Singapore: Two men with HIV jailed for non-disclosure to same man at different times

A 27 year-old former civil engineer and a 48 year-old married man who had casual sex at different times with a 37 year-old man (who subsequently tested HIV-positive) have each been sentenced to 18 months in prison because they did not disclose they were HIV-positive. 

This is the first time that I'm aware that one complainant has resulted in two different convictions, and highlights the unbelievable unfairness of a criminal justice approach to HIV prevention.  There have now been three convictions for HIV non-disclosure in Singapore - all of those prosecuted have been men who had sex with men during a single encounter.  The first, in 2008, was simply for performing oral sex, for which there is no HIV risk for the receptive partner. 

The 27 year-old was the first person to be sentenced under the 2008 Infectious Diseases Act for having oral sex (without condoms) and anal sex (with condoms) and not disclosing he was HIV-positive with the 37 year-old in January 2009, according to a report on channelnewsasia.com.  He also had an undetectable viral load.  Taken together, this means there was no risk to his partner.

In his mitigation, he said he found it difficult to disclose his HIV-positive status. He said the intention was not to harm the victim, but was one of "self-protection" as he was afraid of being "abandoned by his social circle". He told the court his condition was under control by medication when he met the victim and that they had protected sex.
However, the prosecutor for the Ministry of Health, K Kalaithasan, called for a jail term of more than a year, saying the victim would not have engaged in sexual activity if he had known about the man's HIV status. In sentencing, District Judge Siva Shanmugam said the nature of the offence was "grave". He said by failing to inform the victim for his "own selfish reasons", the offender had "endangered the safety of others".

The second man, who had sex with the 37 year-old in May 2009, was also given an 18 month sentence.  He says that he couldn't have been the source of the complainant's infection because he was the receptive partner and the 37 year-old had used a condom.  Ironically, the complainant could not confirm that he used a condom (and surely, as a 'top', it was his responsibility to wear one!) 

In a remarkably sympathetic report in The Straits Times, the man reveals how the prosecution has had a devastating effect on his wife and how he had considered suicide.

When a 48-year-old HIV-infected man pleaded guilty last November to having had sex with another man in May 2009 without revealing his status, he knew he might have to go to jail. Since then, his sentencing has been adjourned a few times to give him time to settle his affairs — including telling his wife about this court case. He could not bring himself to do it. He told The Straits Times last month that she knew he had tested positive for the virus that causes Aids, but he could not tell her about his conviction because she was already stressed in her administrative job.

“I can’t burden her more. I don’t know how to face her,” the former quality assurance technician said.

She now knows. The 40-year-old woman told The Straits Times yesterday that he broke the news to her just before Chinese New Year, but said she was in no frame of mind to say more. The couple have no children. Her slim, short and bespectacled husband, who did not have a lawyer, broke down in tears yesterday on hearing that he would be behind bars for 1-1/2 years. ...

Sometimes I feel like killing myself. But I can’t do it... I hold back because of my family,” he added.

Again, the sentencing judge pulled no punches when sending the man to prison.

In passing sentence yesterday, District Judge Janet Wang said it is not the intention of the legislature to enforce the law against every HIV-infected person. However, she added, the penalties for keeping one’s HIV status a secret and failing to obtain a sex partner’s consent to being exposed to the risk of infection are in place for deterrence and to reflect the gravity of such offences. The judge said that, for his own sexual gratification, the accused had knowingly concealed his HIV status from his male sex partner, which she said was ‘highly unconscionable’ and showed a disregard for the other person’s well-being. “Such a deliberate omission only heightens his culpability,” she said.

I do wonder about "the intention of the legislature", though, and whether Singapore will, in fact, "enforce the law against every HIV-infected person" who comes to their attention when a newly infected individual is looking for someone to blame for their infection. 

The prosecution of both of these men seems especially unjust since the first man could not have been the source of the complainant's infection and the second man was relying on the complainant to wear a condom.  But since the law is only about non-disclosure and not about risk, or transmission itself, convictions are oh-so-easy, making all HIV-positive individuals extremely vulnerable to prosecution. 

