We are treated differently:
8 HIV patients share their stories

Mr Calvin Tan, 28, recalls when he told his mother he was gay. He was 15 years old. Her response was curt: “Continue this lifestyle, and you’re going to get Aids.”

“That will never happen to me,” he replied.

By the time he was 19, he was regularly engaging in unprotected sex and having one-night stands with strangers. Looking back, he says this was coping behaviour, as he was confused about his sexuality.

“As a gay boy whose likelihood of impregnating females was zero, and who was indifferent about sexually transmitted diseases (STDs), I thought I had a free pass when it came to consequences,” says Mr Tan, who was then a student in Singapore Polytechnic.

In March 2015, he found himself bedridden for a month, battling a high fever. He connected the dots, thinking that he might have caught an STD. When his fever subsided, he decided to go to AfA’s anonymous test clinic. There, preliminary results of an HIV test indicated he could be infected.

“I felt like the world just stopped,” recalls Mr Tan. It would take two more weeks for the diagnosis to be confirmed.

Without an income, he questioned how he would afford treatment. Should he tell his family and friends? Would he even be able to find a job with his diagnosis?

“I remember feeling that I had let myself down, because it was something that could have been prevented,” he adds.

He decided to keep his diagnosis from his family. His medication cost $600 a month, but as a student, he was able to apply for financial assistance under MediFund and had to pay only $60.

He received a weekly allowance of $100 then. “I set the money aside once I got my pocket money. Even in months when it was tight, I just had to find the money for the medication,” he says.

That period felt extremely isolating for him. Even though he had the phone number of an AfA staff member, he did not confide in anyone.

“I had no one I felt I could trust to talk to. I told myself that this happened because of my decision. So I didn’t really contact anyone, I just kept my thoughts to myself.”

A few months after he got his diagnosis, he chanced upon an advertisement for a campaign called Paint The Town Red. It was a final-year project by a group of university students who wanted to spread awareness about HIV.

“Though I had yet to fully process my condition, I felt this pull to reach out and share my story,” he says.

Sharing his story with the students lifted a weight off his chest. It was the first time he had told anyone other than his doctor that he had HIV.

He found it cathartic. After that, he looked online and asked around the AfA network for closed-door sharing sessions for PLHIV. There, he started sharing his story with more people.

Thanks to antiretroviral medication, Mr Tan has been able to live a more or less normal life for the past nine years. He takes a pill called Triumeq, which used to cost him around $600 a month. Thanks to subsidies, it now costs him $200 a month. His viral load is so low that a standard lab test cannot detect it.

“Whenever it is time for my daily medication, I open my pill case, take a second to look at it, and remind myself that I am taking charge and care of my own health. It’s a daily affirmation that I’ve followed since day one, and it has helped me tremendously.”

While medication kept the virus in check, he still struggled initially with how to break the news to those closest to him.

It took him a year to tell his close friends, and another year before he told his family.

He braced himself for a negative reaction when telling a school friend, but was taken aback when she reacted with a mix of surprise and concern about his well-being.

“I guess for her, to see someone of a friendly disposition go through an ordeal all by himself was worrying. Shortly after, I selectively shared my diagnosis with acquaintances. I began to need some support – some validation that I deserved to be around, to live on this earth.”

He decided to tell his parents when he found out he was exempted from national service, as he did not want them to learn about his HIV status from the exemption letter that would be sent to their home.

He told his father first.

“I was already prepared for him to scream the words ‘get out of my house’. What surprised me was how knowledgeable my father was about it. For one thing, he knew that with treatment, the virus could be kept in check.”

He told his mother a few months later.

“She was devastated by the news, as she thought I was going to die. Then came the ‘I told you so’ and the ‘I knew your lifestyle was going to kill you’ remarks.”

He decided to bring his mother along for a doctor’s appointment to assuage her fears.

As his doctor began talking to her about HIV, and how he had been diligent with his treatment, she said: “Thank you so much for taking such good care of my son.”

From the cost of treatment to the lack of awareness surrounding how HIV is transmitted, today’s PLHIV still face many challenges, says Mr Tan.

“A routine check-up costs around $200, and a working adult can afford that, but what about those who aren’t working? Those in the army can’t. Students can’t.”

He adds that many PLHIV do not disclose their status to their family members. This means some are unable to get the necessary documents to apply for assistance under MediFund.

