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 "Ministry issues Aids pamphlet", The Straits Times, 25 March 1985
 * See also: Archive of "Three in S’pore found with Aids-linked virus", The Straits Times, 10 April 1985

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 or 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". Their 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 (CDC; 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.

It seems uncanny that barely two weeks before the public announcement of the discovery of the first cases, the MOH had presciently published a pamphlet describing the signs and symptoms of AIDS as a measure to prevent the spread of the disease. It urged all prospective blood donors to read it before donating blood. The pamphlet became available from Friday, 22 March 1985 at the Blood Transfusion Centre along Outram Road and at all mobile blood donation stations. A spokesman from the Blood Transfusion Centre clarified: “This pamphlet is really because of AIDS.” Because laboratory tests for HIV were not available yet, the information in the publication aimed to allow prospective blood donors with the disease to exclude themselves. About 70,000 pamphlets were available in English and about 40,000 in Mandarin. The Health Ministry had also recently set up an advisory committee on AIDS which would look into ways of preventing and controlling the disease. In retrospect, it is reasonable to speculate that before the announcement of the first three cases of HIV infection in Singapore, the ministry had already known for some time about their existence and had instituted precautionary measures to safeguard Singapore's supply of donated blood.

=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 CDC’s staff about having to deal with the HIV 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 went on to develop 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 were soon to be available at Middle Road Hospital. The hospital also offered AIDS and STI counselling service.

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

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 3 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. As it turned out, Ratnam had the last laugh as his research paid off.

Initially the transvestites from Bugis Street, Johore Road and Claymore Hill were reluctant to speak up, but when they realised the benefits of the study, 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 mmunology 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. Blood tests for AIDS were then 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.

1 of the 3 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 3 were scared. The danger was that the 2 who had not shown any symptoms (it could take up to 4 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

On 15 April 1985, it was reported in the press that about 26 nurses had asked to be transferred out of the CDC because they were afraid of dealing with AIDS patients. Two doctors even resigned. The nurses' union, the Amalgamated Union of Public Employees (ACPE), wanted the Health Ministry to delay admitting patients until the centre was equipped to have them.

ACPE General Secretary G Kandasamy said the day before that if the men needed hospitalisation, they should be quarantined somewhere else and not at the CDC in Tan Tock Seng Hospital. "They should not be in the hospital where there are patients with other illnesses and who have relatives visiting them," he elaborated. The union was concerned about whether it was in the public interest to let the three men move about freely. "AIDS is an infectious disease and it is incurable," Kandasamy stressed.

In a letter to the ministry dated 10 April 1985, the union said that staff at the centre had not been briefed on procedures in handling AIDS patients. The union was worried that the ward earmarked for them, Ward 76, was not adequately equipped with staff safety in mind. Among other things, the union pointed out that the nurses’ station and the patient care area were not clearly set apart. It suggested that only staff who volunteered should be made to work in Ward 76. The union also called for a compensation scheme to be worked out for staff who may get the AIDS virus during their work.

Kandasamy reported that he had not yet received a reply from the ministry. A source at the CDC said there was some panic among the nurses, who were not mentally prepared for the patients. The source said that the centre had only a few days' notice that the men may be hospitalised but preparations had been made to receive them. The nurses had been assured that they would not be asked to take blood samples from these patients, thus reducing the risk of their getting infected with HIV if they accidentally pricked themselves while withdrawing blood.

=Iris Verghese=
 * Main article: Iris Verghese

One exceptional health worker at the CDC who did not shy away from dealing with AIDS patients was Iris Verghese. She even offered them comfort and a shoulder to cry on. She recollects: "The humiliation connected to the disease was horrible. People did not want to come close to them, let alone touch them." Verghese went on to dedicate much of her life to helping people living with HIV/AIDS. In the ensuing three decades, she would go on to counsel countless patients and their families, as well as raised funds for HIV prevention. In 2019, in honour of her bravery and compassion, Verghese was featured in a short film called Plague, directed by Boo Junfeng and dedicated to the Action for AIDS charity. The film was part of the National Volunteer and Philanthropy Centre's 15 Shorts project, which featured 15 Singaporeans who went to extraordinary lengths to help others.

 

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

On Monday, 15 April 1985, the Health Ministry advised the public not to panic following the growing concern over the discovery of the AIDS virus locally. Dr Kwa Soon Bee, Permanent Secretary (Health) and Director of Medical Services, told a press conference at the Ministry of Health that people who were not promiscuous should not worry about getting AIDS as it was contracted through intimate sexual contact. "Avoid promiscuity," he advised. The ministry's disclosure the previous week that three men were found to have HIV touched off a scare despite a ministry statement that day which said that AIDS was not spread through contact at work, places of entertainment and public transport. Dr Kwa called the press conference to repeat this assurance, respond to press reports on AIDS, and elaborate further on the condition of the three men. He also gave an assurance that steps had been taken to ensure the safety of medical staff who would have to deal with cases of AIDS.

He said that there had been no substantiated study that AIDS could be contracted through the sharing of food or ordinary social contact. He added that the infectiousness was not like the flu and one did not get AIDS just by sitting next to a patient or a carrier. He informed the press that the ministry was still trying to trace the contacts of the three men. There were no other known carriers of the virus to date apart from the three men. And he stressed that there was no known case of "clinical AIDS” in Singapore.