Singapore: Half of Singaporeans unaware that condoms prevent HIV

Half of the Singapore population are unaware that condoms can prevent HIV transmission, according the results of a survey by the Health Promotion Board. Of greater concern is that those most at risk - aged 18 to 29 - know the least about HIV transmission and how to prevent it.

One wonders how Singapore's safer sex laws passed in April can possibly be legitimate given this startling discovery.

Reports from Bloomberg.com and the Straits Times below.

Condom Use to Prevent HIV Is Unknown by Half of Singaporeans

By Simeon Bennett

Oct. 17 (Bloomberg) -- Almost half the people in Singapore don't know that condoms can prevent HIV infection, and three in four wouldn't eat with an infected person, according to a survey by the nation's Health Promotion Board.

Only 54 percent of those surveyed in the city-state last year knew that condoms can stop the AIDS-causing virus, the study of 1,768 people aged 18 to 69 showed. Almost half also said they wouldn't look after a relative sickened by HIV, the study found.

"These negative attitudes can be a barrier for the at-risk to know their HIV status as they might fear being discriminated against,'' said JoAnn Taylor, deputy director of the board's communicable-disease-education unit, in a statement yesterday.

Singapore, battling to curb an HIV infection rate that has doubled in the past decade, is running art exhibitions and plans pop concerts and a Mandarin-language television program to educate people about HIV prevention, the board said. This year, 345 people have been diagnosed with HIV in Singapore, compared with 316 in the same period last year and 199 in the whole of 1998, according to data on the health ministry's Web site.

About 82 percent of those surveyed knew limiting sex to one partner could help prevent infection, and 75 percent knew abstaining from casual sex could help, according to the latest survey. Those aged 18 to 29 were least informed about ways to prevent infection, the study found.

Sexually transmitted infections including HIV, syphilis and chlamydia among people aged 15 to 24 rose 45 percent to 418 per 100,000 people in Singapore last year from 231 per 100,000 in 1998, Health Minister Khaw Boon Wan said last month.

The government has also strengthened its anti-HIV laws. In April lawmakers passed amendments to laws that make it a crime for a person who doesn't know their HIV status and has "reason to believe'' they may have the virus to have sex without informing a sexual partner or taking "reasonable precautions'' to protect them.

Know how to prevent Aids?

Those aged 18 to 29 ranked lowest in health board's survey on Aids awareness
By April Chong
Oct 17, 2008

YOUNG people aged 18 to 29, who are more likely to be sexually active than any other group, know the least about how to prevent Aids, a new survey has found.

They ranked lowest among the age groups, with just three quarters knowing at least two ways that the Aids virus could be prevented, compared with more than 80 per cent for the other age groups.

Those in the 30 to 49 group were best informed, according to the first survey of its kind conducted by the Health Promotion Board (HPB), which oversees HIV prevention programmes in Singapore.

It polled 1,800 people aged 18 to 69.

The survey also found that only one in two of the population knew that consistent condom use would prevent Aids, though at least three quarters were aware that abstinence and faithfulness to one's partner were other measures.

The survey will be conducted every three years and will help the HPB fill the gaps in its public education programmes.

One such gap is the lack of knowledge among young people, which has grave consequences.

At the Department of STI Control clinic, patients in the 20 to 29 age group make up some 40 per cent of all its cases.

More distressingly, there has been a spike in sexually transmitted infections among the young. Between 1998 and last year, the incidence of such diseases among those aged 15 to 24 rose nearly 45 per cent, from 231 to 418 cases per 100,000 population, Health Minister Khaw Boon Wan told Parliament last month.

'The younger group just wants to have fun and they do not care less about awareness,' said Mr Lionel Lee, executive director of the voluntary organisation Action for Aids.

HPB said it would have new programmes targeted at the younger crowd, such as a concert at Fort Canning Park on Nov 29, to bring home the message of Aids prevention. More details can be found at www.loveamp.sg.

On the issue of condom use, it said that the general population may not be aware of its role in HIV prevention because the Board's emphasis to the public has always been on abstinence and faithfulness, said Ms JoAnn Taylor, deputy director of Communicable Disease Education in HPB's Adult Health Division.

