SINGAPORE – People with the human immunodeficiency virus (HIV) will no longer be legally required to disclose the risk of contracting the virus to their sexual partners as long as they have maintained undetectable viral loads for at least six months, under a Bill passed in Parliament on March 7.
They must also have test results showing that they have an undetectable viral load dated nine months or less before the date they have sex, and they must have adhered to their medical treatment during this time.
“Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner,” said Senior Parliamentary Secretary for Health Rahayu Mahzam in Parliament.
Currently, those who have tested positive for HIV must not engage in sexual activity with another person unless they first inform the other person of the risk of contracting HIV, and the other person agrees to accept the risk. Those who fail to do so can be fined up to $50,000, jailed for up to 10 years or both.
Ms Rahayu said the changes align with medical advancements, as well as Singapore’s public health objective to curb transmission by shifting greater responsibility to individuals.
“The objectives of the amendments are to encourage individuals who are at higher risk of getting HIV to be tested regularly for HIV, and if possible to get treated early, so that they can achieve undetectable viral load as early as possible,” she said. She urged those living with HIV to adhere to treatment and monitor their viral load closely with their doctors to reduce the risk of transmission.
The amendments to the Infectious Diseases Act mean that laws on disclosure will no longer apply to such individuals if they have maintained an undetectable viral load for a prescribed period before having sex.
Ms Rahayu noted that Singapore is not the first jurisdiction to amend HIV disclosure laws. Sweden, Taiwan and the United States have also removed the disclosure requirement for persons living with HIV who have no risk of transmitting the virus.
“I would like to emphasise that in proposing the amendments, we are not relaxing the public health safeguards against HIV transmission, but encouraging infected persons to come forward to be tested and treated, thereby better protecting their sexual partners,” she said.
Ms Rahayu added that irresponsible behaviour that can lead to the transmission of HIV remains an offence and appropriate enforcement action will be taken.
It is still a criminal offence for any person who knows that he or she has HIV to donate blood at any blood bank in Singapore. Those who do so can be fined up to $50,000, jailed for up to 10 years or both.
HIV attacks the immune system, with acquired immune deficiency syndrome (Aids) being the final stage of its infection. Aids is fatal if left untreated. While there is no cure for HIV infection, antiretroviral therapy can improve the immune system and suppress the viral load in a patient’s body to an undetectable level.
The Straits Times reported in December 2023 that infectious diseases and HIV experts were of the view that the disclosure law needed updating in the light of medical advancements.
Mr Louis Ng (Nee Soon GRC) on March 7 asked if the threshold of determining an undetectable viral load and the length of the prescribed period would be determined and periodically updated based on the latest scientific knowledge.
Ms Rahayu said a person is considered to have an undetectable viral load when they test consistently at below 200 copies per millilitre of blood. She added that this was determined based on the latest scientific evidence and clinical knowledge, after consulting with HIV and infectious diseases experts. She said test results must be from a recognised laboratory in Singapore. More details will be set out in subsidiary legislation.
Workers’ Party MP He Ting Ru (Sengkang GRC) asked if the Government plans to eventually do away with the disclosure law, and why it decided to tweak the law instead of repealing it.
Ms Rahayu said the law remains relevant to reduce the sexual transmission of HIV by requiring persons living with a detectable HIV viral load, as well as those who do not know their status but have reason to believe they have HIV, to disclose the risk of transmitting HIV to their sexual partners before sexual activity.
This allows people to make informed decisions before engaging in sexual activity and encourages responsible sexual behaviour. “The intention of HIV laws is not to criminalise persons living with HIV, but to deter irresponsible behaviour,” she said.
Minister for Health Ong Ye Kung noted that the amendment provides an exemption for those who have been tested and sought treatment to lower their viral loads to undetectable, non-transmissible levels, which MOH believes is the best combination to protect public health.
Responding to Ms He, who also asked how many investigations the authorities have conducted under the HIV disclosure law, Ms Rahayu said from 2015 to 2023, seven people were convicted of failing to inform their sexual partners of the risk of infection.
Four of them had undetectable viral loads at the time of their offences, and all four convictions had aggravating circumstances, including simultaneous offences such as drug abuse, recommitting an offence while under investigation for a first offence, or where the victim was a minor.
As at end-2022, Singapore had close to 7,000 people living with HIV out of a total of 9,331 who have been diagnosed since 1985, MOH said in an update on the situation in June. The rest have died, including 107 in 2022.
There were 188 newly diagnosed cases of HIV in the first 10 months of 2023, 97 per cent of whom were men. This is 10 per cent higher than the number of cases diagnosed in the same period in 2022.
