forecast of one million AIDS cases by 1991, compared with the 100-million estimate by the US Congress' General Accounting Office earlier. Misconceptions abounded largely because medical science still knew little and the public even less. For example, a Dutch airline took out and burned a plane seat on which a man with AIDS vomited. Yet AIDS was not known to be spread by vomit. In fact, there was no evidence that Aids can be transmitted through air, water, food, mosquito bites or casual contact - even quite close contact - in the course of daily activities.

Only direct blood and blood-semen vaginal fluid contact have been conclusively shown to transmit the disease. The Singapore Ministry of Health has issued guidelines for the different professions that may come in contact with these fluids, such as dentists and laboratory technicians, funeral parlour workers, prison personnel, barbers and acupuncturists.

Precautions are also taken to protect the blood supply. Dr Ong Yong Wan, medical director of the Blood Transfusion Service and chairman of the Aids Task Force, says they are in line with those in developed countries. They include a medical interview with prospective donors and the screening of donated blood. These safeguards, she says, make the risk of contaminated blood getting into the bank "very small".

The risk comes from the so-called "window period" between infection and the body showing signs of it. Blood from a donor in this state would join other normal blood in the Blood Bank.

But most often, Aids comes through sexual contact, whether homosexual or heterosexual, when one of the parties is a carrier. Obviously, one of the high risk groups comprises those who indulge in casual sex. In the words of Dr Luisa Lee, medical director of the Health Ministry's Training and Health Education Department, "the best protection is to avoid casual sex altogether".

At least one man seemed to have taken this advice to heart. Mrs F, a 35-year-old housewife, said: "My husband is actually very flirtatious and used to be quite a playboy even after we were married. But since the Aids publicity, he has been coming home early and I think he fools around a lot less." Among those who persisted with their amorous adventures, caution was the in thing. Their armour was the condom, sanctioned by the Health Ministiry which had lifted the ban on its advertising, though some feel it may have the

=Overreaction of hotel to tourist with AIDS=
 * See also: Archive of "Tourist with Aids-related illness in hospital", The Straits Times, 3 June 1988

On Thursday, 2 June 1988, the Ministry of Health informed the public that an Australian tourist who arrived in Singapore on Sunday 29 May 1988 had been admitted to hospital because of AIDS. The hotel where he stayed had isolated his room and drained the swimming pool. On Friday, 3 June 1988, the hotel burned all sheets, towels and anything else the tourist had or might have used. Staff who dealt with the man when he became ill on Monday, 30 May 1988 were given a blood test for HIV and cleared. The women's toilet he used had been disinfected a an additional precautionary measure. The 29-year old man, who was suffering from an AIDS-related illness, was being treated in Ward 76, the special ward set aside for AIDS patients at Tan Tock Seng Hospital's Communicable Disease Centre. His condition was stable and he would be sent back to Australia when he was fit to travel.

The drama at the hotel started with a pot of tea the patient ordered through room service. The hotel manager said when a staff member took the tea to the tourist's room between 3pm and 4pm on Monday, 30 May 1988, the man collapsed. Hotel security personnel helped him to the bed. He was not bleeding, but said he felt dizzy and refused to see a doctor, the manager added. At about 7 pm, the duty manager called the police when the guest acted "strangely". He appeared in the lobby in an unbuttoned shirt and shorts. He refused to return to his room and, at one point, made a beeline for the women's toilet before security staff could stop him. The hotel manager recounted: "The staff tried to pacify him until the police arrived and called an ambulance to take him to Singapore General Hospital. "He did not resist. My understanding is that he had a medical certificate from Australia which helped the doctors in their diagnosis."

The tourist was then sent to Tan Tock Seng Hospital. The hotel swung into action as soon as they were informed that the man had an AIDS-related illness. The management contacted the hotel doctor for advice. The doctor asked a surgeon for advice. The hotel manager said: "We were not sure if the man, who checked in without a booking on Sunday, swam in the hotel pool but as a precautionary measure, we drained the pool. The sheets, towels and everything else that he may have used in his room will be burnt by a team from a professional company tomorrow. We are in the process of disinfecting the room he had occupied which is still isolated. We were not sure if he had any meals, but the doctor pointed out that the AIDS virus is very brittle and with the present system of washing crockery, it would automatically be killed. The same would have happened when washing the linen, but we are destroying it as a precautionary measure."

