The first case of HIV in Singapore was detected in 1985.  Since then, the number of HIV cases has continued to grow, and by the end of 2009, the estimated number of people living with HIV was around 3,400, up from 2,800 estimated in 2001 [1], or about a 21% increase. Nonetheless, HIV prevalence among adults aged 15-49 has remained low at 0.1% [1]. As of 2009, there was a cumulative total of 4,404 reported HIV cases, with 448 among females and 3,956 among males [2].  By  the end of 2010, the Ministry of Health reported a cumulative total of 4,845 people living with HIV/AIDS, with 4,359 males and 486 females [3]. As of 31 December 2010, 2,319 persons were asymptomatic carriers, 1,137 had AIDS-related illnesses and 1,389 had died [3].

A big majority (98%) of the 441 cases reported in 2010 pointed to sexual transmission as the main mode of HIV transmission, with heterosexual sex accounting for 52% of infections, followed by homosexual (37%) and bisexual (9%) modes. Intravenous drug use accounted for 1% of infections. Two foreign-born children were reported to have been infected through the perinatal route [3].

Majority of new HIV cases in 2010 was found among persons aged between 30 and 49 years (55%). Of note, however, is that 54% of newly diagnosed HIV cases in  2010 were already in late stages [3], a similar finding to 2009, which suggested  a need for more HIV testing among those who engaged in high-risk behaviour such as unprotected casual sex [4]. New HIV cases were detected through HIV testing in the course of medical care (56%), as a result of routine health screening (17%) and voluntary screening (12%), and screening in prisons and drug rehabilitation centers (5%) [3].

Based on a survey carried out among men who have sex with men (MSM) in 2006, almost 50% of respondents (n=1,479) reported having 2-5 partners during the last three months preceding the survey [5]. Many respondents reported not having used condoms regularly with casual partners (33%) and with regular partners/boyfriends (51%) during same period. The same survey found that 57% of MSM received HIV testing in the last 12 months (in 2006) and knew the result [5]. Although injecting drug users (IDUs) have accounted for only 1% of the cumulative number of the reported HIV infections in 2010 [3], strict drug laws likely result in the underrporting of this mode of transmission, similar to the situation among MSM. Another cause for concern is the reported HIV prevalence among IDUs, which had been steadily rising at 0.2% in 1993, 1.6% in 1998 and 1.9% in 2005 [6].

There is substantial information available on female sex workers (FSWs) in Singapore with published documents on FSWs dating back to late 1990s.  According to the Report on the Global AIDS Epidemic (2010), 99% of sex workers (only representing those brothel-based) used a condom with their most recent client in 2007 [7].

Among the vulnerability factors include strong stigma and dicrimination towards people living with HIV, existence of laws that criminalise homosexuals and drug users thereby resulting in underreporting of HIV cases among these groups, and the low level of comprehensive HIV knowledge among young people aged 15-24. A study in 2007 revealed that only 17% young people aged 15-24 had comprehensive knowledge about HIV – that is, who were able to both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV [8].

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic 2010

[2] Singapore Ministry of Health, Update on HIV/AIDS Situation in Singapore, 2009

[3] Singapore Ministry of Health, Update on the HIV/AIDS Situation in Singapore 2010

[4] Singapore UNGASS Country Progress Report, 2010

[5] Action for AIDS Singapore. 2006 MSM survey, 2006

[6] WHO/UNAIDS, Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, 2006

[7] UNAIDS, Report on the Global AIDS Epidemic, 2010

[8] WHO/UNAIDS, Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, 2008