We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.
There are currently an estimated 34 million people living with human immunodeficiency virus (HIV) worldwide. In Singapore, the cumulative total of HIV-infected Singapore residents is 5306 as of end 2011. Between 1991 and 1998, the incidence of reported cases of HIV and AIDS increased rapidly from 15 per million to 62.6 per million before stabilising from 1999 to 2003. Since 2003, the incidence has increased steadily again from 71.9 per million to 125.2 per million in 2008, with a slight drop to 121.7 per million in 2011.2 Between 1985 and 1990, homosexual transmission was the main mode of transmission. After 1990, heterosexual transmission from sex workers as the main source took over as the main transmission route till 2011 when the homosexual (including bisexual transmission) route again accounted for the majority (51%) of sexual transmission. In 2011, 93% of the new cases were males, and half of all new cases reported were aged between 30 to 49 years old. Approximately 67% were single, 25% were married and 7% were divorced or separated. The epidemiology of sexually transmitted infections (STIs) gives an indication of the seriousness of the HIV situation because STIs facilitate the transmission of HIV. In recent years, the incidence of STIs has risen from 155 per 100,000 population in 2000 to 215 per 100,000 population in 2011,3 representing an increase of almost 50%. There has also been a rapid rise in STIs among youths aged 10 to 19 years old from 238 cases in 2002 to a peak of 820 cases in 2007 with a decline to 619 cases in 2010.
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