“I wanted things to change. I had to suffer through my diagnosis alone because I was ashamed of myself.”

In 2018, he decided to do an interview with media outlet Mothership, which ran his name and photo. He wanted to put a human face to HIV while sharing what the journey is like for PLHIV, from the point of diagnosis to daily routines.

“If even my parents, who are of the older generation, can accept my condition, maybe society no longer sees HIV as a stain. Maybe all my worries were unfounded,” he reasoned then.

He adds: “Medical advancements today have allowed us to live longer and healthier lives, so it would be great to be seen as human too.”

It has been six years since Mr Tan started being publicly open with his diagnosis. He has noticed less stigma around PLHIV in recent years, along with greater understanding of how the virus is transmitted.

Previously, his sexual partners often ended things as soon as he revealed his status, reacting with visible discomfort, while some friends distanced themselves.

In recent years, new partners he meets have been more understanding, asking about his experiences. They are also aware of the fact that he would not transmit the virus to them, even without the use of a condom.

“However, we are still treated differently,” he says.

Today, Mr Tan is one of just six openly HIV-positive individuals who have become AfA ambassadors, out of the 7,083 PLHIV recorded here at the end of 2023.

Since 2018, he has been working full time in AfA’s outreach programmes department, and is currently a programme executive. He helps to plan HIV prevention and safer sex programmes for marginalised communities.

A person’s health is their private responsibility, and it is their choice how much and whom they want to share their health condition with, so being an ambassador is not for everyone, Mr Tan adds.

After his interview with Mothership was published, he was targeted by an anti-LGBT group and criticised for “wasting taxpayers’ money”. Online trolls have sent him hate messages through his social media profiles.

“You slot yourself into a position that greys in between being human proof of modern medicine and being an attention seeker for validation. You get recognised by people you don’t know. Your friends and loved ones become targets of serophobia,” he says, referring to an extreme or irrational fear of people living with HIV.

In October 2023, Cherry (not her real name) found herself suddenly losing a lot of weight. Within a month, she became a gaunt 55kg from her usual, slightly plump 68kg. She also started shedding hair in clumps.

“I was thinking: ‘What the hell is it? Old age or what?’ I couldn’t understand what was happening. I was eating normally,” says the manager, who is in her early 50s. She declined to disclose what industry she is in.

She went to see a doctor, did a full medical check-up, had scans from head to toe and even saw a specialist. Nobody could tell her what was wrong with her.

At a doctor’s suggestion, she went for an anonymous HIV test. She was shocked when the results came back positive.

Her last relationship, which lasted six months, had ended more than 10 years ago.

“I didn’t know he was HIV-positive, I also did not check. I haven’t had sex with anyone since then,” Cherry says.

The virus had remained undetected even though she went for regular health check-ups.

“I was very normal, you know? I was like, going around the world. I was doing my work, I worked long hours, and I exercised every day. I never had any serious illness, I was in perfect health.”

Everything felt like a blur in the wake of the discovery. But she recalls a doctor giving her some hope: The condition was treatable, medical advancements were on her side, and she could likely have a normal lifespan.

“I had heard so many scary stories of people, including famous singers, dying... After much education from the hospital and the doctors, I realised that it is actually a treatable condition.”

The doctor prescribed her Triumeq, which she needs to take at a specific time once a day.

“After one week on medication, suddenly, it was like the whole world became a rainbow. I felt so different. There were no side effects for me,” she says.

Thanks to the medication, her immune system bounced back – before she was diagnosed, she often caught Covid-19, sometimes even monthly. Her HIV viral load is undetectable.

“The medication is really very wonderful, it’s like a miracle drug,” she says.

Cherry, who lives alone, barely even took any time off from work. She takes just a few hours off to go for a check-up every few months.

In the year since, she has gained back the weight she lost, and her CD4 count has improved. HIV attacks white blood cells called CD4, reducing the body’s ability to fight infections. A low number of CD4 cells indicates a weakened immune system.

Aside from her doctors and her medical social worker, she has not told anyone about her diagnosis, including her elderly parents and brother.

“I don’t think I will tell anybody,” she says, wanting to avoid gossip and questions about how she got infected, as well as making people apprehensive about being around her due to their misconceptions.