The management also tried to reassure the staff who feared that they may have picked up the virus when they came in contact with the guest. The hotel manager added: "We talked to all the staff and checked on what they did. Only three who had more contact with the man than others, when they helped him, were sent for a blood test." The Australian High Commission had removed all the man's belongings from the room.

More AIDS talks for hotel staff

 * See also: Archive of "More Aids talks for hotel staff likely", The New Paper, 30 November 1988

In late November 1988, the Singapore Hotel Association, SHA, held a seminar on AIDS for hotel staff. This was because thousands of guests checked into hotel rooms in Singapore each day. So it was likely that some might be carrying more than luggage; some might walk through the doors with AIDS.

“Hoteliers are not sure how to deal with a situation of a guest with Aids,” said Teo Poh Kheam, assistant director of the association, on 29 November 1988. “We hope to educate hotel staff on Aids. I think the seminar helped to allay hoteliers’ fears,’’ she added. SHA was well aware that there was a problem because of a lack of knowledge about AIDS within the industry. That became obvious a few months before when an Australian guest collapsed at a local hotel in May 1988 and died about a week later in hospital of an AIDS-related illness. The hotel took extraordinary action. It burned all the bed linen and towels from the dead guest’s room. It even drained the hotel swimming pool.

At the time, the hotel’s action was criticised by medical circles as an overreaction. But Teo said the hotel simply adopted a “better be safe than sorry” attitude. She explained that the Innkeepers Act did not list sickness as a reason for barring a guest from a hotel. Thus the seminar was aimed at educating staff on how to deal with guests known to have AIDS. It was held at Carlton Hotel, with expert help from the Training and Health Education Department of the Ministry of Health. With the government’s current AIDS awareness campaign, SHA felt it was time for the industry to confront the issue head on.

“Not knowing for sure what AIDS is about makes you not want to take risks. People think that maybe the information on AIDS is not complete,” said Teo. Besides it was not easy to tell if someone had AIDS. She added that the lack of solid information about AIDS contributed to a feeling of uncertainty, not just among hotel workers but the public as a whole. She said the seminar covered the subject of AIDS in broad terms this time. “But the transfer of knowledge about Aids within the hotel industry must be a continuous effort,” she added.

Teo expected there to be more seminars in the future. They could be directed at specialised departments within hotels. For example, people in housekeeping must be made aware that they need not be too wary if they found blood in the bathroom from a guest who had cut himself shaving. It should be made clear to them that HIV would not survive for long in blood exposed to the air. Also, food and beverage people should know that if a chef was found to have AIDS, it was not likely that the food he had touched was contaminated. She said that as yet there were no guidelines to follow should hotels discover that they had a guest with AIDS. What they should do for the meantime was to report the case to the Communicable Disease Centre at Tan Tock Seng Hospital and seek guidance.

=Government backs Church's conversion therapy for gays=
 * See also: Archive of "Ex-homosexual to share experience", The New Paper, 18 March 1989
 * See also: Archive of "Gays 'are made not born'", The New Paper, 31 May 1989

In May 1989, Pastor Derek Hong of the Church Of Our Saviour in Queenstown, who had heard about the charismatic American ex-gay preacher Sy Rogers, invited him to move to Singapore. The church was keen to institute a local ex-gay programme to deal with gay Christians. Rogers' arrival and activities were given great publicity in the local press. This was encouraged by the Singapore government in the wake of the discovery of the first cases of HIV infection in 1985 and the first reported death from full-blown AIDS in 1987. Presumably, the Government decided that a good way to combat the epidemic of HIV/AIDS especially amongst gay and transwoman Singaporeans was to subject them to conversion therapy.

=Insurance firms test applicants for HIV=
 * See also: Archive of "Insurance firms test applicants for Aids", The Straits Times, 21 May 1989

By May 1989, some major insurance companies had started to require potential clients in "high risk" jobs to be tested for HIV before deciding whether to accept their life policies. Single males working as flight stewards, tour guides, hairdressers and well-travelled businessmen were the ones considered as risky by the insurance companies. Three of the five major firms contacted - Prudential Assurance, Great Eastern Life and the Insurance Corporation of Singapore (ICS) had adopted this guideline and would send the prospective clients for the blood test if their policy was worth at least $100,000. But if the sum insured was higher - more than $500,000 - clients would be asked to undergo the blood test that determined if they were HIV carriers regardless of their jobs.

