Singapore's
Shame: Dying like a dog and double-bagged into the bargain
ASIAWEEK Web posted April 19, 2000.
BY ROGER MITTON Singapore
SINGAPORE calls itself the "intelligent island," but its treatment of citizens with AIDS is anything but enlightened. Anyone who dies of the virus is double-bagged and incinerated within 24 hours, regardless of the wishes of family or deceased. The practice is mandatory under the government's health regulations for infectious diseases.
AIDS patients are treated as outcasts in life as well as in the afterlife. In a medical emergency, they are routinely denied pickup up by the ambulance service. To get help, callers must resort to deception. They have to say they have some other ailment aside from AIDS and they must say that they need to go to any hospital except the Communicable Disease Center at Tan Tock Seng Hospital -- the only place in Singapore that handles AIDS patients. If they naively say CDC, the ambulance service immediately suspects they are dealing with AIDS and will refuse to respond. The only way to get help is to trick the service into sending a unit and, after the hospital trip is underway, insisting on going to the CDC instead.
This humiliating situation gets worse. If the service does respond but finds out their customer is HIV+, they will invariably increase their fees on the grounds that bedsheets and other materials in the ambulance will need to be destroyed -- nonsense, of course, because the virus can't be transmitted through chance contact with inanimate objects. The sad saga continues if an AIDS patient winds up at a facility other than the CDC. They are invariably refused treatment on grounds that their medical records are at the CDC (this occurs even if they have gone in for treatment for a non-HIV-related ailment -- so much for the Hippocratic Oath).
Aggrieved citizens tried to do something about their plight in the mid-1990s. Following meetings between HIV sufferers and government health officials, the Health Ministry drafted a document forbidding denial of treatment to HIV/AIDS sufferers. The edict has been routinely ignored and continues to be ignored to this day.
AIDS is not widespread in Singapore -- making it easier for bureaucrats to turn their backs on the problem -- but the disease is making inroads. In 1998, there were 854 reported cases, up from 111 in 1995 (some 300 Singaporeans have died from AIDS). The real total is likely to be several times higher, bearing in mind that most infections have not yet been detected. Heterosexual sex is now the most common form of transmission. This is alarming, given that prostitutes are frequently carriers of the disease and that Singapore is pursuing a much more pragmatic policy on prostitution. The island republic now openly allows in hundreds of sex workers in from the Philippines, Myanmar, Vietnam, Malaysia and Thailand.
What do ordinary Singaporeans think about all this? Evidence suggests that most feel that HIV/AIDS patients should 'repent' -- implying that many people still think they somehow deserve their illness. Employers are certainly unsympathetic. An HIV+ patient was asked to leave his job at one of Singapore's top hotels recently. There have been cases of HIV/AIDS patients being kicked out of homes by their families.
Young people are a bit more open and tolerant, although many regrettably still see it as a gay-related disease -- and homosexuality is a criminal offense in Singapore. Yet even the government admits that the majority of infections in Singapore are occuring among 'real men,' heterosexual males, many with families. Perhaps the trend will encourage Singapore to catch up with Hong Kong and Taiwan, where medical costs for the treatment of HIV is fully subsidized. But until that day, Singapore's silent underclass will likely be forced to continue what they do now when they need help. They fly to Thailand for medication and healthcare, where treatment is cheaper, state-of-the-art -- and definitely more civilized compared with the backwards mentality that pervades Asia's intelligent island.