AfA’s Prof Chan says that even now, recently diagnosed PLHIV are still hesitant to openly reveal their HIV status to friends and family.

“They don’t want to be discriminated against at home, in the community and at work. They are afraid to lose their social support network,” he says.

“Generally speaking, the younger generation of PLHIV is less frightened to come out to their families and friends, and even to the public. We have several who have become the faces of HIV in Singapore.

“While it can be very empowering, it does take a lot of courage for anyone to do that.”

Nestled in a quiet corner of Thomson is a residence with a spacious garden in the back. Here, the Catholic Aids Response Effort (Care) charity – a member of Catholic social organisation Caritas Singapore – operates a shelter for homeless PLHIV, and has provided a safe haven for more than 100 men since 2002. The shelter can house up to 20 people at a time.

Paul (not his real name) is one of 11 current residents there.

A slight man with a buzz cut, the 68-year-old has lived with HIV for more than half his life.

When he was in his 20s, he worked odd jobs – such as at a petrol kiosk and as a painter – and never stayed in one job for more than a few months.

“I was a womaniser. When I was young, all I thought about was partying and clubbing. Carefree life lah, that time,” he says.

One day in the late 1980s, he suddenly fell sick with a high fever. Rashes developed all over his body and spread rapidly. He went to a clinic and then to a hospital, where he had a blood test. A few days later, he was asked to return to the hospital.

“Before he told me the results, the doctor said, ‘You must be mentally prepared.’ Why? Why must I be mentally prepared?” Paul says, recalling his reaction. “Then, he told me I was HIV-positive.”

At that point, he had heard of the virus, but it had never crossed his mind that he would get it. For about a week, he could not eat or sleep. He heard there was no cure for HIV, and thought about dying by suicide.

Then, a counsellor from the hospital told him there was medication he could take to prolong his life and manage the condition, and he was not doomed.

But the medicine was expensive, as there were no subsidies then, and cost Paul up to $500 here. “I had to buy it from Thailand,” he says.

Both his parents, first-generation migrants from China, had died before his diagnosis. He has some living relatives here, but has since lost contact with them. “Actually, we were very close, but I don’t want to let them know all this.”

Younger people who were more recently diagnosed with HIV may be more open about their status, but he prefers to keep his a secret. In all his decades living with HIV, he has told only two close friends.

In 2004, he was unemployed and did not have a place to stay. His social worker referred him to Care, where he has lived since.

For the past two years, he has been working as a cleaner. He takes Dovato, a fixed-dose combination antiretroviral medication, which he gets from a Singapore hospital. It costs him about $250 a month after subsidies, paid with his MediSave and around $50 out of pocket.

He gets along well with the other residents and sometimes joins outings organised by the shelter.

Aside from providing a roof over their heads for as long as they need, the shelter takes care of residents’ food and clothing, monitors their medical appointments, and helps them find employment. When a resident is mentally and financially able to, the shelter works with him to find a permanent housing solution.

“We journey with them in what you might think are simple ways: buying them their favourite food, talking to them, listening to their stories without judgment, treating them like a friend,” says Miss Jacinta Rajoo, 58, secretary of Care.

She has been volunteering with the Catholic organisation since 2004, and served two terms as president.

“The biggest need in the 80s and 90s was to make sure that people were not dying on the streets,” says Miss Rajoo, adding that the shelter used to house more residents with late-stage HIV infection and Aids, and took care of them until they died.

“Back then, anything to do with HIV was taboo. It was something that came with judgment. It was almost like saying, ‘Well, you caused this, and now you’re on your own.’

“You could lose your friends, your family, your home, your job and your health in an instant. Especially in Singapore, where we live in close quarters and people get worried. You may then be out of a home,” she says.

Over time, Care evolved from being just a shelter and now offers a more comprehensive range of services and support for PLHIV. The Dum Spiro Spero “While I Breathe, I Hope” programme, for example, encourages residents to appreciate the joy of work, handmaking items like candles using recycled wax and rosaries for sale.

Being in an environment where they feel accepted and have a sense of belonging has helped residents improve their overall health, adds Miss Rajoo.

In January 2016, Emerson and his Taiwanese boyfriend of two years, Lance (not their real names), celebrated New Year’s Day together in Taipei, before he flew back to Singapore.

In March, Emerson received a call from his boyfriend. He was in hospital, bedridden.

