People with HIV no longer need to inform sexual partners of infection risk if ‘undetectable viral load’ maintained over time
A technician extracts blood from a patient for an HIV test.
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BY
GRACE YEOH
Published March 7, 2024Updated March 7, 2024
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SINGAPORE — People living with the human immunodeficiency virus (HIV) will no longer be required to inform their partner of the risk of contracting HIV infection before sexual activity, if the individual has maintained “an undetectable viral load for a certain period of time” preceding the sexual activity.
The person living with HIV is presumed to have zero risk of transmitting the infection if “certain conditions” have been met, said Senior Parliamentary Secretary for Health Rahayu Mahzam on Thursday (March 7).
First, the person living with HIV must have maintained a stable undetectable HIV viral load “consistently below 200 copies per ml of blood, for at least six months, based on test results from a recognised laboratory”.
Second, their most recent undetectable viral load test result should be nine months or less before the sexual activity in question.
And third, they have adhered to medical treatment for HIV infection up to the time of the sexual activity.
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This amendment to Section 23(1) of the Infectious Diseases Act, among other amendments to the Act, was unanimously passed on Thursday in parliament.
The HIV disclosure amendment aligns with medical advancements and Singapore’s public health objective to curb transmission by “shifting greater responsibility to individuals” to get tested and treated for HIV in order to achieve and maintain a stable undetectable viral load, highlighted Ms Rahayu.
More details will be set out in subsidiary legislation to allow for “timely and responsive adjustments” should medical science change in the future, she said.
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Prior to the amendment, Section 23(1) required a person living with HIV to inform their partner of the risk of contracting HIV infection before sexual activity takes place.
Doctors regularly informed patients of this legal obligation at the point of HIV diagnosis.
The previous requirement accorded “choice and protection” to the partner — who could then decide whether to engage in sexual activity and to take precautions if so, such as through the use of condoms, thereby reducing the risk of spreading HIV, the Ministry of Health (MOH) told CNA last year.
The ministry was then conducting a review of the HIV disclosure law and noted that it would take the “latest scientific evidence into account”.
'NOT RELAXING' PUBLIC HEALTH SAFEGUARDS
Ms Rahayu reminded the House on Thursday that “irresponsible behaviour” that can lead to the transmission of HIV remains an offence in Singapore, and appropriate enforcement action will be taken as required.As such, Section 23(2) of the Infectious Diseases Act will remain. This legislation requires people who don’t know they have HIV but who have reason to believe they may carry the virus to inform their sexual partners of the risk of infection.
That legal obligation will continue to deter irresponsible behaviour, “including from those who attempt to hide behind the ignorance of their HIV status”, she said.
However, while there are safeguards in place, it is also important for HIV legislation to be “aligned with medical advancements in HIV treatment, in order to encourage early detection and treatment of HIV”, Ms Rahayu explained.
Even though HIV remains incurable, medical advancements in HIV treatment mean that a person living with the virus and maintains a stable undetectable viral load over time, as a result of consistent adherence to their treatment, “cannot transmit HIV to their sexual partner”, she said.
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“The sexual partner therefore is not at risk of contracting HIV from these individuals.”
Responding to MP Louis Ng’s (PAP-Nee Soon) queries about how the Health Ministry defines “undetectable viral load”, Ms Rahayu emphasised that the criteria for the maintenance of an undetectable viral load were “rigorously determined” based on the latest scientific evidence and clinical knowledge, after consultation with HIV and infectious diseases experts.
From 2015 to 2023, seven people were convicted for failing to inform their sexual partners of the risk of getting HIV infection. Among them, four had undetectable viral loads at the time of their offence, she added.
Singapore is not the first or only country to amend its disclosure law, she also noted.
Other jurisdictions, such as Sweden, Taiwan and the United States, have removed the disclosure requirement for people living with HIV with no risk of transmitting the virus.
Ms Rahayu also emphasised that MOH is “not relaxing public health safeguards against HIV transmission” with the proposed amendments.
Rather, the ministry is encouraging infected persons to come forward to be tested and treated, thereby better protecting their sexual partners.
SINGAPORE’S UPDATED PUBLIC HEALTH RESPONSE
With the amendments to the Infectious Diseases Act in place, Singapore’s public health response will thus comprise four postures.These postures are baseline, outbreak management, public health threat and public health emergency, said Health Minister Ong Ye Kung.
Baseline denotes a “peacetime state” where routine disease prevention and control measures, as well as public health surveillance programmes, are in place.
Outbreak management measures will kick in, for instance, when there are signs of an emerging infectious disease overseas. Measures like temperature screening may be implemented to prevent the disease from being introduced into Singapore.
This posture also includes measures to curb a local outbreak, with Mr Ong citing the recent tuberculosis screening at Jalan Bukit Merah, which concluded last month.
The Health Ministry’s public health threat posture may describe situations that require “more widespread or prolonged measures”, such as measures imposed during the Covid-19 “circuit breaker” period.
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A state of public health emergency, meanwhile, would imply “the most dire of public health crises”, leading to the possible implementation of curfews or requisition of resources.
Under the amendments, the Minister for Health will now be able to declare either a public health threat or public health emergency depending on the severity of the situation, added Mr Ong.
The Act previously only provided for the declaration of a public health emergency. This state was not declared during Covid-19 as the pandemic “fell short of an emergency”. Under the new provisions, the Covid-19 outbreak in 2020 would have been considered a public health threat.
The amendments will also now allow the Minister for Health to exercise the relevant powers under the Requisition of Resources Act 1985 (Rora) in a public health emergency declaration.
Rora, which allows for the requisition of necessary resources to secure the safety of human life and health in a public health emergency, can already be exercised by the Minister for Defence. CNA