But the survey also found that only 22 per cent of those at risk - men who have sex with other men, those with multiple sexual partners, or who engage in casual sex - use condoms consistently during sexual activity.

To combat the spread of Aids and its misconceptions, the Board will be rolling out education strategies in workplaces and in the heartland.

This includes community art exhibitions and a Mandarin drama serial which revolves around the Aids theme. The drama serial, By My Side, will be broadcast on Channel 8 at the end of the month.

Singapore: Man gets a year in prison for HIV exposure via oral sex

The first person to be convicted of HIV exposure in Singapore has been sentenced to a year in prison. Incredibly, the HIV-positive man performed oral sex in a public toilet, which, as I had noted in my previous blog posting on this case, results in no risk to the person being sucked.

In a report from Bloomberg, Dr Andrew Grulich, professor of epidemiology at the University of New South Wales in Australia, commented, "In a case like this where the risk is miniscule, it seems ludicrous to be prosecuting a person.''

There are two reports below: the first from Singapore's Straits Times reporting the story 'straight', and the second, from Bloomberg, with commentary.

Man jailed for not telling boy of risk in first HIV case
Elena Chong
July 14, 2008

IN THE first case of its kind, a 43-year-old HIV sufferer was jailed for 12 months on Monday for having sex with a boy without telling him of the risk of contracting the infection and getting him to agree to accept that risk.

Chan Mun Chiong, a former chef, pleaded guilty to performing oral sex on the 16-year-old boy at the third level male toilet of Northpoint Shopping Centre in Yishun last year.

Deputy Public Prosecutor Royce Wee said that Chan had been diagnosed to have human immunodeficiency virus infection (HIV) since March 1999.

On Sept 15 2007, he was at the mall's toilet cubicle when he initiated some hand signals under the partition to the victim in the adjacent cubicle, indicating that he was interested to engage in sex.

The duo went one floor up to a cubicle for the disabled. He then performed oral sex on the boy for two to three minutes.

The DPP said Chan did not inform the victim of the risk of contracting HIV infection from him and did not get the boy's voluntary agreement to accept that risk before the sexual intercourse.

After that Chan asked the victim to turn around, but he refused. Chan persisted but the boy again refused. The victim told him to get out of the cubicle.

Angry, Chan left but followed the victim around the shopping centre. The victim became worried and approached a security officer for help.

The court heard that the boy regretted what Chan did to him and his parents no longer speak to him. The DPP said fortunately, he was not infected.

He asked Principal District Judge Bala Reddy to impose an appropriate sentence on Chan, who could have been fined up to $10,000 and/or jailed for up two years.

Under the new laws passed last month, the penalties have been upped to $50,000 or a jail term of up to 10 years or both.

Singapore Jails Man With HIV for Performing Oral Sex on Youth
by Simeon Bennett

July 15 (Bloomberg) -- Singapore jailed a man with HIV for performing oral sex on a teenage boy, the first time the city- state has used its laws to prosecute someone with the virus that causes AIDS, the Straits Times reported.

The 43-year-old chef was sentenced to one year in jail after pleading guilty to a charge he exposed the 16-year-old to HIV without informing him of the risks first, according to the report. The teenager didn't contract the virus, the report said.

"The risk of transmission of HIV through oral sex is so low that it hasn't been able to be measured in epidemiological studies,'' Andrew Grulich, a professor of epidemiology at the University of New South Wales in Australia, said in a telephone interview from Sydney. "In a case like this where the risk is miniscule, it seems ludicrous to be prosecuting a person.''

Singapore is seeking to curb its HIV infection rate, which has doubled in the past decade. In April, lawmakers passed amendments to laws that make it a crime for a person who doesn't know their HIV status and has "reason to believe'' they may have the virus to have sex without informing a sexual partner or taking "reasonable precautions'' to protect them.

The man performed oral sex on the teenager in a shopping mall toilet cubicle in September, the Straits Times reported. After the teenager refused his request for anal sex, he followed him around the mall until the boy asked a security guard for help, the newspaper said.