The three men did not have clinical AIDS, although one of them had slight weight loss and fever, which were some symptoms of the disease. The other two did not have any AIDS symptoms. When asked what steps were being taken to stop these men from spreading the HIV virus, Dr Kwa replied: “We can only counsel them not to be so promiscuous. If that’s their way of life (homosexual prostitution), there’s little we can do about it." The men had been told to report for weekly check-ups. Dr Kwa said a checkup once a week was adequate because “it is not likely that they will develop Aids suddenly*'.

He called on the media and public to see the three men’s plight “in perspective”. There was a big jump from carrying the HIV virus to contracting AIDS. It was not necessary to ostracise or incarcerate the men in a camp, he said. The ministry had no intention of ostracising everyone who had a positive blood reaction to the test for HIV, he added. But any case of clinical AIDS would immediately be hospitalised at the Communicable Disease Centre, Tan Tock Seng Hospital, which was fully prepared to handle infectious diseases including Aids, he explained. Dr Kwa said that the ministry was gathering more information before coming up with a "master plan" to deal with the disease. It was gathering data on how many people in the "high risk groups" such as male homosexual prostitutes had the virus and whether female prostitutes had it too. This could be tested when more detection kits for HIV arrived.

Dr Kwa disputed a press report that an Aids scare had caused staff at Middle Road hospital to “revolt”. The report implied that two doctors had resigned rather than deal with AIDS patients and that 26 nurses had asked for transfers. He said the resignations had nothing to do with AIDS and that the nurses, 25 in all, from the Communicable Disease Centre at Tan Tock Seng Hospital, were believed to have been “pressured” into asking for transfers. He did not say by whom. Two or three of the nurses had already withdrawn their letters. He said that when and if clinical Aids surfaced, anyone who asked for a transfer would have his request considered. 

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

On Monday, 15 Aril 1985, Dr Kwa Soon Bee announced that the Ministry of Health would make HIV infection and AIDS notifiable diseases within the next few days, just as was the case for yellow fever, malaria and viral hepatitis. The move would give the ministry extensive powers to monitor the spread of the disease and tackle it more effectively. Once HIV/AIDS was included in the schedules of diseases listed in the Infectious Diseases Act, the ministry would be able, among other things, to:
 * Require doctors by law to notify the MOH of any case of HIV/AIDS among their patients
 * Quarantine anyone suspected of having the disease
 * Order people to undergo blood tests or any examination to determine if they had HIV/AIDS
 * Question the public in order to trace the spread of the disease among the contacts of a carrier
 * Order post-mortems in deaths due to AIDS or suspected of having been caused by AIDS.

Dr Kwa said that doctors at Middle Road Hospital, where cases of sexually transmitted infections were referred to, had been on the lookout for signs of HIV/AIDS since 1981 when the disease first hit the headlines. He disclosed that the ministry had zeroed in on male homosexual prostitutes, considered a high risk group, since March 1984 following the increase in reports of the incidence of AIDS around the world. The ministry also began to look into the possibility of blood tests to detect the presence of HIV. He said that the tests were only recently found reliable, which is why they were not used earlier. The Elisa test for HIV had just become available in Singapore. But blood samples with the virus would still be sent to the US for confirmation by the special Western Blot test not currently available locally.

Meanwhile, Dr Ong Yong Wan, head of the Advisory Committee on Aids, was in Atlanta attending the world's first major conference on AIDS. She was among 2,000 participants from 30 countries who had registered for the three-day gathering. The public would be able to get snapshot answers about the disease in a week or two when a Health Ministry pamphlet, entitled What You Should Know About Aids, was printed. Yeo Cheow Tong, Minister of State (Health and Foreign Affairs), would visit Tan Tock Seng Hospital on Friday, 19 April 2019, planned some time ago as part of a routine programme of visits for him.

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

On 20 April 2019, a particularly woke reader of The Straits Times wrote in to commend the paper for its fair and informed reporting on the subject of AIDS. He said that the Straits Times' strict adherence to facts, avoidance of emotive language, and choice of educational as opposed to exciting news angles showed that the paper was responsible and credible. He slammed another newspaper, most probably the tabloid of the day, which in contrast was a disappointment to him. The Straits Times' headlines, "No danger from social contact" and "Don't panic over Aids" reflected the facts but he took issue with the other paper which preferred headlines with commercial appeal. Its reporting served only to cause panic among some members of the public.

The Straits Times not only refuted the other paper’s report that the AIDS scare had caused two doctors to resign and the staff of Middleton Hospital to “revolt", but that the Ministry of Health also reiterated the facts about HIV/AIDS to counter the damaging rippling effect of misinformed journalism. The reader lamented the unfortunate situation that there was a tendency to associate homosexuals or homosexuality with AIDS as the link was understandable as a high proportion of those afflicted were homosexuals. But he stressed that the truth was that homosexuality per se did not bring about AIDS. It was promiscuity which increased the risk of  contracting HIV infection. He also pointed out the tendency to confuse homosexuals with transsexuals and transvestites. The public now knew from the interview with Dr K V Ratnam that the three "homosexual prostitutes" afflicted were actually transsexuals. He cautioned that readers should not be led to believe that sexuality per se or a particular group was responsible for AIDS because that could start a witch-hunt when moral panic gripped society.