The requirement came in 1988 after Prudential paid out a total of $150,000 to the families of three AIDS patients - two flight stewards and a tour guide. "This was the main instigator that brought about the requirement. It was then that we opened our eyes to the fact that Aids is not very far from Asia," said a Prudential spokesman. The plight of life insurers in the US, Europe and other Aids-afflicted countries also made local companies more aware of the problem. In the 1980s, the life insurance industry in the US and Europe gave out large sums of money in claims when Aids sufferers took up huge policies.

The spokesman for Prudential said: "Flight stewards, tour guides and businessmen who travel overseas regularly, especially to high rish areas like the US or Europe, are often in contact with foreigners. This made them a potential hazard. "For example, a businessman who goes to the US regularly may indulge in promiscuous activities with some women there who in turn are also sexually active. Thus there is a possibility that he might contract Aids from them. It's not just the homosexuals that we are worried about." The blood test for HIV also applied to bar waitresses and hostesses, homosexuals, bisexuals and haemophiliacs who needed regular blood transfusions, all of whom were also considered to be in the high risk group.

Ng Seng Leong, general manager of the ICS, said his firm's prospective clients would have to first answer certain questions in their application form. "If there are indications in the form that point in that direction it is likely that he would be asked to go for a blood test. Even then, we will ask him to fill another questionnaire about his lifestyle before deciding whether to send him for the test. It's not just because of the fact that they travel regularly in their jobs that we subject them to the test. It's a combination of several factors," he added. A spokesman for NTUC Income said there were no AIDS-related questions in its proposal form but the company was looking into adding some. The disease had claimed seven Singaporeans since the first case was discovered four years prior. A total of 35 Singaporeans, including those who died, had been afflicted with the disease.

=HIV cases predicted to double in 1989=
 * See also: Archive of "Aids toll likely to double this year", The New Paper, 4 July 1989

The June 1989 issue of the Epidemiological News Bulletin forecast that the number of people in Singapore known to be infected with HIV could double that year. 30 to 40 new cases were expected to be discovered locally by the end of 1989. This would be a phenomenal rise - a one-year total that almost matched the total accumulated since 1985. So far, 38 people in Singapore had been found to have HIV. The Bulletin said the projected jump in the number of cases reflected those persons who had been infected for an unknown period of time but were just then being detected. The Health Ministry had also been successful in detecting more HIV-infected people in recent months because of the intensification of contact tracing and counselling, and backed up by the Infectious Diseases Act, the Bulletin added. The publication was produced by the Ministry of Environment’s Quarantine and Epidemiology Unit.

“The estimated predictions are based on past statistics, we don’t have anything else,’’ said an AIDS doctor. 2 HIV-infected persons were detected in 1985, 7 in 1986, 10 in 1987, and 15 in 1988. 4 cases had been discovered thus far in 1989. The steady increase in the number of cases detected had resulted from intense counselling by the Health Ministry. Its drive to trace people who had had contact with AIDS patients had also turned up more cases. The Bulletin emphasised that these efforts had to be further intensified due to recent evidence that HIV was spread locally. All AIDS counselling and tracing of sexual partners were done in a confidential manner. Thus, HIV-infected persons were now more willing to name their multiple local partners. In May 1989, a World Health Organisation official warned that the number of AIDS cases worldwide would top one million by 1993. This was double the estimated 500,000 people with AIDS since it was identified in 1981.

The June 1989 issue of the Epidemiological News BulletinAnother also reported that a foreign sex worker had been sent home after testing positive for HIV. This brought the number of HIV-infected foreign sex workers repatriated to three - all women. The first two cases were detected in May 1989. In mid-May 1989, a third foreign prostitute was found to have the virus after a routine test. Once a sex worker was diagnosed as having the AIDS virus, she received counselling. Sex workers who did not have HIV but had other sexually transmitted infections were told what precautions to take.

The doctors treating them were not surprised by the three HIV cases. “We have been expecting this for quite a number of years,” said one. She explained that sex workers had multiple sexual partners, sometimes of both sexes. Thus they fell into the high-risk group for AIDS. She declined to estimate the number of foreign sex workers in Singapore. But the three who tested positive for HIV were part of a group regularly surveyed by health authorities. Male and female sex workers underwent regular check-ups, usually for STI's every two weeks. During this routine test, they also took a blood test for HIV. “Once they come to us, we start keeping regular checks on them,” said the doctor. The frequency would depend on the individual case.