A spokesman for Action for AIDS, Singapore's HIV advocacy group, said he needed the approval of a committee to comment.

In the April amendments to the law, Parliament also increased the penalties to a maximum 10 years jail and S$50,000 ($37,000) fine. The man was charged before the amendments came into effect.

So far this year, 192 people have been diagnosed with HIV in Singapore, compared with 167 in the same period last year, according to data on the health ministry's Web site.

Singapore's legal age of sexual consent is 16. The city- state also outlaws any act of "gross indecency'' between men.

Singapore: Man pleads guilty to HIV exposure following oral sex

The first-ever prosecution for criminal HIV exposure is now taking place in Singapore, two weeks after a law increasing the maximum penalty from two to ten years – and making it illegal to have unprotected sex even if you suspect you might be HIV-positive – was passed, although it not yet come into effect.

(This has been covered on my blog here and here, and there is a more recent summary from Kaisernetwork.org here)

A 43-year old chef was charged under existing 1992 laws with "engaging in oral sex with a 16-year-old without informing him of the risks". He faces up to two years in prison and/or a £3730 fine.

If, as one might imagine given the situation (an encounter in a public toilet between a younger and older man) that the HIV-positive man was the man doing the sucking (i.e. the receptive partner), then, in fact, there was only a theoretical risk of HIV exposure (the extremely low risk of HIV transmission via oral sex is only there for the receptive partner, and is based primarily on the viral load of the HIV-positive person and the oral health of the receptive partner).

Story from The Earth Times below.

HIV-infected man charged with failing to tell teen partner
Wed, 07 May 2008 23:48:02 GMT

A chef infected with the HIV virus was charged in a Singapore court with engaging in oral sex with a 16-year-old without informing him of the risks, news reports said on Thursday.

In the first case of its kind in the city-state, Chan Mun Chiong, 43, pleaded guilty to the charge and another of committing an act of gross indecency with the teenager. Failing to disclose HIV to a potential partner carries a fine of up to 10,000 Singapore dollars (600 US dollars) or up to two years in jail, or both, The Straits Times said.

The two allegedly performed the sex acts in a cubicle of a men's toilet at a shopping centre on September 15 last year, the court heard. The man faces a jail term of up to two years on the gross indecency charge.

Stiffer penalties were passed by parliament last month, but have yet to go into effect. The health ministry has investigated similar cases in the past, but no one was prosecuted until Wednesday.

Singapore: Government plans to criminalise 'risky sex' without prior disclosure

An interesting article from Bloomberg (which is usually more associated with business news than with HIV policy) on Singapore's worrying plans to criminalise people who do not disclose they have previously had "unsafe" sex, and have "reason to believe" they may be HIV-positive, previously reported here last September.

Offenders would face as much as 10 years in prison and a S$50,000 fine. Penalties for those who know they're HIV-positive and don't inform their partners, already a crime under legislation that took effect in 1992, would be increased to the same level. No one has been prosecuted under the existing law.

Enforcement would depend on an aggrieved partner filing a complaint and prosecutors proving that a defendant had a history of high-risk sexual behavior.

HIV Ignorance Is No Defense in Singapore Plan to Curb Risky Sex

By Simeon Bennett

Feb. 12 (Bloomberg) -- Every weekend, men from Singapore take a one-hour ferry ride to Indonesia's Batam Island for cheap golf, beer and sex.

About S$70 ($49) hires an island prostitute for the day, compared to just an hour with a Singapore hooker. The trade has contributed to a doubling of Singapore's HIV infection rate in the past 10 years, the government says.

The city-state proposes to curb infections by making it a crime for those who engage in such unsafe practices, and thus have "reason to believe" they may be HIV-positive, to have sex without informing their partners of the risks. United Nations groups and AIDS activists say that would violate human rights and increase infection rates by encouraging anonymous sex.

"Stigma and discrimination are major drivers of the HIV epidemic," Dr. Roy Chan, president of the Singapore advocacy group Action for AIDS, said in written comments on the legislation, which may be considered by parliament this month. "The net effect will be poorer control of HIV infection."

