ST speaks to infectious disease experts onwhat the recent legal change means, and how Singapore is tackling HIV transmission.
Q What is an undetectable viral load?
A When a person is infected with HIV, the virus will replicate in his bloodstream and attack the immune system, said Dr Wong Chen Seong, director of the National HIV Programme at the National Centre for Infectious Diseases (NCID).
By taking a blood sample, a doctor can find out how many copies of the virus there are per millilitre of blood. This measurement, called the viral load, lets people living with HIV and their doctors determine how well antiretroviral therapy is working.
A person who is not on treatment will have a viral load that ranges from thousands to hundreds of thousands of copies of the virus per millilitre of blood. A person who has been taking medications is expected to have a level of virus so low that it is below the threshold of detection by laboratory tests, also known as an undetectable viral load.
Q How do HIV medications work? Are they subsidised?
A HIV medications, also known as antiretroviral therapy, work by preventing the human immunodeficiency virus from replicating in the cells of the infected person, said Dr Wong.
This prevents the virus from attacking the immune system, allowing the infected person to return to a good state of health.
Currently, almost all HIV medications are taken orally every day. There are medications administered as long-acting injections, but these are not suitable for the majority of people living with HIV, said Dr Wong.
The most commonly used medications are subsidised and are on the Standardised Drug List maintained by the Ministry of Health. Singapore citizens and permanent residents can use MediSave to pay for the medications. Singaporeans who cannot afford subsidised medications can rely on MediFund.
Assistant Professor Dariusz Piotr Olszyna, director of the HIV Programme at the National University Hospital, said that with government financial assistance schemes in place, the clinic has no Singaporean patients who cannot access medications due to cost concerns.
Q Can those with an undetectable viral load spread HIV?
A Multiple large, international studies have all shown that a person living with HIV who has achieved and maintains an undetectable viral load – or less than 200 copies of the virus per millilitre of blood – does not transmit the virus to his sexual partner.
Under the amended law, HIV patients must meet this requirement of less than 200 copies per millilitre of blood for at least six months, based on test results from a recognised laboratory, to be exempted from disclosure.
They must also have test results showing an undetectable viral load dated nine months or less before they have sex, and they must have adhered to their medical treatment during this time.
Assistant Professor Rayner Tan at the Saw Swee Hock School of Public Health noted that in July 2022, the World Health Organisation published guidelines that recognised unequivocally that people living with HIV with an undetectable viral load cannot transmit HIV through sex.
Q How much do viral load tests cost? How often are they required?
A The cost for HIV viral load tests is subsidised for Singapore citizens and permanent residents, under the same framework of healthcare financing assistance that covers other medical conditions. Each test is around $140 after subsidies at NCID.
People living with HIV are expected to undergo these tests about twice a year, the same frequency as their regular consultations with their HIV doctors.
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Source: The Straits Times © SPH Media Limited. Permission required for reproduction.
