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SINGAPORE: When French virologist Francoise Barre-Sinoussi co-discovered the Human Immunodeficiency Virus (HIV), little did she expect that 27 years later, stigma would be one of the biggest obstacles that patients would face, and worse - that many would not have access to treatment.
Today, despite the progress made in research, about 60 per cent of HIV-infected patients are still not treated.
"I'm very furious," said the 2008 Nobel Prize of Medicine winner. "I'm furious also to see that people are discriminated (against)."
The self-described "scientist-activist" also lamented that "we will not reach the (global) objective of universal access to treatment by 2010".
In Singapore's case, "the stigma, the fact that they (people) have to pay everything, it's the worst condition for stimulating people to be tested and treated", said Professor Barre-Sinoussi.
Prof Barre-Sinoussi, who was at the Biopolis last week to share her latest research findings on natural protection against Aids, said she was initially impressed with Singapore's "wonderful facilities". "Then, I rebalanced my positive view," she said.
Singapore's proportion of new HIV cases - there were 456 in 2008 and 423 in 2007 - to the general population is "a little more" compared to France, said the research director. Throw in "stigma and discrimination" - the No 1 barrier to tackling HIV/Aids - and the figures are probably under-reported, she said.
"Coming from a country (France) where everything is free, this is difficult to accept," she added.
"HIV, like cancer, is a very severe deadly disease and should be considered as 100 per cent free for patients," she stressed.
When contacted, the Ministry of Health (MOH) agreed that the stigma of HIV was "still prevalent" here.
It is working to encourage greater acceptance of people with HIV.
But MOH pointed out that unlike France, where the state-funded healthcare system "means a higher tax burden", Singapore's approach of "heavy Government subsidies and co-payment" allowed for affordable healthcare without heavy taxes.
"Like all other patients, HIV/Aids patients have access to subsidised ... care," said MOH. Patients here can use Medisave and Medifund.
HIV prevalance among Singapore residents is "similar" to other developed nations, said MOH.
It was about 0.1 to 0.2 per cent last year, while UNAIDS 2008 figures showed France's HIV prevalence at 0.4 per cent.
MOH said it had "expected" that more HIV-infected people would be discovered as MOH encouraged testing. Over half of 2008's new cases had late-stage HIV infection.
But what is the cost to the economy when young people who should be working die, asked Prof Barre-Sinoussi, suggesting that Singapore conduct studies to determine the cost. "The answer (in similar studies) was clearly in favour of access to free treatment," she said.
Action for Aids' executive director Lionel Lee said free treatment subjects the healthcare system to abuses and "may not translate to long-term economic benefits" because of the side effects of HIV medication.
For now, the "test and treat" concept on trial in some countries is "very attractive" to Prof Barre-Sinoussi.
It aggressively tests for HIV, and promptly treats those infected with anti-retroviral drugs.
Patients are much less likely to transmit the disease, and reports say this approach could halt the HIV epidemic by 2040.
But it would be complicated to apply this concept universally because of, for instance, stigma, said Prof Barre-Sinoussi. The next step is to ensure access to treatment in developing countries, she said.
But Prof Barre-Sinoussi is "very sceptical" that the virus will be conquered in this lifetime because "it's almost impossible" to eliminate all the HIV-infected cells.
Researchers are working at developing a vaccine to suppress HIV replication, she said, as this will delay the development of Aids and reduce transmission.
Research has found a group of "elite controllers" - under 0.3 per cent of the HIV-infected - who have developed a "natural protection" against the development of Aids, and they are "fine, without any treatment," she said.
Her views on HIV have come a long way since the virus was first discovered in 1983. Prof Barre-Sinoussi said her confidence then in treating HIV was "so naive".
She and her fellow researchers only started realising the "magnitude of the epidemic" in 1986, when an African colleague had sought help for his country during a conference, at the risk of being thrown in jail.
- TODAY/sc
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