Another reader wrote in to say that although HIV could be transmitted through blood transfusions, that is by receiving blood, it was not possible to contract the virus through blood donations. He cautioned that this point could be misinterpreted by the public and lead to the blood bank running dry as had happened in Australia.

=New 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

Just after completing a three-hour tour of Tan Tock Seng Hospital on 19 April 2019, ending at Ward 76 which was reserved for AIDS patients, Yeo Cheow Tong, Minister of State for Health and Foreign Affairs said that a new Communicable Disease Centre (CDC) to treat AIDS and other infectious diseases would be set up at the hospital. The 200-bed centre with special facilities to deal with AIDS would replace the present 160-bed CDC. To be built under Phase II of the Redevelopment Plan for Tan Tock Seng Hospital, it would be on a site between Jalan Tan Tock Seng and Mandalay Road, opposite the existing CDC.

Yeo said there were no details on the special facilities or number of beds for AIDS patients at the moment as the plan was at a conceptual stage. But the ministry would send a proposal for redeveloping the hospital to the Finance Ministry for approval as soon as possible. Since AIDS involved a malfunctioning of the body’s immune system, the ministry’s decision to develop clinical immunology, a medical speciality, at the hospital was seen as a welcome move. Yeo explained that his tour was part of a programme of visits to major government hospitals to give him an overall appreciation of hospitals. He said steps to contain the disease included stepping up blood tests for blood donors and high-risk groups, such as male and female prostitutes. At least 15,000 people would have their blood screened for HIV with the ELISA test over the next three months or so. The ministry also planned to bring from the US the confirmatory Western Blot test in about three months. Yeo added that the ministry would send more doctors overseas to keep up with the latest developments on dealing with the disease. Dr Ong Yong Wan, Director, Blood Transfusion Services, Head of the Haematology Department,. Ministry of Health, and Chairman of the Advisory Committee on Aids, was the first Singapore doctor sent. She had just attended the world's first major conference on AIDS in Atlanta, US, which ended on Wednesday, 17 April 2019.

A ministry spokesman said tender documents were being prepared to further upgrade Ward 76 facilities. The ward would have six individual patient rooms and two intensive care units. The individual rooms were to reduce infection risks for AIDS patients because even simple infections could be fatal for them due to a breakdown of their immune system. Ward 76, where Aids patients would stay, had acquired two new machines - the bedpan steriliser costing more than $10,000 and the $10,000 autoclave machine to sterilise articles such as nurses’ gowns. Notification forms for HIV/AIDS could be obtained from the Medical Director, Middle Road Hospital, or the Head, CDC, Tan Tock Seng Hospital.

Dr Kwa Soon Bee said the day before that the Western Blot test would be conducted in the pathology laboratory. A Health Ministry spokesman explained that the ELISA test was a more general test to detect the presence of HIV and the Western Blot test was a double check to weed out "false positives". On the same day, a Tan Tock Seng Hospital official said that 23 of the 25 nurses at the CDC had withdrawn their requests for transfers. The other two were considering whether they too should withdraw their requests.

Meanwhile, there had been no discernible drop so far in the number of blood donors following reports that three people in Singapore have contracted HIV. This was apparent from an analysis of the amount of blood donated. It had not varied since the first report of HIV cases on Wednesday, 10 April 1985. Figures from the Blood Transfusion Service for the past three months showed that on average more than 1,000 units of blood had been collected each week. For the week beginning from Monday, 8 April 1985 to Sunday, 14 April 1985, 1,184 units were collected. The number of units of blood collected in the previous few days were: Monday, 154 units; Tuesday, 115 units; Wednesday, 169 units and Thursday, 163 units. This was close to the daily average of about 140 units. A Health Ministry spokesman said that regular blood donors were well informed about AIDS, as more than a month ago, they were issued with a pamphlet explaining that the disease could not be contracted through blood donation. He said: “This s because when someone gives blood, we use a new, sterile, disposable needle to collect the blood. The needle is discarded after each use.”

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

On Saturday, 20 April 1985, Professor Edward Tock, Dean of the Faculty of Medicine, National University of Singapore said that medical students would soon be taught about AIDS, Professor Edward P C Tock said yesterday. As doctors would be asked many questions on AIDS, medical students would have to be made aware of the latest developments in the disease. Tock was speaking at a symposium on Training of Our Future Doctors, which was organised by the Singapore Medical Association. The symposium, held at the Hyatt Regency Hotel, was part of a four-day SMA Silver Jubilee National Medical Convention. Today is the last day of the convention. Tock said AIDS would be taught under immunology and infectious diseases, two subjects in the five-year medical course. As there was as yet no cure for the disease, students would be taught prevention. This would include patient education and the study of the effects of HIV.

=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

The AIDS Screening Clinic at Middle Road Hospital started work on Thursday, 25 April 1985 and four men were screened for HIV infection. Dr K V Ratnam, the immunologist at the hospital who discovered Singapore's first three cases HIV infection said the day before that since the announcement of the three carriers, more than 50 men had been to the hospital worried that they might have the virus. He revealed: "Because of the publicity and education through the media in exposing the three cases, a lot more people have come forward and can now be diagnosed.” But he added that "a lot of them have a guilt complex more than anything else." For example, one of the men who had been to the clinic had intercourse with a male homosexual about 10 years ago. The clinic would screen people mainly from the high-risk groups every Thursday from 8:30 am to 12:30 pm and follow up on those with AIDS and counsel them.