Patients who did not come on the appointed day were reminded by phone or post. However, the doctor feared many sex workers were not yet aware that HIV screening was available in Singapore. “That is why we have gone to the various brothels and bars and met the managers to let them know where they can get treatment,” she said. One could go for a blood test to any of the 10 government clinics. In Singapore in 1989, the total number at people infected with HIV remained at 38. 12 of those developed into AIDS cases. So far, 8 had died. 2 more had AIDS-related illnesses and 23 were infected with the virus but showed no symptoms.

=Foreign workers to be screened for HIV=
 * See also: Archive of "New foreign workers may face Aids test", The New Paper, 17 July 1989
 * See also: Archive of "Man picked up Aids from foreign prostitute", The Straits Times, 26 July 1989
 * See also: Archive of "New Filipino maid suspected of having Aids sent home", The Straits Times, 29 August 1989

On 17 July 1989, a Health Ministry spokesman said that the Government was considering HIV tests for foreign workers who wanted to work here but that "no decision has yet been made." He could not say if foreigners already working here would also have to take the tests. “We are working on it (the proposal) along with the other ministries like Home Affairs.” Asked why HIV screening was being considered, he replied, “I think the reason is obvious - (it’s) mainly for prevention more than anything."

About 150,000 foreigners worked in skilled and semi-skilled jobs in Singapore. In addition, there were about 40,000 expatriate professionals locally. The count did not include foreign sex workers who sneaked into Singapore, but there was speculation that the Health Ministry had raised the issue because of concern over the recent discovery of three foreign sex workers who tested positive for the AIDS virus. All had been sent back to their countries. So far, 38 people in Singapore - including the three foreign sex workers - had been found to have HIV. Twelve had AIDS and eight had died. Two others had AIDS-related illnesses.

Several countries required foreigners to be tested for HIV infection. They included China, Austria, West Germany and Belgium. China had enforced mandatory blood-testing for long-term foreign residents and Chinese who had lived abroad since 1987. Big eastern cities in China including Beijing, Shanghai and Guangdong also tested any Chinese whose jobs brought them into contact with foreigners - including hotel workers and tour guides.

India required HIV tests for foreigners who stayed in the country for more than six months. But it had not strictly enforced the rule. Thailand had been considering introducing legislation requiring long-staying tourists to produce certificates proving they did not have the AIDS virus. Australia was considering compulsory testing for all would-be immigrants. Other countries that required HIV tests for long-term stayers included Austria, West Germany and Belgium.

On Monday, 24 July 1989, the Ministry of Health issued a statement informing the public that a Singaporean man had died of AIDS after contracting HIV in a local pub from a foreign woman whom he did not know was a sex worker. He was the ninth Singaporean to die of AIDS. So far, the wife and child he left behind had shown no signs of the disease. This kind of sexual contact with sex workers, especially those from overseas, was worrying health officials as they did not know how many foreign sex workers were operating in Singapore. And they found it difficult to keep tabs on these women.

“We do not know who the carriers are," said a ministry official, who did not want to be named. “Many of them appear to be social escorts. But they can also be AIDS carriers. It is up to the men to take the right precautions. People should be aware that even prostitutes themselves don’t know that they have Aids. When you go to a prostitute you are open to such risks," he cautioned. “This is to be expected with the increasing number of foreigners coming in here and our men travelling out."

For its part, the Government was stepping up its AIDS awareness programmes and campaigns. And it was considering making HIV testing compulsory for all foreign workers coming to Singapore, though no decision has been taken yet. Doctors and health officials had visited brothels and escort agencies. They gave talks and told brothel and agency owners to keep tabs on their women. The anti-vice authorities also played their part. “When prostitutes are arrested, they are brought to us for tests," said the health official. When asked what it was that lured men to play with these women and possibly court death, he replied: “We cannot tell, really. It’s probably something that happens just at that moment,” said a private doctor who sees such men often. After all, we are human and have our weaknesses. No one thinks of Aids or anything at that moment."

