Earliest cases of HIV/AIDS in Singapore

Earliest cases of HIV/AIDS in Singapore deals with the period from 1985 to 1990, beginning with the discovery of HIV infection in Singapore to the diagnosis of the first patient with AIDS, his subsequent death, the spread of the epidemic and its effects on society.

=Initial reports from USA=

In the first half of the 1980s, Singaporeans, especially the gay community, read with increasing disquiet the development of a new scourge called AIDS (acquired immune deficiency syndrome) which was first clinically observed in 1981 in the United States. The earliest cases were a cluster of injection drug users and gay men with no known cause of impaired immunity who showed symptoms of Pneumocystis pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems. Soon thereafter, additional gay men developed a previously rare skin cancer called Kaposi's sarcoma (KS). Many more cases of PCP and KS emerged, alerting the US Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak. The Singaporean gay community, already marginalised and discriminated against, was horrified that the mysterious malady was being referred to with negatively sensationalistic terms such as the "gay plague" and "gay cancer".

In the beginning, the CDC did not have a definitive name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. In the general press, the term GRID, which stood for gay-related immune deficiency, had been coined. It came as some relief to some gay Singaporeans when the CDC, in search of a name, and looking at the infected communities discovered that it not only affected the gay community but also heroin users, haemophiliacs, and Haitians. It was thus also dubbed the "4H disease". However, after determining that AIDS was not confined to homosexuals, it was realised that the term GRID was misleading and "AIDS" was introduced at a meeting in July 1982. By September 1982 the CDC had started officially using the name AIDS.

In 1983, two separate research groups led by American Robert Gallo and French investigators Françoise Barré-Sinoussi and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science. Gallo claimed that a virus his group had isolated from a person with AIDS was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) his group had been the first to isolate. Gallo's group called their newly-isolated virus HTLV-III. At the same time, Montagnier's group isolated a virus from a patient presenting with swelling of the lymph nodes of the neck and physical weakness, two classic symptoms of primary HIV infection. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV). As these two viruses turned out to be the same, in 1986 LAV and HTLV-III were renamed HIV.

=Calm before the storm=
 * See also: Archive of "Tight lid on Aids problem here, says doctor", The Straits Times, 9 December 1984

Even though Singaporeans were alarmed at the scale and speed with which the AIDS epidemic was growing in America, it seemed remote because the country was half a world away. There was a sense of complacency and smugness in some quarters of society that the possibility of the dreaded disease reaching the island republic's shores was highly unlikely. During an episode of Talking Point, a prime time Channel 5 televised forum devoted to the issue, a member of parliament from the ruling party who was invited to speak even quipped that Singaporeans were protected from AIDS by their "Asian values".

This view seemed to be affirmed when Dr K V Ratnam, a registrar at the Middle Road Hospital, announced on Friday, 8 December 1984 that unlike Western countries, Singapore had a "tight lid" on the AIDS problem. He said that Singapore did have some AIDS-linked factors, such as drug abuse and homosexuality but these were "under control". Speaking on the topic of "AIDS and Homosexuality" at a Rotary Club of Singapore East gathering, Ratnam said the number of homosexuals in Singapore was small compared to the United States. The 120 homosexual male prostitutes here were given blood and skin tests and thorough check-ups regularly.

Dr Ratnam explained that homosexuals risked getting AIDS because some of them practised extreme sexual acts. Prolonged exposure and close contact helped to spread the disease. AIDS, which broke down the body’s immunity system and normally caused death, could be transmitted through blood transfusions. But Singapore's blood donation system was another defence against AIDS. Singapore depended on voluntary blood donations, which allowed donors to be screened. Drug abusers were a high-risk group because drugs further depressed the body's immunity system. But there were very few hard drugs on the streets here, Ratnam noted. His comments, published in The Straits Times the following day, on Saturday, 9 December 1984, assuaged the fears of the general public.

=Three in S'pore found with AIDS-linked virus=
 * See also: Archive of "Tight lid on Aids problem here, says doctor", The Straits Times, 9 December 1984

It therefore came as a profound shock to everyone when the news broke in the press on Wednesday, 10 April 1985 that three men in Singapore had been found to harbour the virus believed to cause AIDS. A Ministry of Health statement the previous day said the men, all homosexuals, had "positive screening tests for antibodies to HTLV-III virus" which were detected during a study of high-risk groups. (Note: In 1985, the nomenclature of the AIDS virus had not yet been standardised as "HIV" (human immunodeficiency virus) and it was still being referred to as HTLV-III (human T-cell lymphotropic virus type III)).