He had advanced HIV infection, as well as tuberculosis, pneumonia and syphilis. He urged Emerson to get tested too.

“So many things were going through my mind. I picked up the courage to go to the Action for Aids evening clinic to get tested,” says the 51-year-old graphic designer.

His worst fears came true. The clinic manager said he had tested positive for HIV, but needed another test to confirm it.

“I couldn’t even cry,” he says, recalling his state of mind at the time. “So what am I supposed to do next? What do I have to plan for? Do I have to make a doctor’s appointment?”

While Emerson went for health check-ups and started getting treatment for himself, his boyfriend appeared to be getting better.

But things took a turn when Lance developed an opportunistic infection in hospital. HIV attacks the immune system as it progresses, and patients become vulnerable to infections that can normally be fought off by a healthy immune system. Within weeks, he was dead.

“His death really shocked me,” says Emerson, who flew to Taiwan in April 2016 to attend his boyfriend’s funeral.

“I couldn’t tell his parents who I was. My emotions didn’t hit me until I got to the columbarium. I just started crying.”

For about a year after that, Emerson was in so much grief that he isolated himself.

Finally, a friend on Facebook who was also a PLHIV messaged him, encouraging him to join a support group. His friend told him that what he needed most was emotional support to prevent him from spiralling.

Emerson is now a regular in AfA’s peer support group, as well as a volunteer. Every week, he visits popular night spots frequented by gay men to spread awareness about HIV prevention and encourage people to go for regular testing.

He tells them: “If you step up and take the test, you won’t be left behind. And you get all the necessary help. You need to make the first move.”

Emerson has been living with HIV for eight years, and sees a doctor every seven months. Since 2023, he has been taking a combination of Lamivudine and Dolutegravir, two of the 16 antiretroviral drugs that were added to MOH’s list of subsidised HIV medication in September 2020.

He now pays half of the $453.70 he used to fork out, and pays for the medicine using his MediSave.

Since his diagnosis, he has become very attuned to his body’s signals, especially when he is about to fall sick. He wears a mask as often as he can, especially when commuting on public transport or when in crowded, confined spaces.

He has not told his mother, whom he lives with, about his sexual orientation or his diagnosis. “Maybe one day she will question me about why I am always at the hospital,” he adds with a laugh.

At work, however, he is much more open. His boss and colleagues know about his HIV status and have been supportive and caring, even reminding him not to overwork himself.

However, he suspects that his boss still has misconceptions about HIV transmission.

Although he does not wear his sexual orientation or his HIV status on his sleeve, he feels it “becomes very clear that I am a PLHIV” from what he shares on social media.

“I want to share certain things, like about the U=U campaign,” he says, referring to the Undetectable = Untransmittable global health campaign.

The community-led movement, started in 2016 by Mr Bruce Richman, the founder of the non-profit Prevention Access Campaign, aims to spread the message that people with HIV cannot pass the virus through sex if they are on treatment and have an undetectable viral load.

“While it is a clinical fact, it is still very hard for most people to digest,” says Emerson, who finds U=U empowering, as it means that PLHIV can be seen and treated normally and have a clear conscience.

Previously, PLHIV here were legally required to disclose the risk of contracting the virus to their sexual partners, irrespective of whether they were on optimal treatment or if they used condoms. Those who failed to do so could be fined up to $50,000 and jailed for up to 10 years, or both.

This is no longer the case, following the amendment of the Infectious Diseases Act in March 2024. PLHIV who are on effective anti-HIV treatment and have documented undetectable viral loads for at least six months need not disclose their HIV status to their sexual partners.

AfA’s Prof Chan says the legal reform had been “a long time coming”.

“It has been shown conclusively that people with an undetectable viral load in the blood cannot infect their sexual partners. I think the law was counterproductive. It discouraged some from wanting to know their HIV status, as it could be and was used against people who did not disclose their HIV status to their sexual partners.”

Emerson feels that many people, while well-meaning, can be patronising in daily conversations with PLHIV, “interrogating” them about whether they have taken their medication or are keeping up with their doctor appointments. That, he says, is a given.

Instead, he wishes people would ask him: “Are you living well? Are you living happily?”

For a month, she contended with fever, flu-like symptoms, and a rash that looked like a severe allergic reaction.