Ratnam, who was speaking at the Rotary Club of Marina City luncheon, said that studies of cases in the United States had shown that between 60 and 70% of people with the virus were "healthy carriers". About 10 to 90% had non-clinical AIDS and only 5 to 10% would have the "full blown symptoms which would show itself within two years." Of the three people who had HIV in Singapore, two of them had non-clinical AIDS and one was a healthy carrier. But anyone with the virus, whether a healthy carrier, or non-clinical or clinical AIDS patient, would be spreading it through sexual intercourse.

He added: "We cannot lock them up. But what we can do is to advise them to use condoms if they want to have sex. Though it is still being studied whether using condoms would prevent the virus spreading, I think the chances are slim." They would also he advised not to donate blood. Ratnam explained: "AIDS used to be known as the gay plague. It’s now no more so." Of the 7,886 cases of AIDS reported in the US between 1 June 1980 and 21 January 1985, 465 patients were not homosexuals, bisexuals, haemophiliacs, intravenous drug abusers or Haitian immigrants. The study showed that 66% of the 465 patients had no identified risk. The others contracted the virus through heterosexual contact (13%) and blood transfusions (21%). In the US, AIDS had been more or less linked with four "high risk groups". These were known as the "four Hs": homosexual men, heroin addicts (and other intravenous drug abusers), haemophiliacs and recent Haitian immigrants. Ratnam said the AIDS Screening Clinic would be collating data on the prevalence of HIV infection in Singapore.

=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

On Monday, 29 April 1985, in a statement to give an update on its monitoring programme on AIDS, the Ministry of Health reported that sixteen more people in Singapore were suspected of being HIV carriers. They had shown positive results to the screening ELISA test. But pending more tests, the ministry was unable to say whether the 16 were carriers of HIV. It added that the three confirmed carriers of the HIV "remain clinically well". They were being followed up regularly at Middle Road Hospital. "The majority of the 16 showed only weak positive results. The significance of the weak positive tests is unclear and false positives due to serological abnormalities are possible," the ministry said.

AIDS Advisory Committee Chairman Dr Ong Yong Wan said the same day: "Initial positive results from laboratory tests may not mean the individual has been exposed to or is carrying the virus." Dr Ong said the ELISA test was used as a screen for antibodies or protein substances to HIV. There could be other proteins in the blood unrelated to the virus, giving a positive test result. All blood samples found positive have been sent to Reference Laboratories in the United States and Australia for the confirmatory Western Blot test. None of the results were yet available. Thirteen of the suspected cases were from the high risk group of haemophiliacs, homosexuals and prostitutes. So far 2,058 people from the high risk group had been screened. Three others were discovered through screening tests done by the Blood Transfusion Service, which tested specimens from 4,723 blood donors.

Dr Ong said that, eventually, about 20,000 people would be screened - about 5,000 in the high risk group and 15,000 blood donors. The 16 suspected cases, screened under the ministry's AIDS monitoring programme, included a man who was discharged from Alexandra Hospital on Saturday, 27 April 1985. The ministry assured the public that during the patient's brief hospitalisation, all necessary precautions were taken to safeguard the public and hospital staff. AIDS could he transmitted through sperm, but a ministry spokesman said that there was no move to ban artificial insemination because of little such activity in Singapore. “The Sperm Bank is dry because people are afraid to donate sperm," she added.

=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

Dr K V Ratnam, a Registrar at Middle Road Hospital and the discoverer of HIV in Singapore, was sent to Atlanta and Washington in February 1985 to learn the latest techniques on confirmatory tests for the as-yet incurable disease. At the Atlanta Centre for Disease Control, he attended a four-day intensive training course on the Western Blot test. He was the only overseas participant in a group of about 30 doctors. The Western Blot test was employed after another test has been made. This first test, called the ELISA test, was used to screen the presence of certain antibodies which might indicate whether the person had been exposed to HIV. Once the ELISA test identified someone as having these antibodies, the Western Blot test was then employed to determine if this person had been actually exposed to HIV virus or was carrying it.

The Western Blot test which Singapore intended to use would be enzyme-linked and was called the ELISA-Western Blot test. It was different from the Western Blot test employing radioactive materials in use in the laboratory of Dr Robert Gallo, the American doctor who discovered HIV. Ratnam said both were just as accurate but the ELISA-Western Blot test was more convenient to use and did not pose the problem of radioactive waste disposal. He added that both Western Blot tests were not commercially available yet. Ratnam had spent a week at Robert Gallo's laboratory in Washington to see the work done there.

Ratnam said the laboratory in Singapore would be operational by July 1985. It would be situated in the Pathology Department of the Singapore General Hospital. He said all precautions would be taken to ensure the safety of the staff, including the proper sterilisation of equipment and proper disposal of materials. Having learnt how to use and interpret the Western Blot test at Atlanta, Ratnam would be responsible for the work in the special SGH laboratory. He said he would divide his time between Middle Road Hospital and the laboratory. He would train two laboratory technicians to help him. Later he would also train some doctors to interpret the results.

