ZONE:

In a speech by Dr Balaji Sadasivan, Senior Minister of State for Health on 10 November 2004 titled "The AIDS Epidemic in Singapore" (Transcript: http://app.sprinter.gov.sg/data/pr/2004111090.htm), it was highlighted that there is an emerging epidemic amongst MSMs (men who have sex with men) in Singapore.

Dr Balaji's concern over the sharp increase of HIV infection amongst MSM is ironic. Even though MSMs have always represented a high-risk group, Singapore's public health service has systematically ignored and left MSMs out of all their public health messages. Focusing instead on abstinence and monogamy, the Ministry has rarely advocated the use of condoms, and never once addressed MSMs directly since its first education program against HIV/AIDS in 1985.

It should thus come as no surprise that this marginalised demographic now finds itself at increased risk for HIV as a result of this gross negligence. That it has taken 20 years for MSMs to finally gain the attention of our public health service is a clear indication of the institutionalised homophobia that MSMs face.

Dr Balaji singled out Action for AIDS, an NGO dedicated to fighting AIDS, for criticism, citing that it was "not doing enough." In fact, it is probably a direct result of AfA's unceasing efforts that MSM transmission rates have been kept relatively low for the last 20 years. Yet, an AfA operated booth at the Nation party in August this year was asked to shut down by the local police jurisdiction who thought that giving out safer sex brochures and condoms was promoting gay sex. In another incident earlier this year, AfA was also stopped from circulating its new range of safer sex postcards by the Advertising Standards Authority of Singapore which objected to any reference to oral and anal sex on the grounds that such acts were illegal.

Therein lies the conundrum: Since gay sex is illegal, how then, can any agency or organisation in Singapore promote safe sex amongst MSMs without being complicit in abetting illegal activity? Do these structural mechanisms restrict our Ministry of Health and organisations such as AfA from fulfilling their public health obligations? How is the MSM community expected to mobilise itself to combat AIDS in the face of such blatant discrimination?

In his speech, Dr Balaji made reference to a website, Fridae.com, where he came across an article that he felt was advocating a "promiscuous and reckless lifestyle." As CEO of Fridae, I would urge for this article to be considered in a larger context.

Fridae.com is the region's largest gay and lesbian web portal. As a trusted information source to a quarter million readers every month, we recognise the important role we play in the fight against AIDS. Fridae's articles are a mix of serious, fact-based features and news, as well as light hearted, lifestyle entertainment pieces, not unlike what may be found in numerous mainstream publications. It is easy to distinguish between the two. We strongly believe that acknowledging a healthy sexual lifestyle is important in getting our readers to relate to our public health messages, which in turn has the highest chance of success in encouraging safe sex behaviours. It is clear that continuing a simplistic message of abstinence or faithfulness to one's spouse (which has no relevance to many in the MSM community) has extremely limited efficacy.

Fridae's commitment to AIDS work began with the company's inception in 2001, with strong working relationships with the region's AIDS NGOs, including Action for AIDS, Malaysian AIDS Council, and the Hong Kong AIDS Concern. Not only have we been active in fundraising and implementing AIDS prevention strategies, we have also taken the initiative to mass produce and distribute at close to cost, our own "Combat AIDS" condoms. We make sure that safe sex messages are prominent in all our communications with our members, and are instrumental in research that helps us understand our local epidemiology. This is only one of many instances where private monies are being used to fund what ought to be a public health initiative. Yet, we believe that the grassroots has to mobilise and take action even if public policy lags behind.

Perhaps Dr Balaji's speech signals a newfound willingness for the MOH to address and engage the MSM community. There needs to be greater communication between the public sector with the grassroots to understand the nature of the epidemic in Singapore, and formulate strategies that take into account the unique needs of the MSM community. If the MOH is serious about avoiding a public health crisis, as it should be, then it ought to engage the community directly, not through a proxy such as the CDC, which has more of a clinical, rather than preventive role. Fridae is prepared to make available the significant resources at our disposal to the Ministry to promote its public health messages, and hope that the government sees this as a valuable and important opportunity for outreach to this high risk, yet difficult to reach community.

We have to continue to develop targeted, effective, sustained prevention efforts that build community capacity to deliver ongoing, lifelong prevention programming for those at risk and those already infected. The only way to start this process is to first put aside our prejudices, and strive towards an open and honest dialog between all the stakeholders. For these public health efforts to be effective in the MSM community, the authorities have to first agree to work WITH the MSM community. The consequences of not doing so will be a continued disconnect between the two parties, and a potentially dire impact on the rates of HIV transmission in Singapore.