The government disagrees, saying the bill would encourage people to get tested and avoid risky behavior such as having unprotected gay sex or frequenting prostitutes. Violators may be prosecuted even if they don't test positive for HIV.

"We're trying to find a way essentially to ask them to be responsible for their own actions," said Koh Peng Keng, the Health Ministry's senior director of operations. "There is a greater impetus to get more people to come forward for testing.''

No 'Witch Hunt'

Offenders would face as much as 10 years in prison and a S$50,000 fine. Penalties for those who know they're HIV-positive and don't inform their partners, already a crime under legislation that took effect in 1992, would be increased to the same level. No one has been prosecuted under the existing law.

Enforcement would depend on an aggrieved partner filing a complaint and prosecutors proving that a defendant had a history of high-risk sexual behavior.

"It's never the intention to go on a witch hunt," Koh said. "It's going to help in public education."

The government also plans to double spending on AIDS prevention programs to S$8 million annually for the next three years, he said.

Zack, a self-employed electrical engineer who suspects he contracted HIV from a prostitute, isn't convinced of the government's motives, especially considering that gay sex is illegal in Singapore.

"People are going to hide," said Zack, 36, who spoke on condition his real name not be used for fear of losing his business.

Infected for Years

Singapore's HIV infection rate has doubled in the past 10 years. About 1 in 10,000 people were newly infected in 2006, compared with fewer than 0.5 in 1996, according to government statistics. More than half of those diagnosed in 2006 also had AIDS, indicating they'd been infected for years without knowing it, Koh said.

In total, about 7 of every 10,000 people in Singapore have HIV, the government says.

UNAIDS estimates the rate may be as high as 30 once undiagnosed cases are included. That's higher than estimated infection rates in other developed Asian nations such as Japan and South Korea. Singapore's rate is lower than in neighboring nations, including Malaysia and Thailand.

The UN agency calculated its figure from government data for high-risk groups -- including prostitutes and their customers, gay and bisexual men, and intravenous drug users -- and statistics provided by HIV and pregnancy clinics.

UN Opposition

Seema Paul, chief policy coordinator for Geneva-based UNAIDS, said the Singapore bill would force people to get HIV tests, putting them at risk of discrimination and violence if others learned they were HIV-positive.

"We have consistently advocated that HIV testing should be voluntary," she said in an e-mail.

Stuart Koe, chief executive officer of media company Fridae Ltd., said those who contract HIV won't disclose the names of their partners to doctors for fear of being prosecuted, and that will contribute to spreading the disease.

"There'll be a lot of unexpected negative effects," said Koe, who works with AIDS support groups in Singapore and whose company runs a gay Web site.

The groups primarily responsible for spreading HIV in Singapore are men who visit prostitutes, and gay and bisexual men, the government says.

Refusing Condoms

In Batam, brothels occupy storefronts scattered among homes, shops and bars like the PP Banana Laptop Lounge. Pimps ply their trade wherever foreigners are found.

The AIDS rate in the province including Batam is the third- highest in Indonesia after Papua and Jakarta, the national AIDS commission said on its Web site.

Ayu, a 28-year-old prostitute, said most of her clients are married Singaporean men and not all practice safe sex.

"Sometimes the customer does not want a condom," she said, her purple eye shadow sparkling under neon lights. "I cannot force."

Like many Indonesians, Ayu uses only one name.

Koh said the government works with activist groups to educate men before they get on the Batam ferry. Those efforts include handing out condoms and HIV prevention information.

"There's this huge reservoir of people who are HIV-positive and may not know," he said. "Once someone knows they're positive, typically they change behavior."

Singapore: Criminal HIV transmission laws proposed

http://newpaper.asia1.com.sg/news/story/0,4136,143384,00.html

I may have HIV। Will you still sleep with me?

Under proposed changes to law, those at risk must disclose sex history to partner TELL the truth, says a new legal proposal that seeks to put the onus on those who lead risky sexual lifestyles to come clean with their partners।

By Ng Wan Ching 30 September 2007

TELL the truth, says a new legal proposal that seeks to put the onus on those who lead risky sexual lifestyles to come clean with their partners। Deceive - if there is a possibility that you have been exposed to the Aids virus - and you face up to 10 years in jail and a fine of up to $50,000. Will such a law be effective in stemming the spread of Aids? Or could it drive people further into secrecy?