The Ministry of Health said that a man was now under observation at Middle Road Hospital for suspected Kaposi's Sarcoma, a skin cancer that was one of the clinical manifestations of AIDS. It added: “So far, all tests carried out have been negative. The patient is still under investigation.” Meanwhile, the three men identified as carriers HIV were well, said Dr Tulip Tan, the Medical Director of Middle Road Hospital. She added that their condition remained unchanged and they were reporting for the weekly check-ups at the hospital. Dr Ratnam said one of them had weight loss and swollen lymph nodes while another had swollen lymph nodes.

The pilot study and blood tests on 20,000 people in the high-risk groups such as prostitutes and haemophiliacs had begun, said AIDS Advisory Committee Chairman Dr Ong Yong Wan. She stressed that there was still no case of AIDS in Singapore. The pilot study should be completed in about three months, she added.

=Man with HIV hospitalised and then 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

On 20 July 1985, a Health Ministry spokesman said that a man who was exposed to HIV had been admitted to Alexandra Hospital. Apparently, he was admitted for severe depression. Screening tests showed the man had the antibodies to the virus but he did not have AIDS or its symptoms. Samples of his blood had been sent to the United States for tests and the ministry was awaiting the results. Until laboratory facilities for the confirmatory Western Blot test were ready locally, blood samples would continue to be sent to the US. Alternatively, some samples might be sent to Australia. Laboratory equipment for the test have been ordered for the Pathology Department of the Singapore General Hospital. The man, admitted the previous week, was not one of the three men identified earlier as carriers of the virus. He was also not the man who reportedly was suspected to have Kaposi's Sarcoma. The spokesman said that all necessary precautions to safeguard hospital and laboratory staff and patients from accidental infection had been taken. These included the isolation of the patient in a room, proper disposal of medical supplies, wearing of gloves and a gown over the uniform, sterilisation of articles such as the gowns, and the wearing of masks.

On 27 July 1985, the man was discharged from Alexandra Hospital. A Health Ministry spokesman said the man was discharged because he was "all right” and did not have AIDS. He had also seen a psychiatrist. The man, a homosexual, was attending counselling sessions at Middle Road Hospital like the other three men who were identified earlier as HIV carriers. It was learnt that more people might be HIV carriers. These probable new cases were people whose blood tests showed they had the antibodies to the virus.

=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

In early August 1985, Health Ministry officials and the Aids Advisory Committee, made up of government doctors, held high-level discussions on a comprehensive plan to deal HIV/AIDS. The plan covered "the total works" from stepped-up public education on the disease to monitoring and tests for the presence of antibodies to HIV. The Health Ministry headquarters had a position paper on the plan which would cover not just the current year or the next, but a much longer term. Health and Finance Minister Dr Richard Hu and the Minister of State for Health and Foreign Affairs, Yeo Cheow Tong, were expected to see the paper before the meeting.

The plan's strategies would most likely include the training of doctors, nurses and laboratory staff, more public education, and perhaps, even the setting up of more laboratories to do the necessary tests. The ELISA screening test for detecting antibodies to HIV was currently done manually and the few laboratory technicians doing the test were hard-pressed. The plan was expected to provide for the training of more staff and even getting equipment which would partially, if not fully, automate such tests. Doctors would, however, still interpret the results.

ELISA tests were done at a Pathology Department laboratory in the Singapore General Hospital for the high-risk groups of haemophiliacs, homosexuals and prostitutes. Tests for blood donors were done at a Blood Transfusion Service laboratory in the SGH. The special laboratory for the confirmatory Western Blot test now done overseas was being set up at the SGH’s Pathology Department. An AIDS Advisory Committee spokesman expected the laboratory to be operational before the end of 1985. The plan was subject to fine tuning and changes. It contained a budget but no details were available. Meanwhile, a ministry statement issued the previous week said that the three confirmed carriers of the virus identified in April 1985 were clinically well. The Western Blot test results for another 16 suspected carriers were still not available.

100,000 copies of a newsletter, devoted specially to the prevention of AIDS, would be distributed later in August 1985. The 60,000 English and 40,000 Chinese editions would be sent to voluntary organisations, welfare homes, hospitals and all general practitioners. Educational institutions, factories, companies, government departments, statutory boards and members of the public on the Health Ministry's mailing list would also receive it. The ministry was additionally working on a publication for the high-risk groups such as haemophiliacs, homosexuals and prostitutes. These moves were part of the ministry's stepped-up efforts to educate the public. Other plans included public talks and the publication of a a new booklet on safety precautions especially for nurses and laboratory technicians.

The training and health education department of the ministry was preparing the special issue of its newsletter, The Health Educator. On 4 September 1985, the department's medical director, Dr Luisa Lee, said: "The article is written to suit the general public and will be illustrated with drawings. The aim is prevention of AIDS. But before you can prevent, you have to help people understand what AIDS is, how it is spread, the symptoms and so on." Later that month, the department would start its series of talks for the public. The talks would be given to those who asked, said Lee.

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

On 9 October 1985, Associate Prof Oon Chong Jin, chairman of the National Scientific Committee on Hepatitis and Related Disorders, announced that Singapore was working towards a research collaboration with Stanford University in California and the use of antiviral drugs for hepatitis B and AIDS. The affiliation might come about in January 1986 and would involve leading authorities on antiviral drugs, such as Prof Tom Merigan of Stanford University. Arrangements for the tie-up were being handled by the Health Ministry.

