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NMP’s views at odds with AIDS relief research paper

Posted by theonlinecitizen on October 27, 2007

By Jinesh Lalwani and Choo Zheng Xi

Safe sex awareness pamphlets censored as pornography. Information booths closed down for distributing “illegal” content. Awareness outreach funding stifled by choking off of charity fundraisers by homosexual groups.

The government has given its repeated assurances that s377A of the Penal Code criminalizing ‘gross indecency’ between two men will not be enforced. However, evidence from healthcare workers on the ground seems to highlight a far more insidious effect of 377A.

A paper by Aids relief expert Associate Professor Roy Chan, President of Action for Aids Singapore, highlights how 377A hobbles HIV prevention efforts by the local sexual healthcare community.

The paper, titled “Sections 377 and 377A of the Penal Code – Impact on AIDS Prevention and Control” (see below) makes a case for how 377A’s continued retention harms efforts to bring down STD rates among men who have sex with men (MSM). The criminalization and attendant discrimination of gay men hampers the effort to reduce the growing rate of transmissions between MSM.

In particular, it points to three former British colonies – Hong Kong, Australia and New Zealand, which have dismantled their anti-gay sex laws. They have since run comparatively more effective and successful AIDS control programs than Singapore.

In the recent Parliamentary debate, NMP Thio Li Ann advanced a public health reason for retaining 377a, saying:

“The New York Times reported that even informed homosexuals return to unsafe practices like bare-backing and bug-chasing after a health crisis wanes.

A British Study showed that the legalization of homosexual sodomy correlated with an upsurge of STDs among gays. Common sense tells us that with more acceptance, any form of consensual sexual behaviour increases. Sodomy laws have some deterrent effect.”

Ms. Thio’s assertions that retaining the law will prevent a public health crisis are directly contradicted by A/P Chan’s study.

In fact, the study points out that an epidemic is being perpetuated by the very law she seeks to retain.

377A hinders HIV prevention and awareness efforts

Contrary to NMP Thio’s position, the paper highlights how 377A effectively precludes healthcare workers and voluntary organizations from identifying and targeting MSM as a distinct group for the purposes of targeted treatment.

That there is a HIV epidemic amongst the homosexual community is not denied.

The paper highlights that in Singapore, although the majority of HIV infections are contracted through heterosexual sex, there is an expanding epidemic in MSM who, in 2005, formed 30% of newly diagnosed infections. By the end of that year, the cumulative number of HIV/ AIDS afflicted persons was 2852.

However, the study singles out 377A and its negative implications on hindering HIV outreach to the constituency that needs the outreach most.

One of the knock on effects of 377A is that much material on safe sex between homosexuals has been banned because of its homosexual content.

The study reveals:

“Action for AIDS has on several occasions been asked to stop distributing materials containing information on homosexuality even though these materials were meant specifically for MSM venues and events. The reasons repeatedly given by the authorities were that because homosexual sex is illegal, it cannot be mentioned; therefore providing information on safe sex relevant to MSM is also illegal.”

The study also cites examples of how AFA was asked to close down a safe sex awareness booth at MSM parties, the reason being that the material contained homosexual content.

A concert by a Christian gay support group was banned in 2005 by the authorities: the proceeds from the concert were to go to funding outreach efforts by AFA.

In contrast to the ignorance and stigma that 377A engenders in Singapore, the study highlights extensive research on foreign jurisdictions that have decriminalized homosexual intercourse.

Case study: Hong Kong

Hong Kong decriminalized sodomy in 1991. Yet, Hong Kong’s 6.9 million population had 2825 persons suffering from HIV/ AIDS in the same year. Hong Kong has over 50% more people than Singapore (4.5 million), but has 27 less reported infections than in Singapore.

Although Hong Kong has noted a rise of HIV infections in MSM, they have been proactive about the situation. The Hong Kong Advisory Council on AIDS in 2006 recommended that HIV prevention programmes “should be sensitive and specific for the culture of different sub-populations”. It also hailed “a non-discriminating and enabling environment”, underpinned by strong “policy, funding and technical” support from the government as a key ingredient to fighting the war on HIV/ AIDS.

Gay community groups and AIDS organizations are openly supported by the health department, and are actively involved in AIDS prevention activities in both Hong Kong and mainland China.

Case study: New Zealand/Australia

In New Zealand, which decriminalized homosexual sex in 1986, the pravelence of HIV infection among adults aged 15 to 49, according to the World Health Organisation, is 0.2%. Singapore has a prevelance rate of 0.3%.

Australia began decriminalization with South Australia (1972), and completed it in Tasmania (1997). Prior to repeal in Queensland, the National Health and Medical Reseach Council found that Queesnland had more than twice the rate of HIV infections and related deaths than South Australia, even, a comparatively higher rate as a percentage of its population.