Imagine saying before sex: 'I may have been exposed to HIV. If you have sex with me, you should accept the risk of infection.' Under the Infectious Diseases Act now, a person who knows that he is HIV-infected must inform his partner before having sexual intercourse. His partner must agree to accept the risk of infection. If he doesn't warn his partner, he's breaking the law.

The Ministry of Health (MOH) is proposing to expand the act to include those who, although unaware that they are HIV-positive, have reason to believe that they have been exposed to the risk of contracting HIV or Aids. This could be from having unprotected casual sex with multiple partners and prostitutes or sharing needles.

Another condition is that he must have had tested negative for HIV and not had sex or engaged in any risky activity since then.

Finally he must take reasonable precautions during sex, such as by wearing a condom.

Said Mr Benedict Jacob-Thambiah, an HIV/Aids educator: 'Who can be bothered? I think this will drive such people underground even more. Because now you are saying they are potential criminals.'

BLAME GAME?

The proposed laws appear to be more intent on ascribing blame rather than to treat HIV/Aids as a public health concern, said Mr Jacob-Thambiah.

Said Mr Brenton Wong, former vice-president of Action for Aids: 'This is putting the law in the bedroom, but how are the authorities actually going to police it?

'This is saying that if you are morally questionable, then you will get HIV. Only if you remove the stigma and make treatment available and affordable will people come forward.'

Dr Stuart Koe, chief executive officer of Fridae.com and a trained pharmacist specialising in HIV medicines, predicts that the new law will rarely be used.

'It will have minimum impact on HIV in Singapore. I think we could use our resources better,' he said He thinks that to accuse someone of infecting another person with HIV is a difficult thing to prove in court.

Said Dr Koe: 'Firstly, the chain of transmission is fairly difficult to ascertain.

'Secondly, if it's between a married couple, usually the wife will not want to prosecute the husband for fear of breaking up the family.'

If the Government is willing to go to the extent of changing the law, he thinks it would be much more helpful to change it to protect HIV individuals from workplace and insurance discrimination.

'We should improve their access to treatment and care rather than further alienating them,' said Dr Koe.

Already, there are fears that there is a hidden HIV epidemic.

A study of more than 3,000 leftover blood samples from public hospital patients early this year showed that one in 350 was infected with HIV.

If accurate, this would mean that Singapore has about 9,000 infected adults, much more than the official figures. Neither the patients in the study nor their doctors were aware of their HIV status. Also, HIV is now a treatable disease like any other chronic disease.

'With treatment, people have stopped dying from HIV. But that message has not gone out. Instead when people find out they are positive, they go underground and they feel helpless,' said Dr Koe. But Health Minister Khaw Boon Wan points out he has good reasons for the proposed changes. Every year, 10 per cent of those newly infected with HIV are women. About half of them are married women whose husbands are HIV positive.

Said Mr Khaw: 'I draw the conclusion that they got it from their husbands.' These are among the people he wants to protect. The new laws will help the Ministry deal with the minority of people who are sexually irresponsible.

For the majority of people, ABC - abstain, be loyal or use a condom - is good enough.

The minority may need CRT - condom and regular testing.

'If you insist on harming yourself by visiting prostitutes and so forth, then do CRT and inform your sexual partner,' said Mr Khaw. Three cases have been dealt with under the existing laws.

In 2005, investigations unearthed the case of an HIV-positive foreigner from Nigeria who had unprotected sex with several women in Singapore.

He did not inform them of his status before they had sex. He left Singapore before he could be charged.

Earlier this year, an HIV-positive man did not inform his wife of his status before engaging in sex, using a condom.

His wife, who was a foreigner and unwilling to testify against her husband, tested negative for HIV.

He was fined.

An HIV-positive individual who may have had sexual intercourse without informing his partner of his HIV status is also being investigated.

Will the amendments take it a step further in preventing the spread of Aids?

Yes - but only if honesty is a policy that is practised in bed.