Oon said that the antiviral drugs would include “new generation interferon". The successful use of antiviral drugs could help stem the spread of hepatitis B infection and the number of carriers by at least two-thirds. Trials on the use of an antiviral drug on hepatitis B will begin soon at the Singapore General Hospital. There was as yet no cure or even a vaccine for AIDS. Various drugs were used in trials overseas to fight the disease. Some were antiviral drugs and others were drugs which helped to stimulate the patient’s natural defence mechanism.

Oon said that there were contingency plans in Singapore to deal with AIDS should there be a need. Groundwork for the plans were laid some time ago. Singapore had the capacity to screen for exposure to HIV because of the anti-Hepatitis B programme. He explained that hospital staff, such as laboratory technicians who had been trained to do hepatitis B screening, could use those methods in screening for exposure to HIV. Prof Oon, of the National University of Singapore's Department of Medicine, said that AIDS and hepatitis B had similar modes of transmission. He stressed that sexual promiscuity was mainly responsible for the spread of both diseases. Surveys showed that male and female prostitutes in Singapore had high rates of hepatitis B infection - 88% in the male group and 64% in the female group. Oon was an adviser to the World Health Organisation regional seminar on cancer, then on at the Regional Language Centre.

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

On 28 November 1985, Dr Ong Yong Wan, Chairman of the AIDS Advisory Committee, announced that more than 20,000 people in Singapore had been screened and all had been found to be free of HIV infection. Those who had their blood tested under the Health Ministry’s screening programme included blood donors and 2,500 prostitutes. The result was described as miraculous by Professor Jean-Claude Chermann, one of the scientists who discovered the AIDS virus.

Dr Ong said Singapore had the advantage of learning about the disease from countries such as the United States and France. She added that the ministry had taken all measures to prevent the spread of the disease. There were only five carriers and all were still all right. With a safe blood supply due 100% screening of donor blood, there was no longer a threat of infection through blood transfusions, Dr Ong remarked.

This left sexual contact with infected people as the main way by which HIV could be spread. So the Health Ministry would focus on public education regarding the risks of promiscuity through talks, posters and publications, Dr Ong announced. The screening of blood donors was an ongoing exercise and the ministry would keep a close watch on the situation where high-risk groups, such as homosexuals and prostitutes, were concerned. Anyone who requested tests would be obliged.

Dr Jimmy Sng, a member of the committee and who was with the Pathology Department of the ministry, said that in early 1986, the confirmation test for exposure to HIV, the Western Blot test which was then done overseas, would be carried out in Singapore. Equipment for the Western Blot test laboratory of the department had been set up and staff trained to do the test. The test kits from Australia would arrive early in 1986.

Dr Flossie Wong-Staal of the US National Cancer Institute said that the situation in Singapore was under control and would not reach the proportions in the United States. Prof Chermann and Dr Wong-Staal were interviewed after they met the AIDS Advisory Committee at the Singapore General Hospital. Prof Chermann was head of the viral oncology laboratory of Institut Pasteur in Paris and Dr Wong-Staal was head of the molecular biology section of the NCI.

=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

While presenting a paper on the control of sexually-transmitted infections at a World Health Organization (WHO) seminar being held at Novotel Orchid Inn on 1 May 1986, Dr Tulip Tan, Medical Director of Middle Road Hospital, predicted that more carriers of the AIDS virus were likely to be uncovered in Singapore through the Health Ministry's screening programme.

The Health Ministry expected to conduct 60,000 to 70,000 screening tests a year, a target it considered adequate for Singapore. A ministry spokesman said there was still no case of AIDS in Singapore although there were five carriers of HIV locally. All five were homosexuals and their conditions were being monitored by Middle Road Hospital. The ministry had three screening programmes - for the public, blood donors and high-risk groups such as prostitutes and homosexuals. Screening tests were available at five polyclinics - Ang Mo Kio, Bedok, Bukit Merah, Clementi and Kelantan Road. The fee per test was $30 for citizens and permanent residents and $36 for others.

Donor blood obtained by the Blood Bank was also screened before use. Since August 1985, 28,500 units of blood had been screened. Sex with infected partners, contaminated blood and blood products and intravenous drug abuse were major means of HIV transmission. This had been the experience of countries such as the United States, where AIDS was a major problem. High-risk groups such as prostitutes and homosexuals were initially screened at the Middle Road Hospital. The confirmatory Western Blot tests were done at the Pathology Department of the Singapore General Hospital. More than 100 of these tests had been done since late 1985, said Dr Jimmy Sng Ewe Hui, Head of the Pathology Department. The department expected to carry out 700 to 800 Western Blot tests a year. Further medical tests were needed before doctors could tell for sure whether a person was either a carrier or had AIDS, an AIDS Advisory Committee member said.

Dr Chew Chin Hin, the ministry's Deputy Director of Medical Services (Hospitals), said when he opened the seminar on Monday, 28 April 1986, that AIDS had added a "fearsome dimension" to the problem of sexually transmitted infections. The closed-door regional seminar, which attracted 20 participants from 18 countries, together with experts from Switzerland, Australia, Japan and the US, ended on Saturday, 3 May 1986.