Three foreign sex workers who tested positive for HIV had been sent back to their home countries. The first two cases were detected in May 1989. The third was discovered the following month. The man who died of AIDS after contracting it from a sex worker was one of 38 Singaporeans known to be carriers of HIV. Of these, 13 had developed AIDS, two has AIDS-related illnesses and 23 showed no symptoms yet of the disease.

Health officials were not prepared to talk too much about the case of the latest AIDS death. Their reason was to assure people who had been exposed to the deadly disease that their identities would be kept secret. They were only prepared to give sketchy information. One said they traced the source of the disease to a foreign sex worker. They did this after speaking to the victim as part of the Health Ministry’s counselling sessions. They assured him his identity would not be revealed. It was understood this had resulted in more HIV-infected people willing to name their multiple partners, foreign or local. One could go for a blood test to any of the 10 government clinics. Test results were known in about two weeks' time. If there was infection, the victim was informed. Then the counselling started.

A Filipina maid, suspected of having HIV, was sent home on Monday, 28 August 1989, just one week after she arrived in Singapore. She had tested negative a month before during a HIV screening test in the Philippines. The laboratory, in Quezon City, was accredited by both the Philippines' Department of Health and Department of Labour and Employment. But the same screening test, called the ELISA test, done in a Singapore private laboratory last week, proved positive for the maid, aged 29. Subsequently a second test, called the Western Blot confirmatory test, was inconclusive. In Singapore, a person was considered to be a carrier of HIV when both tests were positive.

When asked why the same ELISA screening test could show different results, doctors explained that this could be due to a "window period" when antibodies did not appear in the blood. A Ministry of Health spokesman said yesterday this is the first case where a maid has been found positive for the Elisa screening test. A ministry source said fewer that 20 foreigners, including three sex workers, had tested positive for HIV since the first case was detected in Singapore in 1985. The Health Ministry was, together with other ministries, still looking into the issue of compulsory testing for foreign workers.

The maid was brought to Singapore on Monday, 21 August 1989 by an employment agency, TC Personnel. Following company policy, P. K. Tan, a consultant with the agency, sent her for hepatitis B and HIV testing the next day. Meanwhile, she was sent to her employer, Madam S. H. Tan, 29, who had a two-year-old son. But on Wednesday, 23 August 1989, the ELISA test result was known. It proved to be positive. Mr P. K. Tan then arranged for the Western Blot test. The maid had spent the night of Tuesday, 22 August 1989 with the family. She had slept in the same room as Madam Tan's nieces aged three and five. Madam Tan said yesterday she did not think her two nieces needed to he tested as there was no close contact with the maid.

A doctor, contacted by the press said that there had been no cases of HIV being transmitted from a victim to other members of a household. The maid had previously worked for two years as a domestic helper for a United States captain's family at Clark Air Base in the Philippines. Tan, who said his agency was one of the few which send their maids for HIV and hepatitis B testing, said: "I hope other compsnies will also start testing for these illnesses. The government should also make testing compulsory for maid agencies in the interest of families in Singapore." A Ministry of Labour spokesman said hepatitis B and HIV tests were not required for a work permit to be granted. At that time, foreign workers had to go through a medical examination which included tests for tuberculosis, syphilis and pregnancy.