The ministry said that, clinically, the men did not have AIDS but they were “under medical evaluation and close surveillance". The men’s blood samples were sent to the United States for verification of the presence of the virus. The patients, apparently Singaporeans, were attending the Sexually Transmitted Diseases Clinic at Middle Road Hospital, but it was understood that they might be warded in the Communicable Disease Centre (the former Middleton Hospital) the following day, on Thursday, 11 April 1985. The medical staff of the CDC had been alerted the previous week to receive the patients.

=Public education=
 * See also: Archive of "Pamphlet soon on how to avoid Aids", The Straits Times, 11 April 1985

There was some apprehension among the centre’s staff about having to deal with these patients. They approached their union for help in obtaining the ministry’s assurances that all precautions would be taken. The ministry advised the public that AIDS was not spread by ordinary social contact. Its statement assured: “Aids is spread by close intimate sexual contact. It is not spread in ordinary activities of school, employment, public transport or places of entertainment.” On 11 April 1985, a Health Ministry spokesman said that a pamphlet to inform the public about AIDS and how to avoid it would be released soon. To protect doctors, nurses and other staff at hospitals and private clinics, the ministry sent out stringent guidelines on the handling of suspected AIDS cases. Medical personnel were advised to take "extraordinary care" in dealing with them. Among other things, staff should wear gloves and gowns when in contact with blood-soiled items, secretions, body fluids and excretions from these patients.

Middle Road Hospital announced it would be holding a series of talks on AIDS for doctors of outpatient clinics and for general practitioners. Studies at the time had shown that only about 10% of homosexual men with the virus developed Aids within 2 to 5 years. Others in the high-risk groups were heterosexual men with multiple partners, drug addicts who injected themselves, and haemophiliacs. Screening tests for these groups would soon be available at Middle Road Hospital. The hospital also offered AIDS and STI counselling service.

=Dr K V Ratnam, discoverer of AIDS virus=
 * See also: Archive of "Aids virus: Doctor who 'found it'", The Sunday Times, 14 April 1985

=Editable text of article=

On 14 April 1985, the press announced that Dr K V Ratnam, a Middle Road Hospital dermato-immunologist, was the man behind the discovery of Singapore's first three cases of HIV infection. Ratnam had started his research in May 1984, a pilot project involving the screening of 100 transvestites with skin and saliva tests, blood analyses and delving into their backgrounds and lifestyles. It was a two-man show with just Ratnam and laboratory technician K. Ali doing the blood tests. But other medical practitioners laughed at him and felt that he was wasting his time because they said AIDS could not hit a society like Singapore's.

Initially the transvestites from Bugis Street, Johore Road and Claymore Hill were reluctant to speak up, but when they realised the benefits of the research, they responded. Word got around and soon Ratnam had more than enough cases to test. It is believed Ratnam first saw AIDS victims when he was studying immunology at Stanford University in California. In December 1984, Ratnam discovered one case which showed positive signs of "early AIDS". A total of 53 blood samples were immediately sent to Dr Robert Gallo, the American scientist who discovered the deadly AIDS virus. Tests were further carried out at the National Cancer Institute at Bethesda in the United States and they proved positive. Middle Road Hospital was informed of the results by Gallo in early April 1985. Sources said blood tests for AIDS had been halted at the hospital until the laboratory technicians could be convinced that all was well and they were out of danger. About 80% of the 150 transvestites had already been screened for AIDS.

One of the three who had the AIDS virus was said to be in "a more advanced stage". His friend, a fellow transvestite, said: "He knows he will die and has told the doctor if that must happen, so be it because he can only work as a prostitute for a living." He added that another transvestite, who had the virus but no symptoms yet, had decided to end his promiscuous ways and become a bus driver. The third had yet to decide what steps to take. But all three are scared. The danger was that the two who had not shown any symptoms (it could take up to four years for the symptoms to surface) could still continue their promiscuous behaviour. "They can go to Bugis Street, eat, have fun and who's to say that some other person cannot pick up the virus if they eat off the same plate or drink out of the same glass which may not be properly washed."

The news affected conversations at Bugis Street and the talk was no longer who had had an operation to join the transvestite fraternity but the in vogue subject had become AIDS instead. And the habitues were going to great lengths to make sure that those who had not been cleared by Middle Road Hospital stayed out of the territory. On Thursday, 11 April 1985, a day after news of Singapore's HIV victims broke, one transvestite in Bugis Street said: "Some of our sisters (a term used to describe fellow transvestites) are moonlighting in our area. We don't mind, but we know they have not had the AIDS test. We don't need them here to infect our partners and ruin business for all of us." After more than two hours of arguing in the wee hours of the morning, the moonlighting "sisters" were seen leaving. A doctor at Middle Road Hospital said they had received many calls after the news appeared in the newspapers. "Many were anxious callers who wanted to know more about how screening was done. We have yet to see them at the hospital. I think they are shy."