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

On Friday, 26 September 1986, Dr Chew Chin Hin, acting Permanent Secretary (Health), told a press conference that the first case of AIDS had been discovered in Singapore. The patient, "a Singapore man who has travelled widely", was being treated for gut and chest infections at the Communicable Disease Centre at Tan Took Seng Hospital. It was confirmed the day before that he had clinical AIDS, which meant his immune system was damaged, and his body was defenceless against infections. HIV carriers had been found in Singapore but their condition was different from this man's as they had been exposed to the AIDS virus, but did not have symptoms of the disease. Statistics from abroad indicated that about 10% of carriers eventually got the disease.

The man had not been told he was suffering from the disease "following requests from his family and relatives who were calm and at the same time anxious about publicity when the news was first broken to them", said Dr Chew. "But we want to discuss it with the family again because we feel the man, who has lost 10 kg in the past few months, ought to know of his condition," he added. The ministry did not believe he fell into any of the high-risk groups, namely haemophiliacs, homosexuals, prostitutes and intravenous drug users. But he had a history of blood transfusions during an operation abroad. "The man is not quite clear when, as it was done many years ago," reported Dr Chew.

AIDS was a disease with a long incubation period and it was "very difficult sometimes to pinpoint the source of infection. But it was likely he contracted the infection overseas through blood transfusions," said Dr Ong Yong Wan, chairman of the AIDS advisory committee and director of the Blood Transfusion Services. The man was admitted to a government hospital for chest infection and bacterial diarrhoea and was transferred to the Communicable Disease Centre when he did not respond to treatment. There had been no outcry from the staff, unlike when the first HIV carriers were discovered in April 1985. This time, medical staff had been briefed on precautions to take when handling him. They also had to be extra careful in prominently labelling bottles with his blood samples as "bio-hazard", said Dr Jennifer Lee, director of the ministry's management services and administrative division. "We are trying our treat his condition, but as far as curing his AIDS is concerned, that's a different matter, said Dr Ong. The man was responding to the potent antibiotics being given to him and his gut infection was clearing, though his chest infection was still not completely clear.

Dr Chew stressed that the disease could not be contracted by such things as breathing the same air as the man or putting an arm around him. HIV was passed on through sexual contact, blood transfusion, via open cuts, or infected hypodermic needles whether shared by patients in a hospital or between one drug user with Aids and his fellow drug users. Another three men had been found to have the AIDS virus, bringing the number of HIV carriers to eight. The new carriers - all men below the age of 40 - were discovered after a year's screening of some 20,000 blood donors. It was not clear whether they fell into the high-risk groups as they were not very forthcoming in the interviews, said Dr Ong.

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

On Tuesday, 7 April 1987, a statement from the Ministry of Health informed the public that AIDS had claimed its first victim in Singapore. The patient was a 55-year-old Chinese man. He died of complications following pneumonia brought on by (AIDS) over the weekend. The ministry did not identify the man. It said the body was cremated after the necessary precautions were taken so there was no danger of the killer disease spreading.

The man was not believed to be in one of the high-risk groups, i.e., haemophiliacs, homosexuals, prostitutes and intravenous drug users. He was said to have travelled widely and was thought to have contracted the infection after receiving blood transfusions during an operation overseas many years before. The victim's AIDS diagnosis was confirmed in September 1986 when he was admitted to the Communicable Disease Centre at Tan Tock Seng Hospital. He had earlier gone to a government hospital with chest and gut infections but was transferred to the centre when he did not respond to treatment. At the CDC, he was treated in isolation in one of the wards in the sprawling grounds off Moulmein Road.

Initially, he responded to potent antibiotics and was discharged. He then went for regular follow-up checks. But he was back at the hospital following chest infections and died in the hospital over the weekend, the ministry spokesman said. To prevent transmission of the disease, his body was wrapped in a plastic bag and chemically sealed in a wooden coffin at the hospital's mortuary. The man's family were advised to cremate the body and they agreed. Sources said that his body was taken to the crematorium from the hospital and Environment Ministry officials accompanied the hearse. The patient was the only one known to have the disease in Singapore, although nine people had been identified as HIV carriers. They were being monitored.

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

In the same month following the first reported AIDS death in Singapore, some condom distributors experienced a dramatic increase in sales of their products which they attributed to fear of the deadly Aids disease. "Contraception can only account for a small part of the growth in sales," said the spokesman for a company which was the sole agent for a leading Japanese brand of condom. "It s the fear of Aids that is the real booster." He said sales of condoms at supermarkets, pharmacies, Chinese medical halls and street-comer stalls he supplied had doubled since HIV cases were first identified locally in 1985. His company also sold to Malaysia and Brunei, where sales were similarly buoyant, mainly because people there were worried about picking up HIV or other infections, he said.

Others involved in selling contraceptives said that the condom was a continual good seller. A distributor and retailer of a brand of condom that contained a sperm-killing agent said sales of that product took off in the past few months. The company which was the sole agent for a British brand of condom with spermicide said its overall sales were up and that demand was particularly strong for the spermicidal condom. "It's moving so fast we have run out of stocks. But we have placed orders for more," the company spokesman said the previous week. She said buyers were attracted by the extra precaution afforded by the spermicide. The transmission of AIDS had been linked to infected body fluids, including sperm. A spokesman for Guardian Pharmacy said recently that sales of condoms at its retail outlets were good and that the condom with spermicide was among the fastest sellers with sales up by 50%. When the AIDS virus was first identified here Guardian decided to increase its condom stocks by 20%.