=Police raid gay cruising areas=
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=See also=
 * Earliest cases of HIV/AIDS in Singapore
 * HIV/AIDS in Singapore's LGBT community
 * Paddy Chew
 * Avin Tan
 * Ajmal Khan
 * Calvin Tan
 * Adrian Tyler
 * Archive of "Aids - deadly disease of the 80s", The Straits Times, 23 April 1983
 * Archive of "Tight lid on Aids problem here, says doctor", The Straits Times, 9 December 1984
 * Archive of "Ministry issues Aids pamphlet", The Straits Times, 25 March 1985
 * Archive of "Three in S’pore found with Aids-linked virus", The Straits Times, 10 April 1985
 * Archive of "Why 3 with Aids virus won't be hospitalised", The Straits Times, 11 April 1985
 * Archive of "Pamphlet soon on how to avoid Aids", The Straits Times, 11 April 1985
 * Archive of "Aids virus: Doctor who 'found it'", The Sunday Times, 14 April 1985
 * Archive of "If Aids strikes Singapore", The Straits Times, 15 April 1985
 * Archive of "Aids: Nurses seek transfer", The Straits Times, 15 April 1985
 * Archive of "Don’t panic over Aids - ministry", The Straits Times, 16 April 1985
 * Archive of "A chance to be ahead in medicine", The Singapore Monitor, 16 April 1985
 * Archive of "Aids on ‘must report’ list", The Straits Times, 17 April 1985
 * Archive of "New centre to be set up to treat Aids", The Straits Times, 20 April 1985
 * Archive of "Tan Tock Seng hospital to get five new blocks", The Straits Times, 20 April 1985
 * Archive of "Fair reports on subject show paper is credible", The Straits Times, 20 April 1985
 * Archive of "Undergrads to be taught about Aids", The Straits Times, 21 April 1885
 * Archive of "Four screened as Aids clinic opens", The Straits Times, 26 April 1985
 * Archive of "Aids: Empat lelaki diperiksa di klinik", Berita Harian, 26 April 1985
 * Archive of "16 more may be carriers of Aids virus", The Straits Times, 30 April 1985
 * Archive of "Aids doctor thanks mum", The Straits Times, 12 May 1985
 * Archive of "Special lab to do Aids tests soon", The Straits Times, 18 May 1985
 * Archive of "New Senior Registrars", The Straits Times, 5 July 1985
 * Archive of "Our health service’s new Senior Registrars", The Straits Times, 5 July 1985
 * Archive of "Doctors, dentists in govt hospitals promoted", The Straits Times, 5 July 1985
 * Archive of "Man with Aids related virus in hospital", The Straits Times, 21 July 1985
 * Archive of "Aids carrier leaves hospital", The Straits Times, 28 July 1985
 * Archive of "Talks on plan to deal with Aids", The Straits Times, 6 August 1985
 * Archive of "Ministry steps up Aids drive", The Straits Times, 5 September 1985
 * Archive of "Singapore ‘first in the world’ to have 100 % screening of donor blood", The Straits Times, 11 September 1985
 * Archive of "S’pore-Stanford research tie-up bid", The Straits Times, 10 October 1985
 * Archive of "Aids: 20,000 cleared", The Straits Times, 29 November 1985
 * Archive of "A year that many would like to forget", The Straits Times, 31 December 1985
 * Archive of "Blood highs and lows", The Straits Times, 13 May 1986
 * Archive of "200 turn up for first public medical convention", The Straits Times, 28 April 1986
 * Archive of "New strains of VD found in S’pore", The Straits Times, 29 April 1986
 * Archive of "Screening tests likely to uncover more Aids carriers", The Straits Times, 1 May 1986
 * Archive of "100 people could be Aids carriers here: Expert", The Straits Times, 3 August 1986
 * Archive of "First Aids case discovered in Singapore", The Straits Times, 27 September 1986
 * Archive of "Unorthodox sex can lower body’s defences", The Straits Times, 25 January 1987
 * Archive of "Aids claims first victim here", The Straits Times, 11 April 1987
 * Archive of "Fear of Aids pushes up condom sales", The Straits Times, 19 April 1987
 * Archive of "Second Aids case detected here", The Straits Times, 25 July 1987
 * Archive of "Govt dental clinics phasing out boiling", The Straits Times, 1 October 1987
 * Archive of "Choreographer Goh Choo San dies in New York", The Straits Times, 1 December 1987
 * Archive of "GE Life is first with question on Aids", 28 December 1987
 * Archive of "Doctor who’s a friend to the poor", The Straits Times, 1 March 1988
 * Archive of "AIDS hits home", The Sunday Times, 6 March 1988
 * Archive of "Tourist with Aids-related illness in hospital", The Straits Times, 3 June 1988
 * Archive of "More Aids talks for hotel staff likely", The New Paper, 3 June 1988
 * Archive of "Insurance firms test applicants for Aids", The Straits Times, 21 May 1989
 * Archive of "Aids cases may hit 74", The New Paper, 4 July 1989
 * Archive of "Aids toll likely to double this year", The New Paper, 4 July 1989
 * Archive of "New foreign workers may face Aids test", The New Paper, 17 July 1989
 * Archive of "Man picked up Aids from foreign prostitute", The Straits Times, 26 July 1989
 * Archive of "New Filipino maid suspected of having Aids sent home", The Straits Times, 29 August 1989

=References=

=Acknowledgements=

This article was written by Roy Tan.