07 January 2011

Testing For HIV

In-patients aged at least 21 years at the six public hospitals in Singapore can opt to be tested for HIV.

134,557 in-patients were eligible for testing in 2009.  82 per cent, or 110,421, opted out.

24,136 in-patients opted to be tested.  0.2 per cent, or 50, were found to be HIV positive.  They accounted for 10.8 per cent of the 463 new HIV positive cases in 2009.

Minister for Health Khaw Boon Wan would like to see more in-patients being tested.  More than half of the new HIV cases in Singapore are diagnosed only when the infection has reached an advanced stage, preventing them from receiving earlier treatment which could improve their health outcomes.

Why aren't more in-patients opting to be tested?

Firstly, people fear being stigmatised by family and friends if they are found to be HIV positive.  Although the test results are disclosed to the patient and doctors only, positive results must be reported to the Ministry of Health.

At the seven clinics that offer anonymous HIV tests, 7,762 tests were carried out in the first ten months of 2010 (some may be repeat tests).

Secondly, the test costs between $6 and $30, depending on the ward class of the in-patient.  Since the test is not free, how many people will opt for the test if they have no reason to believe that they are at risk?

The 463 new cases in 2009 represented a rate of 124 per million population.  Assuming the same incidence among the in-patients who opted for the test, there should have been only three new cases among them, far fewer than the 50 actual cases.

Alternatively, if we assume that there were no HIV cases among the in-patients who opted out of the HIV test, the incidence of 50 cases among 134,557 in-patients translates into 1,387 new cases in the general population, or three times as many as the 463 actual cases.

These seem to indicate that there are many undiagnosed HIV positive individuals out there.

While the Ministry of Health should encourage more people to undergo the HIV tests, there is no particular reason to focus on in-patients; there is no known correlation between their being warded and their being HIV positive.

It may be instructive if the Ministry of Health could find out from the 50 in-patients who were tested positive why they did not go for anonymous testing prior to being warded.  Did they not suspect that they were at risk?

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Notes:

"Over 80% Of In-patients Reject HIV Screening", The Straits Times, 5 December 2010.

"Characteristics Of New Cases Of HIV Infection Reported In First Six Months Of 2010", Ministry of Health, 28 November 2010.

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