The Australian Federation of AIDS Organizations in 1989 argued that outlawing homosexual acts would place impositions on health programmes targeting at-risk groups, because “the government cannot be seen as supporting or encouring illegal activity”, and that individuals cannot be engaged because they fear there may be negative repercussions.

The Queensland AIDS Council went further, saying that the attitude towards homosexuality severely blunted the response to the AIDS crisis there:

“If there had been State government support for education and behavioral change programmes, it would not be unreasonable to claim that 25 percent of the cases of Aids woudn’t have occurred.” The law was finally struck down in 1990.

How does this square with the Singapore scenario? NMP Thio is rightly concerned that an escalation of disease is something that warrants concern. Yet, going by the experience of other countries, 377A would be a blunt tool to deal with the problem. It is clear that a law that requires people to acknowledge they have sex which is illegal before receiving treatment does not help the cause of HIV prevention.

The deterent effect of the law is not one of disease prevention, but in preventing a man from saying “I had sex with another man”, hence incriminating himself. This is despite the fact that this candour is the surest way of ensuring proper, targeted education for at-risk individuals. .

A/P Chan’s paper quotes New Zealand researcher Dr Phil Parkinson, commenting on his country’s own laws:

How on earth could an effective campaign against an epidemic be carried out if the very measures to prevent infection, such as the promotion of safety in sexual practices were vitiated by the confirmed criminal sanctions against those very practices?”

Associate Professor Roy Chan’s research paper: “Sections 377 and 377A of the Penal Code – Impact on AIDS Prevention and Control” can be found here.

—————————————-

Jinesh is a first year undergraduate at the NUS Faculty of Law. He has experience writing for several mainstream magazines and online publications.

Editor’s note: A/P Chan’s paper was written before the recent Penal Code amendments, hence the reference to s377 of the Penal Code, which has since been repealed.

A/P Chan is also the director of the National Skin Center.

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22 Responses to “NMP’s views at odds with AIDS relief research paper”

  1. Thanks guys for this article. If I may ask, what is the citation for the paper? Am thinking of quoting this and Lynette Chua’s paper as substantiation in argument. Further thanks in advance! 🙂

  2. sarek_home said

    The following is from A/P Chan’s paper:

    The epidemiology of HIV infection in HK SAR closely resembles that of Singapore in a number
    of ways. The cumulative number of HIV/AIDS at the end of 2005 was 2825 (Singapore 2852).
    The male to female ratio of infections in 2005 was 4:1 (Singapore 9:1); MSM formed 37% of
    infections in 2005 (Singapore 30%).
    Hong Kong has over 50% more people than Singapore, however it has the same number of
    reported HIV infections than Singapore, i.e. our HIV problem is 50% bigger than Hong Kong’s.

    The our HIV problem is 50% bigger than Hong Kong’s seems to be based on the assumption that Hong Kong has over 50% more people than Singapore so its homosexual population is also 50% more. Is this assumption factual?
    It appears the paper wants to associate this our HIV problem is 50% bigger than Hong Kong’s claim with the policy used in HIV prevention efforts in MSM in Hong Kong to justify the argument of repealing 377A.
    How do we explain that while the MSM infection figures are close: MSM formed 37% of infections in 2005 (Singapore 30%) yet there is big differences in male to female ratio of infections: 2005 was 4:1 (Singapore 9:1>?
    It would appear more Singapore heterosexual men are infected? Why? Drug usage? Sex tour to neighbouring countries? Wild unprotected sexual lifestyle among Singaporeans?
    We all know that HIV problem is not a “homosexual only” problem. The above questions raised factor in the consideration of the sexual behaviors of the HIV infected groups in both Hong Kong and Singapore which this paper omitted to provide proper breakdown.
    Hence, there is no reason to accept any suggestion that the “policy used in HIV prevention efforts in MSM in Hong Kong” helped to reduce HIV problem in HK by half as the our HIV problem is 50% bigger than Hong Kong’s implied.

  3. sarek_home said

    One of the knock on effects of 377A is that much material on safe sex between homosexuals has been banned because of its homosexual content.

    The questions are:
    Why safe sex material need to be sexual orientation specific?
    Is there any difference in safe oral sex and anal sex between heterosexual and homosexual?
    Will safe sex materials targeting the sexual act without specific regarding homosexual or heterosexual reference equally effective?

  4. […] so its homosexual population is also 50% more. Is this assumption factual? …Original post by sarek_home delivered by Medtrials and […]

  5. sarek_home said

    It is clear that a law that requires people to acknowledge they have sex which is illegal before receiving treatment does not help the cause of HIV prevention.

    While 377A makes homosexual acts illegal, I have to ask what is this “acknowledge they have sex which is illegal before receiving treatment” means? Is there a requirement of declaring sexual orientation before treatment is administrated? Are people fear of “acknowledge they have sex which is illegal” even it is a knowledge within the confine of doctor-patient relationship?