Sarah (not her real name) dismissed this at first, as she was often sickly. But when the symptoms did not fade, she saw a doctor, who immediately advised her to go to the hospital.

It was 2021, when the Covid-19 pandemic was at its peak. The hospital staff kept swabbing her, and she kept testing negative for Covid.

“It didn’t occur to the doctors and nurses that it could be HIV,” says the 29-year-old, who currently works in the social services sector.

She was sent to the National Centre for Infectious Diseases for more comprehensive tests, and the results showed that she was HIV-positive.

She took it well at first, nodding and smiling while the doctor explained what the diagnosis meant. Later that day, however, she had a psychological breakdown that lasted for two days.

Time ground to a stop for her, and words on her phone seemed to float, disconnecting her from reality. “I didn’t realise how much of a shock it was to my system. I couldn’t process it.”

The hospital asked her if she knew who infected her. After contacting her exes and past sexual partners so that they would get checked and not risk infecting their current partners, she found out who passed the virus to her.

“It was actually from a non-consensual sexual experience.”

She and her colleagues had gone to a party to celebrate her birthday a year prior, only for a more senior colleague to take advantage of her. “I was drunk, and I don’t remember if I said yes or no,” she says.

After her diagnosis, she was warded for about a month. Her CD4 count was found to be dangerously low, indicating that her immune system was severely weakened.

Sarah was prescribed a pill to take every day. For the first two months, the medication gave her terrible side effects – nausea, rashes and hair loss. But after some trial and error, like taking her medication at night instead of in the morning, and switching to medicine that gave her fewer side effects, she has found it much easier to manage the virus.

“I think what really threatened my life wasn’t HIV itself, but my mental health after that,” she says. For the first year, she struggled with significant self-stigma, which contributed to depression and mental health struggles. At her lowest point, she almost attempted suicide.

She had been working in hospitality for three years, but was told she could no longer continue in her role – due to concerns that she might have to perform cardiopulmonary resuscitation while on the job – and was offered a different position instead.

After leaving the hospitality industry in 2021, Sarah pivoted to the social services sector, focusing on mental health.

When she attended support group meetings for PLHIV, she found that she was the only young female. “I felt very dismissed. When we shared our stories of how we got it, I felt others couldn’t really empathise,” she says.

In the three years since her diagnosis, Sarah has told the people in her immediate circle – family, close friends and trusted colleagues.

She credits her family and friends for supporting her and helping her overcome her mental health struggles. She also reconnected with her faith by going to church.

What also really helped her, she recalls, was a doctor telling her: “If I could choose between diabetes, cancer or HIV, hands down I would choose HIV”, because among the chronic conditions, the virus was considerably easier to manage, and she is unlikely to die from HIV-related complications.

“As you can see, I’m very good now, lah. Two years ago, I could not have imagined where I am now,” she says. “I’m very blessed. The people who are in my life are amazing.”

She has been in a relationship for two years, but had to take a leap of faith in telling her now boyfriend about her HIV status before they made their relationship official.

“I was like, ‘Okay, there’s something you need to know. You go and think about it and consider whether you are okay with it.’ His only concern was, ‘Will you die early? Because I want to live a long life with you,” she says, smiling at her boyfriend seated next to her during this interview.

“Honestly, when this happened to me, I was forced to change and grow and adapt. I think I’m prouder of who I am now than the person I was before it happened to me.”

There are many things Sarah is thankful for today, but her one regret is not doing more for herself after getting sexually assaulted. She did not know then about post-exposure prophylaxis, a type of medicine that can be taken within 72 hours after possible exposure to HIV to prevent transmission.

“It’s difficult for sexual assault victims. You want to pretend it didn’t happen, so you wouldn’t think to get preventive medication. Like, I don’t get pregnant, very happy already!

“If I ever have the guts to actually be an ambassador for PLHIV, then yeah, I think that’s something I want to push for,” she says.

His 20s and 30s were a hedonistic ride of drugs and unprotected sex, but the consequences caught up with him.

“With that kind of lifestyle I lived, it was just a matter of time,” says Christopher (not his real name), now 52.

He was diagnosed with HIV in 2010, after feeling unwell for about a month. “I had no appetite, I was losing weight, I was having diarrhoea and coughing my lungs out. I wasn’t functioning any more,” says Christopher, who was working up to 12 hours a day in retail then.