Dr K. V. Ratnam, a senior registrar at Middle Road Hospital who was conducting a study of 100 transsexuals said the transgender sex workers had become aware of the dangers of contracting the deadly disease after being told by doctors at the hospital. He said the week before that many of them were now insisting that their clients, who are men, used condoms. They had been told to avoid exchanging semen or blood, which had been associated with HIV infection. Some were doing this. However, Dr Ratnam noted that a few had resisted it because of what he termed their "fatalistic attitude". "They felt that since death was inevitable, they were prepared to get AIDS and were not prepared to adopt any precautionary measures." Others had the misconception that their risk of contracting HIV was negligible since they were going to the hospital for regular check-ups. Dr Ratnam said this belief stemmed from the false notion that AIDS was similar to gonorrhoea and syphilis and could be cured with antibiotics.

The sex workers were men between 19 and 55 years old when the study began in 1984. More than half had little or no education. They were selected from a hospital register for the study. The findings of the study entitled, Awareness of Aids Among Transsexual Prostitutes in Singapore, was published in the December 1986 issue of the Singapore Medical Journal. Working with them, Dr Ratnam, who was in his 30s, discovered the first three HIV carriers in Singapore. He said the carriers' condition was unchanged, that is, they had not developed AIDS. Between August 1984 and February 1985, Dr Ratnam interviewed 100 transsexual sex workers to find out how many knew about AIDS. He found that only 58 out of 100 knew what AIDS was. And of these 58, only about half had taken precautions against getting HIV from clients. But the picture has since changed, Dr Ratnam said. Last year, far more of the prostitutes said they were aware of the disease and taking measures to protect themselves. He was studying another 20 to 30 transsexual sex workers, who were younger, to find out how they compared with the original 100.

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

At a meeting of dental surgeons over the weekend commencing on 26 September 1987, Dr Myra Elliot, said during her talk that it was believed that almost half of all dental surgeons still boiled their instruments. More government and school dental clinics were sterilising instruments with high-pressure steam, chemicals or hot-air ovens instead of with boiling water. The change had been taking place daring the past year under a Health Ministry programme to ensure that dental instruments were totally germ tree. The programme was expected to be completed soon. The dental clinic at the National University Hospital had already fully converted to autoclaving and the hot air method. As a further precaution against infection, many disposable items were used, like needles, cups, salivary ejectors (to drain out saliva during treatment), and suction tips.

Private dental clinics, on the other hand, had been slow to change. The risk in not autoclaving, or using hot air ovens with temperatures up to 180 degrees Celsius, was that some hepatitis B or AIDS viruses might not be destroyed. Some spores were resistant to heat and sometimes boiling did not destroy them. With about 140,000 hepatitis B carriers in Singapore, or 5.5% of the population, dentists could become agents of infection if they used poorly sterilised instruments. Private dentists who were slow to change cited two reasons - practicality and cost.

A dentist in private practice said: "In autoclaving, or sterilising with high-pressure steam, the instruments must be able to withstand the pressure and temperature. Over time, these could damage the delicate hand pieces. It is also difficult to recover the cost spent on these units because we want to keep our fees low." Another said: "Boiling of instruments is still practical for non-surgical operations, such as filling teeth, where the likelihood of contamination is not great. But when it comes to surgeries, the instruments will have to be 100 per cent sterile." Two others said the switch to autoclaving could be done overnight because of the cost. However, one dental surgeon with a clinic in town felt that in terms of hygiene for himself and his patients, buying an autoclave and hot air oven was worthwhile. He bought them a few years ago for about $4,500 but then had to raise his fees by between 2 and 5%.

=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

On 16 February 1988, the press reported that the Criminal Investigation Department (CID) had issued a warning to owners of nightspots to stop admitting homosexuals and transvestites into their establishments and cautioned that clubs flouting the regulation could end up losing their licences. Several dicos were also told to stop promotions of "macho nights" and all-male swimwear fashion shows. CID director Chua Cher Yak said it was for moral reasons that the action was taken: "We do not want to encourage such behaviour". However, it was widely thought that the clampdown was a reaction to the first reported AIDS death in April 1987 (see above). The following year, in 1989, the second incarnation of Niche disco in Chinatown had its liquor license withdrawn and was given only a week to close down. No reason was provided for the police action but a person, personally involved in the running of the disco, believed it was also a similar unwarranted response on the part of the authorities.

=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

=Government backs Church's conversion therapy for gays=
 * See also: Archive of "Ex-homosexual to share experience", The New Paper, 18 March 1989
 * See also: Archive of "Gays 'are made not born'", The New Paper, 31 May 1989

In May 1989, Pastor Derek Hong of the Church Of Our Saviour in Queenstown, who had heard about the charismatic American ex-gay preacher Sy Rogers, invited him to move to Singapore. The church was keen to institute a local ex-gay programme to deal with gay Christians. Rogers' arrival and activities were given great publicity in the local press. This was encouraged by the Singapore government in the wake of the discovery of the first cases of HIV infection in 1985 and the first reported death from full-blown AIDS in 1987. Presumably, the Government decided that a good way to combat the epidemic of HIV/AIDS especially amongst gay and transwoman Singaporeans was to subject them to conversion therapy.

=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

=Police raid gay cruising areas=
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=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.