    The deterent effect of the law is not one of disease prevention, but in preventing a man from saying “I had sex with another man”, hence incriminating himself. This is despite the fact that this candour is the surest way of ensuring proper, targeted education for at-risk individuals.

    Is there any case where a man from saying “I had sex with another man”, hence incriminating himself and such individuals get charged?

  6. sarek_home said

    HIV infection is being diagnosed in younger MSM, this trend is evident in recent years (Figure 4).
    Of the 101 MSM diagnosed with HIV infection in 2005, 4 were in their teens, 24 were between 20
    to 29 years, and 44 between 30 to 39 years of age at diagnosis.

    While figure 4 shown HIV infection is being diagnosed in younger MSM, it also shown big increment among the 30 to 39, and 40 to 49 age groups. Why?

    I have to say that to show “377A hobbles HIV prevention efforts”, we have to compare infection trend between the heterosexual group and the MSM group. The report need to show something like “HIV infection is being diagnosed in younger MSM” but not in younger active heterosexual people.

    However, we know younger heterosexual active individuals get STD also:

    http://www.singaporeangle.com/2006/12/premarital-sex-whose-burden.html

    According to figures from a Straits Times dated 12 November 2005, in the 5 years prior to 2005, there was a yearly average of 1,500 teenage abortions, 840 teenage mothers and more than 600 teens who contracted sexually transmitted infections. A report (.pdf) by the Ministry of Community, Youth and Sports also concluded that teenage sexuality is an area of concern.

    The Queensland AIDS Council went further, saying that the attitude towards homosexuality severely blunted the response to the AIDS crisis there:

    “If there had been State government support for education and behavioral change programmes, it would not be unreasonable to claim that 25 percent of the cases of Aids woudn’t have occurred.” The law was finally struck down in 1990.

    Again, there need a contrast of statistics between heterosexual and homosexual groups to justify the severely blunted the response to the AIDS crisis claim.

  7. xpy said

    roy chan is also the editor of the International journal sexual health. and A/P of NUS med school

  8. Zheng Xi said

    Hi Cognitivedissonance,

    This paper wasn’t published in a journal at the time it came into our possession. You might want to do a medical journal database search to see if there’re any updates on its publication history though.

  9. […] Numb: Blaming the victims – Hear ye! Hear ye!: Of morals, rights and harm – The Online Citizen: NMP’s views at odds with AIDS relief research paper – Theory.isthereason: What Singapore could learn from the 377A debate… – The Kway Teow Man: On […]

  10. ET said

    Some observations:

    The paper has indeed given proof that homosexuals are far more likely to contact STDs than heterosexuals.

    “In 2005, MSM formed 30% of newly diagnosed infections.” -> This figure shows that homosexuals account for a very huge proportion of those who contact STDs.

    As someone pointed out:

    Why safe sex material need to be sexual orientation specific?

    Is there any difference in safe oral sex and anal sex between heterosexual and homosexual?

    Will safe sex materials targeting the sexual act without specific homosexual or heterosexual reference be equally effective?

  11. sarek_home said

    Hi ET,

    If you are referring to this:

    In summary although the majority of HIV infections in Singapore are contracted through heterosexual sex, there is an expanding epidemic in MSM who now form 30% of newly diagnosed infections.

    then, you should take note that the 30% is limited to HIV infections, not STD infections in general.

    This is another issue with this paper. If the focus is on One of the knock on effects of 377A is that much material on safe sex …, then the more accurate way to gauge the effect is to include all STD infections between heterosexual and MSM instead of limiting to HIV in the statistics argument.

  12. Kris Lee said

    With regards to the issue of safer sex materials, it is related to the principles of marketing.

    For generic matters, such as promotion of courteous behaviour or anti-littering, a single message can be used for all instances.

    However, when it comes to the more private and sensitive topic of sex, sexual practices and sexual behaviours, more targeted messages need to be sent.

    Just imagine, if the message is a generic one promoting the practice of safer sex through the use of condoms, most people looking at it will think that it does not affect them, and will just dismiss it.

    Specially-tailored campaigns are usually more effective in these instances. For the straight community, especially those who visit sex workers or engage in anonymous sex with multiple partners, the message can be that if they take risks, they may end up infecting their girlfriends/wives with STIs, and their future children can be affected.

    For the sex workers, the message is more of advising them to empower and protect themselves. Afterall, if they were to fall ill or get infected with STIs, their means of livelihood will be directly affected.

    The focus has to be different for the gay community because the ‘girlfriend/wife’ argument does not apply. To make the message convincing, the materials have to address the dangers of unprotected oral and anal sex between. The problem is that these are considered as acts of gross indecency under S377A of the Penal Code.

    So, how does one talk about safer sex in relation to activities that are criminal in nature, and something which is not even supposed to be practised in the first place? That is the dilemma that organisations such as AFA face when coming up with suitable campaign materials.