He saw a general practitioner, who conducted a blood test. When he came back for the results, the doctor told him he was HIV-positive and that he had to be immediately admitted into the Communicable Disease Centre.

“When he told me that, I was like, okay, I’m going to die,” he says.

At that point, he had been in a 10-year-long relationship. “He was fine, I was fine, so we didn’t do regular checks.” His then partner also tested positive for HIV. They are no longer together.

Ironically, Christopher had been a volunteer with AfA since 1989, but it had not occurred to him to get himself tested.

He was hospitalised for three months and received antiretroviral therapy, but remained in denial about the severity of his HIV diagnosis.

For the first few weeks, he refused to take the medication, instead slipping the pills into the pockets of his patient pyjamas.

“The nurses found all the medication in my pocket and told my sister. I told my sister I had a difficult time swallowing the pills,” he says.

He refused to talk to any of the doctors or volunteers. Fortunately, he met a doctor who was patient and sat in his room with him until he decided to open up. To this day, she is still his doctor.

He recovered after taking his medication, and was discharged after three months. Eventually, his viral load fell to the point where it was undetectable, and he regained the weight he lost.

His health woes, however, were not over. In 2018, he was diagnosed with stage 1 lymphoma.

“When I got my cancer diagnosis, I was in my late 40s. It was stage 1, so it was still quite okay, very isolated,” he says.

After several rounds of chemotherapy, Christopher is currently in remission.

He is currently working as a volunteer manager at a mental health charity, a job he got through the Yellow Ribbon Project. He is also pursuing a degree in counselling.

Most of the people in his life – including his younger sister, nephews, father, colleagues and friends – know about his HIV status. However, his elderly mother is still in the dark. Christopher is unsure how she would react, and feels that it is better not to burden her with this information.

Jovial and candid, he shares openly with others in the PLHIV community and members of his church about his past – from his HIV diagnosis and cancer to his year-long incarceration at a drug rehabilitation centre in 2020 after he was caught doing methamphetamine.

He says he became more relaxed once he was no longer hiding his sexual orientation, his HIV status and his past drug abuse.

Now, he is an open book. “I have nothing else to hide.”

He often reminds others that just because they are not currently infected with HIV, it does not mean that they should continue risky sexual behaviour.

“You don’t get flu now, doesn’t mean you don’t get flu later, right?”

While he empathises with PLHIV who are afraid to reveal their status and seek support, he says it is important that they seek help.

“For example, you have diabetes, but you cannot tell anyone. What happens if you miss an insulin shot and crash? Imagine if nobody knows what you're going through – how do people help you?”

There are many ways to tell that Mark (not his real name) is “more of a feeler than a thinker”, as he describes himself.

He pauses between words to process his emotions. He is acutely aware of the needs of those around him. When someone in the room is seized by a coughing fit, he immediately offers the person some lozenges.

Being HIV-positive and having two stints in jail for drug use and trafficking have heightened his sensitivity to others, possibly stemming from his own fear of being judged.

Mark, who is in his mid-60s, was first interviewed by The Straits Times in 2008 – a year that saw a record high in HIV diagnoses, driven partly by more people stepping forward to get tested.

In the same year, there was a surge in HIV cases among gay men, too, showing how the virus has disproportionately affected homosexual individuals like himself.

Mark was diagnosed in 2001 after being advised to do an HIV test while checking if he had contracted syphilis from his former partner.

Asked how he has been since, he pauses again before replying: “Not as bad as before.”

His words, seemingly simple and matter-of-fact, carry the weight of the harsh realities he has endured: discrimination, costly treatment and losing peers who could not afford medication.

Some incidents linger sharply in his memory, like how his sister-in-law quietly separated his cutlery from the rest of the family when he returned home after his first release from jail. “I felt very sad at that point,” Mark says.

He also remains scarred to this day by an incident in 2008, when he visited a polyclinic for a tooth extraction.

He says it was clear to him that the dentist’s attitude changed when she saw he was HIV-positive on his referral letter.

“She sent me for an X-ray and told me to come back six months later,” Mark recalls, adding that he inferred the dentist did this knowing she would be rotated out by then and not have to treat him.

This was despite him having a stable undetectable HIV viral load, which made him non-infectious.

As his pain was unbearable, a friend took him to a private clinic, where he did not have to declare his HIV status.

