HIV/AIDS in Singapore's LGBT community

=Management=

HIV patients will have a social worker designated for him/her. As the patient would see the doctor/nurses/social worker/medical staffs lifelong, the hospital would have a fixed arrangement.

Hospitals themselves do not have funds to assist HIV patients. Financial help would be through Medisave, Medifund and other ministry-supported sources. These financial aid don't last forever, they have to be re-applied and subjected to approval every 6 months or so. And they rarely cover 100% of costs.

Without any subsidy: One month supply of patented medicine at the hospital price is $450+. The regular blood tests which happens every 2 to 6 months (based on the doctor's assessment) is $300+ per visit. The initial once-off full blood and virus resistance test is around $950+.

Call the coordinators at AfA (62540212) or email Avin Tan at avin.tan@afa.org.sg

Find out more and how they can help to:

1) seek treatment in Singapore (which is often cheaper)

2) access to quality generic medication

3) access to counselling and follow up

4) application of medical subsidies to lower your cost of treatment

Seeking treatment in Singapore has many benefits and often proves to be cheaper than going oversees.

Once you get the prescription from NUH, SGH or CDC (TTSH), you can start buying drugs with your medisave/medifunds or through AfA. It should cost between $80 to $160 for the usual prescribed line.

Consultation and blood test fees cost anywhere between $100 - $300. You are also able to access your doctor if emergencies arise.

Antiretroviral drug price list
The following drugs are obtainable with a doctor's prescription by emailing haart.sg@gmail.com

The number of tablets in each pack is not given in the following list, accurate as of October 2014:

GPO-VIR Z250 $27.00

GPO-VIR S30 $24.00

Ziagenavir $152.20

Zilavir $30.00

Stocrin $40.50

Efamat $16.50

Lamivir $12.00

Neravir $18.00

Edurant $10.50

Truvada $105.00

Ricovir-EM $51.00

Stripla $130.60

Teevir $52.50

Kivixa $151.00

Tenofovir $67.50

Ricovir $40.50

Other sources are Hotspunk, tel: 97531592, who stocks generic Teevir.

Bangkok
Although not advised, some Singapore PLHIV journey to Bangkok to procure their drugs. They are available from the Thai Red Cross, amongst other sources.

The price list in Thai baht for the following antiretroviral drugs sold in Bangkok as of July 2012 was posted on Blowing Wind:

1 Lamivudine 150 mg (3TC) LAMIVIR --- Price 360.00 (60 tab)

2 Lamivudine 300 mg (3TC) LAMIVIR--- Price 360.00 (30 tab)

3 Efavirenze 600 mg (EFV) STOCRIN--- Price 810.00 (30 tab)

4 Zidovudine 100 mg (AZT) ANTIVIR --- Price 450.00 (100 tab)

5 Tenofovir 300 mg (TDF) Viread Price 1,350.00 (30 tab)

6 Stavudine 30 mg (d4T) STAVIR Price 240.00 (60 tab)

7 Nevirapine 200 mg (NVP) NERAVIR Price540.00 (60 tab)

8 Lopinavir/Ritronavir 133.3/33.3 (LPV/r) Kaletra Price5,400.00 (180 tab) 9 Lopinavir/Ritronavir 100/25 (LPV/r)Aluvia Price 1,440.00 (60 tab)

10 Didanosine 250 mg (ddI) VIDEX*EC 250 Price2,430.00 (30 tab)

11 Didanosine 400 mg (ddI) VIDEX* Price3,750.00 (30 tab)

12 Abacavir 300 mg (ABC) Ziagenavir Price8,520.00 (60 tab)

13 Ritonavir 100 mg (RTV) Norvir Price 3,024.00 (84 tab)

14 Darunavir 300 mg (DRV) PREZISTA Price 12,000.00 (120 tab)

15 Indinavir 400 mg (IDV) CRIXIVAN Price 2,160.00 (180 tab)

16 Atazanavir 200 mg (ATV) REYATAZ Price 9,750.00 (60 tab)

17 Atazanavir 300 mg (ATV) REYATAZ Price 8,640.00 (30 tab)

18 Saquinavir 500 mg (SQV) Invirase Price 9,600.00 (120 tab)

19 AZT 300 mg+3TC 150 mg Zilavir Price 930.00 (60 tab)

20 3TC 150 mg+NVP 200 mg+d4T 30 mg GPO-VIR S30 Price 750.00 (60 tab)

