More getting treated for HIV

Singapore closer to UN targets as more are diagnosed and more manage to keep viral loads low

More people living with HIV in Singapore are diagnosed, treated and able to keep their viral loads low, said Senior Minister of State for Health Amy Khor yesterday at the Singapore Aids Conference 2018 held at the Lee Kong Chian School of Medicine.

This reflects an improvement in Singapore's 90-90-90 results based on targets set by the United Nations, said Dr Khor.

The 90-90-90 targets state that by 2020, 90 per cent of people living with the human immunodeficiency virus should be diagnosed and aware of their condition, and of them 90 per cent should be placed on antiretroviral treatment.

Out of those who receive treatment, 90 per cent should achieve viral load suppression. This is defined as having fewer than 200 copies of HIV per ml of a person's blood. If the load falls below 50, it is considered undetectable and untransmissable.

Based on the latest data from 2013 to 2015, the number of people with HIV in Singapore who were diagnosed rose from 69 per cent to 72 per cent.

This figure is derived from a statistical estimate of the number of undiagnosed cases.

In the same period, the proportion of those diagnosed who received treatment increased from 77 per cent to 89 per cent, while the proportion of those who were treated and achieved viral suppression rose from 82 per cent to 94 per cent. "Even though the numbers are encouraging, we can and must do more to help people living with HIV," said Dr Khor.

The number of people using an HIV prevention drug known as pre-exposure prophylaxis (PrEP) has also increased, said Dr Benson Yeo, a consultant at the Department of Sexually Transmitted Infections Control (DSC) Clinic.

From January to November this year, 231 people were prescribed PrEP at the DSC Clinic, including 181 Singaporeans and 50 non-Singaporeans, said Dr Yeo. This is more than twice the 99 cases seen for the whole of last year.

PrEP, which first became available in Singapore in 2016, has been shown to be highly effective in preventing HIV infection. In Australia, the total number of diagnoses fell from 365 in 2016, when PrEP was first implemented on a large scale, to 241 last year, said Monash University professor of public health Christopher Fairley.

In Singapore, new cases of HIV infection may also be on the decline. On Dec 1, the Ministry of Health said that there were 265 newly diagnosed cases of HIV in Singapore from January to October this year, down from 361 cases over the same period last year.

But Dr Yeo said that a significantly wider uptake of PrEP is needed among high-risk groups, including men who have sex with men and men who often visit sex workers, in order to have a greater impact on HIV infection rates.

Barriers still remain before Singapore can achieve its goal of eliminating HIV by 2030, he added.

Truvada - the brand of PrEP available here - is still expensive for many, costing $400 a month.

Generic versions can be imported for personal use at about one-tenth the cost, but only up to three months' supply at once. Stigma and a lack of understanding about HIV also remain issues.

Prof Fairley said that PrEP use in Australia correlated with lower rates of condom use, which led to an increase in the incidence of other sexually transmitted infections not prevented by PrEP.

"Safe-sex practices, including condom use, remain a cornerstone of HIV prevention even with PrEP use," said Dr Yeo.

A version of this article appeared in the print edition of The Sunday Times on December 09, 2018, with the headline 'More getting treated for HIV'. Print Edition | Subscribe