    Hope the above helps to enlighten….

    P/S: The terminology commonly used is ‘safer sex’. The only 100% safe sex is solo sex. Once there is a partner involved, especially an anonymous one, there will be risks involved. Using the various preventive measures help to make it safer, but there is no 100% guarantee of complete safety.

  13. sarek_home said

    The focus has to be different for the gay community because the ‘girlfriend/wife’ argument does not apply.

    Simply replace this ‘girlfriend/wife’ with “partner/significant other” and it will work fine.

  14. shoestring said

    Very good observation Sarek_Home. I don’t see how s377A prevents materials on safe sex, applicable to everyone, from being distributed to homosexuals. Unless the writer is suggesting that homosexuals will only read materials that are specifically customized for them, which begs the question – don’t homosexuals read magazines, newspapers, watch commercials etc.?

    Assuming that homosexuals only read customized materials, the problem isn’t s377A, but perhaps the attitudes preferences of the homosexuals. The presence of absence of s377A is not relevant.

    Repealing s377A to coax homosexuals to change their attitudes and reading preferences is akin to giving in to an already spoiled brat who should be taught the proper way to behave instead.

  15. WeiHan said

    Shoostrings,

    You can save all your uncompassionate ranting.

  16. J said

    Shoestring:

    “Repealing s377A to coax homosexuals to change their attitudes and reading preferences is akin to giving in to an already spoiled brat who should be taught the proper way to behave instead.”

    “Giving condoms to coax straight couples to prevent pregnancy is akin to giving in to wanton couples who should just abstain if they want to stop popping out kids.”

    Sports injuries occur amongst professional S-league players at a higher incidence than they do your typical neighbourhood soccer league. Do you “give in to them” if you promote specific injury minimising training methods relevant to pro-athletes in their club’s newsletter? or is it enough to have an article on stretching tips for people who exercise published in Mind Your Body? Would doing the former be “giving in” to “already spoiled brats” who should change their reading habits/ behaviour (because they shouldn’t be playing that much sport if they don’t want to be injured in any case)?

    This is a simple question of relevance and effectiveness. Some time ago, there was a campaign that ran across bus stops. It depicted a dank, dim bedroom, in which the bed’s headboard was a gravestone, and a girl – presumably a sex worker – in dark shadow with the warning not to have unsafe sex unless you wanted to go to your grave.

    Most gay men do not visit prostitutes/ have sexual contact with women, so the ad’s pitch is entirely lost on them. Mainstream advertising is accessible only because it’s placed all over, but there is a tendency to tune off when an ad does not concern oneself.

    “don’t homosexuals read magazines, newspapers, watch commercials etc.?”

    Firstly, don’t be facetious; secondly, even if they read “mainstream” (what is mainstream? 8 days? and GQ would be esoteric?) magazines/ watch TV. Mediacorp has excised every gay sub-plot in their foreign shows, and how many times can they run that Paddy Chew story? Show me a programme that talks about health issues facing gay men frankly, and i’ll say the law isn’t standing in the way of education.

  17. sarek_home said

    the ad’s pitch is entirely lost on them

    Why try to drag in a heterosexual safe sex message example when we are asking why not using sexual orientation neutral safe sex act material?

    It shows how creative is the mind and we have to wonder if the “the ad’s pitch is entirely lost on them” statement underestimated that power of association.

  18. J said

    Sarek

    “Why try to drag in a heterosexual safe sex message example when we are asking why not using sexual orientation neutral safe sex act material?”

    Sexual orientation neutral? Orientation is axiomatically something which one is inclined towards, so there is no ‘neutrality’ and would be pretty foolish of advertisers not to play certain inclinations up in their ads.

    Suppose the cat food market isn’t being effectively targeted, while there are many dog food ads in circulation. Do you think having an ad that sells food for pets (pets being ‘animal neutral’) would appeal to both cat and dog food owners?

    “Power of association”

    The association becomes most tenuous and derivative, and the message becomes ineffective for both straight and gay people, if you have neutral ads. In no country has a blanket one size fits all HIV campaign worked. I doubt it’s gone done effectively in this one.

  19. sarek_home said

    The term used is “sexual orientation neutral safe sex act material”, the ‘neutral’ is not carrying any sexual orientation specific message.

    Say, do we need charity fund raising Ads targeting specific social groups or the Ads can be effective to all in general. Don’t just think straight or gay, think sexually active and safe sex. How you think shape the kind of Ads and effective messages.

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  22. […] at odds with AIDS relief research paper. The Online Citizen. Accessed on 10 December 2010 from: https://theonlinecitizen.wordpress.com/2007/10/27/nmp%E2%80%99s-views-at-odds-with-aids-relief-resear… Explore posts in the same categories: Ethics, Religion, […]

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