21 3TC 150 mg+NVP 200 mg+AZT 250 mg GPO-VIR Z250 Price 870.00 (60 tab)

22 TDF 300 mg+FTC 200 mg Truvada Price 2,100.00 (30 tab)

23 Etraverine 200 mg Intelence Price 10,200.00 (120 tab)

24 Tenofovir 300 Tenofovir (India) Price 810.00 (30 tab)

25 Raltegravir 400 ISENTRESS Price 16,680.00 (60 tab)

Malaysia
Caring Pharmacy branches are reported to stock antiretroviral drugs.

=Subsidy=

Tzu Chi Foundation is reported to subsidise the treatment of PLHIV in Singapore, or at least a good portion of it. You will need to apply with them directly and once approved, they will subsidize your medications.

=Pre-exposure prophylaxis (PrEP)=

Prevention of HIV infection is much more cost-effective than managing post-infections. Commonly known as Truvada, medications are still expensive at around 500USD a month but lower than post-infection medication costs (PEP) although affordable service providers like prepsingapore.com has began to servicing Singapore clients who have budget constraints.

Studies of PrEP being used on demand (48 hours prior exposure until 48 hours after) were more than 86% successful in preventing HIV infection in sex without condoms and continuous usage daily has been shown to be more than 90% in HIV infections.

PrEP in Singapore
Affordable options has also become available - Prep Singapore, or Prepsingapore.com has partners across Asia which provides legitimate access to PrEP for Singaporeans at substantial cost savings vs traditional channels, whilst maintaining a prescription or blood test based model, approved by doctors.They provide both Teno Em and Truvada as well as Advanced PEP thru doctor blood tests and prescription mailed to Singapore homes with a limit of 3 bottles per time.

=Post-exposure prophylaxis (PEP)=

Introduced to the MSM community in 2014 in a big way by AfA.

Available at DSC and Dr. Tan & Partners.

Dr. Tan & Partners
What HIV PEP drugs do we use?

We use the latest Gold Standard PEP Medicines with fewer side effects and better HIV prevention. This is in accordance with the latest International Standards.

We use a variety of different Anti-Retro Viral medications in various combinations based on a patient’s specific circumstances.

We do not believe in a ‘on-size-fits-all’ approach.

Although different medicines are used, they all have to be taken for 1 month.

What are the HIV PEP side effects?

With the new PEP Drugs we use, side effects are very rare. Fewer than 1 in 100 of our patients actually develop any side effects.

Common (< 1%) side effects include nausea, diarrhoea and feeling very tired.

Rash and fever are uncommon (< 0.1%) side effects.

There is a theory that these drugs can affect the liver and kidneys temporarily so these have to be monitored.

We routinely monitor all patients who take PEP but have never come across anyone develop kidney or liver problems with the medicines.

The new HIV PEP Drugs that we use are much more less side effects than the old medicines. Make sure you know what drugs you are taking before you start on the PEP.

How much does the HIV PEP cost?

The usual costs involved are:

Consultation $60-$80 Depending on the duration of the consultation Blood tests (Full Blood Count, Liver Function, Kidney Function) $140 These tests are to establish a baseline We do not need to wait for these results to start the PEP treatment You may not need these tests if you had them done recently e.g. when you did an executive health screening Rapid HIV test $50 This is to ascertain that you do not have an established HIV infection Medication $1800 This is for the entire 1 month of medication The price is the same regardless of which drug regime we use

Total cost $2193.50 – $2214.90 with GST

Other private clinics charge between $2800 and $3500 for their PEP treatment.

Why are we so much cheaper?

Our margins on drugs are much smaller We do not sell you a ‘package’ that forces you to come back to us for follow up    We do not do unnecessary tests like STD screening tests which are going to be inaccurate anyway We also do not do unnecessary tests for a ‘health screening’

So what now?

If you think you are at risk of being infected with HIV, come down to see us as soon as possible.

We will have an in depth discussion with you on your risks and whether or not it is recommended that you take PEP.

We are a walk in clinic, you do not need an appointment.

28-day course costs about $300.

=See also=


 * HIV/AIDS in Singapore

=References=


 * Blowing Wind discussion "Cost of HIV drugs in Singapore":