All public hospitals to implement opt-out HIV screening on inpatients by year's end
By Pearl Forss, Channel NewsAsia | Posted: 08 November 2008 2045 hrs

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SINGAPORE: HIV screening will be an opt-out process in all public hospitals by the end of this year.

This comes as HIV infection rates continue to climb. In the first nine months of this year, there were 345 new cases, and the Health Ministry expects the year's total to exceed last year's 423 new cases.

Since last December, Changi General Hospital has diagnosed 50 HIV-positive patients out of the 3,000 people who participated in the pilot voluntary opt-out HIV screening programme. In fact, seven in 10 patients opted out.

An earlier survey showed that one in 350 patients discharged from hospitals had HIV, but were not being diagnosed.

"Such patients may not have been tested for HIV during their admission for a whole lot of reasons, perhaps because their doctors failed to take their detailed history, which is often very time consuming," said
Senior Minister of State for Foreign Affairs, Dr Balaji Sadisivan.

"Whatever the reasons for failing to diagnose HIV may be, this is not something our hospitals can be proud of. Every failure to make the proper diagnosis of all the medical problems of a patient, including HIV, may represent a failure on the part of the hospital and the doctor," he added.

"One of the reasons could be that in hospitals, many of the people are very specialised. We need a mindset change in hospitals and doctors so that they are more in tuned with the HIV problem," said Dr Balaji.

He was speaking to reporters at an AIDS conference in Singapore. Dr Balaji is also the chairman of the National HIV/AIDS Policy Committee.

Failure to diagnose HIV also leads to higher infection rates in society.

With treatment, the possibility of HIV being transmitted is reduced by up to 90 per cent.

But in Singapore, more than half of new cases are already in a late stage of infection when they are diagnosed, meaning they were unaware of their infection for the past eight to 10 years and could have spread it to their partners.

An opt-out HIV screening programme in public hospitals will certainly reduce its spread.

The Health Ministry is also talking to private hospitals about implementing such a programme.

But experts say that without access to treatment, many may not want to test for HIV.

Roy Chan, president of Action For AIDS, said: "You have to give people a reason why they want to get tested....(screening)... that is not the end of the story, you still have to provide support services.

"Currently, the programmes are not strategic. Patients who have to seek medication overseas are really doing it on their own.

"For example, getting medication, the supply may not be completely reliable. It will require that they make overseas trips indefinitely."

Due to a lack of funding here, the majority of HIV patients get their medication in Thailand or Malaysia.

Dr Balaji said: "The issue is that in our current funding system, there are drugs that are on standard list and on the non-standard list.

"And there will always be arguments about which drug should be on the standard list or non-standard list. Ultimately, we leave it to the experts, doctors who sit on the committee, decide what's standard and non-standard drug. And we should let them decide."

HIV medication is not subsidised in Singapore, unlike medication for other chronic diseases.

Latest data show that if a person is diagnosed and receive treatment, the person can live for another 40 years.

- CNA/ir