=Nurses seek transfer=
 * See also: Archive of "Aids: Nurses seek transfer", The Straits Times, 15 April 1985

=Iris Verghese=
 * Main article: Iris Verghese

=MOH: Don't panic=
 * See also: Archive of "Don’t panic over Aids - ministry", The Straits Times, 16 April 1985

=HIV/AIDS put on notifiable disease list=
 * See also: Archive of "Aids on ‘must report’ list", The Straits Times, 17 April 1985

=Letters to press decrying sensationalism=
 * See also: Archive of "Fair reports on subject show paper is credible", The Straits Times, 20 April 1985

=CDC set up to treat AIDS=
 * See also: Archive of "New centre to be set up to treat Aids", The Straits Times, 20 April 1985

=Medical undergrads taught about HIV/AIDS=
 * See also: Archive of "Undergrads to be taught about Aids", The Straits Times, 21 April 1885

=Four screened as AIDS clinic opens=
 * See also: Archive of "Four screened as Aids clinic opens", The Straits Times, 26 April 1985
 * See also: Archive of "Aids: Empat lelaki diperiksa di klinik", Berita Harian, 26 April 1985

=16 more may be carriers of HIV=
 * See also: Archive of "16 more may be carriers of Aids virus", The Straits Times, 30 April 1985

=Special lab set up for HIV diagnostic tests=
 * See also: Archive of "Special lab to do Aids tests soon", The Straits Times, 18 May 1985

=Man with HIV hospitalised and discharged=
 * See also: Archive of "Man with Aids related virus in hospital", The Straits Times, 21 July 1985
 * See also: Archive of "Aids carrier leaves hospital", The Straits Times, 28 July 1985

=MOH steps us anti-AIDS drive=
 * See also: Archive of "Talks on plan to deal with Aids", The Straits Times, 6 August 1985
 * See also: Archive of "Ministry steps up Aids drive", The Straits Times, 5 September 1985

=S'pore-Stanford research tie-up=
 * See also: Archive of "S’pore-Stanford research tie-up bid", The Straits Times, 10 October 1985

=20,000 cleared of having HIV=
 * See also: Archive of "Aids: 20,000 cleared", The Straits Times, 29 November 1985

=Screening test likely to uncover more HIV carriers=
 * See also: Archive of "Screening tests likely to uncover more Aids carriers", The Straits Times, 1 May 1986

=First AIDS case diagnosed=
 * See also: Archive of "First Aids case discovered in Singapore", The Straits Times, 27 September 1986

=First AIDS death=
 * See also: Archive of "Aids claims first victim here", The Straits Times, 11 April 1987

=AIDS fear boosts condom sales=
 * See also: Archive of "Fear of Aids pushes up condom sales", The Straits Times, 19 April 1987

=Govt dental clinics phase out boiling=
 * See also: Archive of "Govt dental clinics phasing out boiling", The Straits Times, 1 October 1987

=Goh Choo San dies of AIDS-related illness in US=
 * See also: XXX

=GE Life is first insurer with question on AIDS=
 * See also: Archive of "GE Life is first with question on Aids", 28 December 1987

=Effect of AIDS on society=
 * See also: Archive of "AIDS hits home", The Sunday Times, 6 March 1988

=Overreaction of hotel to tourist with AIDS=
 * See also: Archive of "Tourist with Aids-related illness in hospital", The Straits Times, 3 June 1988
 * See also: Archive of "More Aids talks for hotel staff likely", The New Paper, 3 June 1988

=Insurance firms test applicants for HIV=
 * See also: Archive of "Insurance firms test applicants for Aids", The Straits Times, 21 May 1989

=HIV cases likely to double in 1989=
 * See also: Archive of "Aids toll likely to double this year", The New Paper, 4 July 1989

=Foreign workers to be screened for HIV=
 * See also: Archive of "New foreign workers may face Aids test", The New Paper, 17 July 1989
 * See also: Archive of "Man picked up Aids from foreign prostitute", The Straits Times, 26 July 1989
 * See also: Archive of "New Filipino maid suspected of having Aids sent home", The Straits Times, 29 August 1989