He was so anxious about encountering the same treatment again in a recent dental appointment that he needed reassurance from his medical social worker.

In the end, his worries proved unfounded.

Prison brought its own form of trauma. Mark befriended other inmates who also had HIV and remembers witnessing the rapid decline of their health as they could not afford treatment.

Back then, the cheaper generic drugs were not allowed in prison due to patent restrictions, which meant many inmates with HIV could not afford life-saving treatment.

According to Singapore Prison Service (SPS), they have worked with a local non-governmental organisation since 2009 to provide medical subsidies for HIV-positive inmates.

Before the 16 antiretroviral drugs were included in MOH’s list of subsidised drugs in September 2020, HIV-positive inmates could receive the non-standard drugs for treatment from their family members or loved ones.

Right now, SPS provides these 16 antiretroviral drugs for HIV-positive inmates at no cost.

Mark considers himself fortunate that he did not require medication in the early years after his diagnosis, as his CD4 cell count was normal. He started medication only in the 2010s.

He is grateful for support from those closest to him, including his sister, who offered him a job to keep him close and ensure he does not “fall apart”. His mother was also a pillar of comfort, and they were very close until her passing just a few months ago.

His family, including his grown nephews and nieces, knows about his condition, and they share a warm, affectionate relationship. He says losing track of time while in jail has left him feeling as though he is still in his 40s.

Pausing again to gather his thoughts, Mark adds that he has “lived through it all”, and life has been anything but easy.

But he is sensitised to feelings of judgment from others. For instance, he decided to cut ties with some of his pre-university classmates – who remain unaware that he has HIV and has served time in prison for drug offences – after they met up once.

“They have not been in your life journey, so they are not here to care,” he reasons. “When you come to this age – 60 plus – they just want to know what you have achieved. If you tell them what has happened to you, they will leave. So, what’s the point?”

Vanessa (not her real name) has lived with HIV her whole life.

She was infected in the womb of her mother, an Indonesian who contracted HIV from contaminated needles while seeking fertility treatment in Batam. Her mother found out they had the virus only when Vanessa was three.

Much has changed since Vanessa shared her story with ST as a 10-year-old in 2011.

She no longer keeps a diary in which she professes her love for “everything in Old Chang Kee”. She did not become a lawyer or work in fashion, as she had dreamed of then.

Now, 13 years on, she is confident, mature and works in the creative industry. She wants to be financially stable so she can take her parents on holidays overseas.

Beneath these layers of self-assurance, Vanessa still harbours the same secret that she has since she was four, when her parents told her about her condition.

“I have never told anyone about my HIV status,” she says frankly. “I live just like a normal person.”

She longs to confide in her best friend. “There are moments when I feel I have been through so much with this friend, maybe I should tell her.

“But I will pull myself back and wonder: Can we still enjoy the same friendship? Will she distance herself or treat me differently once she knows?”

While Vanessa’s condition is under control, she fears others would not understand.

“When you declare, you cannot add that you are stable, with an undetectable viral load,” she says. Vanessa has been receiving treatment since she was three. “People won’t focus on that. They will choose to see that I am an HIV patient.”

While she channels her energy into building a career and enjoys the freedom of young adulthood, she keeps the idea of dating, marriage and children at an arm’s length.

Fear, she admits, is a large part of her hesitation.

“If I ever have a partner, when will I tell him about my condition? Do I say it at the start and risk him walking away immediately? Or wait until things are serious, and then he may feel I have lied to him all along?”

She adds: “There is no right time to say it, and I can never be sure if he is the right person to understand.”

Vanessa believes people today are much more informed about HIV compared to the past, when the condition was mostly feared and misunderstood.

But she remains deeply uncertain about whether others will receive her normally if she were to disclose her HIV status. Because of this, she would rather keep it a secret.

Nonetheless, she hopes that she can eventually live openly with her condition.

“I am not ready now, but maybe one day, if I know living with HIV won’t change the life I have built, I will tell my friends, ‘Look, we have been close for years – sharing meals and travelling together – but nothing happened to you.’”

Dr Ho, the medical social worker, notes there is some progress towards acceptance of people with HIV.

“As people with HIV live longer with better health outcomes, we hope for greater acceptance towards people with HIV in Singapore so that having HIV becomes a non-issue, like the way people share that they have diabetes.”