One In 350 Patients Is HIV-Positive And They Don’t Even Know It

18 Jul

SINGAPORE: More Singaporeans could be infected with HIV than they realise.

According to a recent Ministry of Health (MOH) study of more than 3,000 anonymous blood samples collected in hospitals, 0.28 per cent were HIV-positive.

The study, done earlier this year, excluded blood samples from known HIV patients.

This means one in 350 hospital patients who think they are free of the disease are actually HIV-positive. In comparison, there were 2,852 known HIV-infected patients in Singapore as of June last year – or about 0.06 per cent of the population.

The problem is “much more acute” for male patients, with a 15:1 male-to-female ratio in the sample population, said Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts, and Foreign Affairs, speaking at the launch of a workplace Aids education exhibition.

The stunning findings made for a stark assessment of the HIV/Aids situation in Singapore, and showed the potential minefield health professionals may have to navigate.

Said Dr Balaji: “The methodology ensured that the patients whose blood samples were positive could not be traced … (so) patients in this survey who’ve been misdiagnosed and wrongly treated will continue to remain misdiagnosed and will continue to receive the wrong treatment.”

While a misdiagnosis of HIV “could be excused” 20 years ago, a misdiagnosis today could “very well lead to complaints of professional failure” against doctors and hospitals, he said.

For instance, some Aids patients could display chronic diarrhoea and weight loss. If a simple blood test for HIV were to be done, the correct diagnosis would be reached.

Without such a test, though, the patient could end up undergoing “expensive and unnecessary” procedures such as MRI (magnetic resonance imaging) and colonoscopy. The diarrhoea and weight loss may be attributed to stress and the wrong treatment would be prescribed, said Dr Balaji.

Last year, Singapore experienced a record high of 357 new HIV positive cases.

Despite the “serious implications” of the latest study, Dr Balaji believes HIV testing – including for medical staff and hospital patients – should not be made mandatory.

“I don’t think there should be a problem with healthcare workers, as they should be knowledgeable,” he said. “What we need to do is make people understand how they can benefit by volunteering for tests. If we can educate people sufficiently, those who should go for testing will go for testing.”

He called on the medical community to “mull over” the findings and come up with “innovative ways” of providing better care for HIV-positive patients.

“The MOH survey ῅ has identified a serious problem. We don’t have all the answers but we should be willing to learn and introduce the best practices from others,” said Dr Balaji, who is leading a study team to Sydney today to evaluate its HIV prevention programmes.

Dr Roy Chan, the president of Action for Aids – a non-governmental organisation for Aids prevention – believes there is no need to push the panic button.

He told Today: “In any country, Singapore included, there’s a proportion of patients who, unknown to themselves and doctors, are infected.”

While few countries have tried to determine how many HIV-infected patients are unaware of their condition, he noted that the MOH’s findings are in line with the latest estimates for Singapore by the Joint United Nations Programme on HIV/Aids (UNAids).

According to UNAids, 0.3 per cent of adults here are HIV-positive. The MOH has also estimated previously that for every Aids patient identified, there are possibly two to four undiagnosed.

While “there’s always a possibility” of a misdiagnosis, Dr Chan thinks that most healthcare workers here are alert to HIV symptoms and echoed Dr Balaji’s views that Singapore must continue to encourage voluntary testing, particularly for those with high-risk behaviour.

But Dr Clarence Yeo, a general practitioner, does not think it is easy to spot early HIV symptoms, as some of these are common in other medical conditions, including cancer.

He said: “Beyond looking at the symptoms alone, if the person is also a high-risk patient – for example, he or she has multiple sexual partners or tends not to use protection (during sexual intercourse) – it would be worthwhile to screen and test them.

“But if the patient doesn’t wish to divulge such personal information, then it would not be obvious to us.” – TODAY/yy

Channel News Asia

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