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

==
 * See also: XXX

=See also=
 * Earliest cases of HIV/AIDS in Singapore
 * HIV/AIDS in Singapore's LGBT community
 * Paddy Chew
 * Avin Tan
 * Ajmal Khan
 * Calvin Tan
 * Adrian Tyler
 * Archive of "Tight lid on Aids problem here, says doctor", The Straits Times, 9 December 1984
 * Archive of "Ministry issues Aids pamphlet", The Straits Times, 25 March 1985
 * Archive of "Three in S’pore found with Aids-linked virus", The Straits Times, 10 April 1985
 * Archive of "Why 3 with Aids virus won't be hospitalised", The Straits Times, 11 April 1985
 * Archive of "Pamphlet soon on how to avoid Aids", The Straits Times, 11 April 1985
 * Archive of "Aids virus: Doctor who 'found it'", The Sunday Times, 14 April 1985
 * Archive of "If Aids strikes Singapore", The Straits Times, 15 April 1985
 * Archive of "Aids: Nurses seek transfer", The Straits Times, 15 April 1985
 * Archive of "Don’t panic over Aids - ministry", The Straits Times, 16 April 1985
 * Archive of "A chance to be ahead in medicine", The Singapore Monitor, 16 April 1985
 * Archive of "Aids on ‘must report’ list", The Straits Times, 17 April 1985
 * Archive of "New centre to be set up to treat Aids", The Straits Times, 20 April 1985
 * Archive of "Tan Tock Seng hospital to get five new blocks", The Straits Times, 20 April 1985
 * Archive of "Fair reports on subject show paper is credible", The Straits Times, 20 April 1985
 * Archive of "Undergrads to be taught about Aids", The Straits Times, 21 April 1885
 * Archive of "Four screened as Aids clinic opens", The Straits Times, 26 April 1985
 * Archive of "Aids: Empat lelaki diperiksa di klinik", Berita Harian, 26 April 1985
 * Archive of "16 more may be carriers of Aids virus", The Straits Times, 30 April 1985
 * Archive of "Aids doctor thanks mum", The Straits Times, 12 May 1985
 * Archive of "Special lab to do Aids tests soon", The Straits Times, 18 May 1985
 * Archive of "New Senior Registrars", The Straits Times, 5 July 1985
 * Archive of "Our health service’s new Senior Registrars", The Straits Times, 5 July 1985
 * Archive of "Doctors, dentists in govt hospitals promoted", The Straits Times, 5 July 1985
 * Archive of "Man with Aids related virus in hospital", The Straits Times, 21 July 1985
 * Archive of "Aids carrier leaves hospital", The Straits Times, 28 July 1985
 * Archive of "Talks on plan to deal with Aids", The Straits Times, 6 August 1985
 * Archive of "Ministry steps up Aids drive", The Straits Times, 5 September 1985
 * Archive of "Singapore ‘first in the world’ to have 100 % screening of donor blood", The Straits Times, 11 September 1985
 * Archive of "S’pore-Stanford research tie-up bid", The Straits Times, 10 October 1985
 * Archive of "Aids: 20,000 cleared", The Straits Times, 29 November 1985
 * Archive of "A year that many would like to forget", The Straits Times, 31 December 1985
 * Archive of "Blood highs and lows", The Straits Times, 13 May 1986
 * Archive of "200 turn up for first public medical convention", The Straits Times, 28 April 1986
 * Archive of "New strains of VD found in S’pore", The Straits Times, 29 April 1986
 * Archive of "Screening tests likely to uncover more Aids carriers", The Straits Times, 1 May 1986
 * Archive of "100 people could be Aids carriers here: Expert", The Straits Times, 3 August 1986
 * Archive of "First Aids case discovered in Singapore", The Straits Times, 27 September 1986
 * Archive of "Unorthodox sex can lower body’s defences", The Straits Times, 25 January 1987
 * Archive of "Aids claims first victim here", The Straits Times, 11 April 1987
 * Archive of "Fear of Aids pushes up condom sales", The Straits Times, 19 April 1987
 * Archive of "Second Aids case detected here", The Straits Times, 25 July 1987
 * Archive of "Govt dental clinics phasing out boiling", The Straits Times, 1 October 1987
 * Archive of "GE Life is first with question on Aids", 28 December 1987
 * Archive of "Doctor who’s a friend to the poor", The Straits Times, 1 March 1988
 * Archive of "AIDS hits home", The Sunday Times, 6 March 1988
 * Archive of "Tourist with Aids-related illness in hospital", The Straits Times, 3 June 1988
 * Archive of "More Aids talks for hotel staff likely", The New Paper, 3 June 1988
 * Archive of "Insurance firms test applicants for Aids", The Straits Times, 21 May 1989
 * Archive of "Aids cases may hit 74", The New Paper, 4 July 1989
 * Archive of "Aids toll likely to double this year", The New Paper, 4 July 1989
 * Archive of "New foreign workers may face Aids test", The New Paper, 17 July 1989
 * Archive of "Man picked up Aids from foreign prostitute", The Straits Times, 26 July 1989
 * Archive of "New Filipino maid suspected of having Aids sent home", The Straits Times, 29 August 1989

=References=

=Acknowledgements=

This article was written by Roy Tan.