As a doctor treating and caring for PLHIV, my role extends beyond the medical sphere. I also spend much of my time advocating to improve treatment and care for my patients. This includes helping those who cannot afford treatment get access to medication and reducing stigma that many PLHIV face.

I remember that when I first started at CDC, one of the early things I did was to appeal for free treatment at least for mother to child HIV transmission. I thought the case was simple as it involved an unborn baby and the medication would not be lifelong but for a limited period during pregnancy and six weeks after pregnancy. The appeal was unsuccessful then.

It is hard work to push for improved care but it has to be done to improve the treatment and care for our patients. Speaking out is not an easy thing to do, and you would certainly feel much trepidation, because you don’t know what the response will be like. At times, our appeals would be rejected. Nevertheless, I feel that it is important for us to be brave and speak up for those who need help. I have also found support along the way from generous donors, and even doctors and surgeons who volunteer their services for free.

Our efforts have not been in vain. Since 2010, qualified patients with HIV are entitled to receive free treatment through MediFund. Many patients have benefitted from this scheme. For example, low-income patients with school going dependants are now able to carry on with their lives, whereas previously the sheer cost of medicine would have been a much bigger burden on them.

However, thinking back, I can still remember the faces of those early patients who passed on because they could not afford treatment. It’s sad but at the same time I am reminded of the importance of our role in pushing for better care.

Very few fields in medicine have their treatment guidelines changed so frequently. HIV medicine is one of them. In this field, we see strategies on treatment, and new drug developments and recommendations change almost every year. 

When I first started out as a doctor treating patients with HIV, we were merely treating the infections and the symptoms of HIV. There wasn’t much else that we could do. However, with the drugs that we have today, patients with HIV who are diagnosed early and receive treatment, are highly unlikely to fall sick from HIV. HIV has mostly developed into an outpatient illness. 

There’s also a lot less stigma and fear for People Living with HIV (PLHIV) to seek treatment. This can be seen in changes such as how overseas patients with HIV are now allowed to enter Singapore for treatment and haemodialysis for PLHIV is done together with other patients at regular dialysis centres.

Additionally, we no longer have operating theatres specifically dedicated for patients with HIV. The operations for patients with HIV are done in regular operating theatres just like any other patient at Tan Tock Seng Hospital.

In a way, working in a field that is stigmatised makes the job more interesting. There’s an added dimension that goes beyond just medicine. It’s a unique place where medical professionals get to practice more holistic care. We are not just treating a physical body, but also healing them mentally and psychologically. CDC and now the National Centre for Infectious Diseases provides a good environment for doctors to learn this aspect of compassionate and holistic medicine.

I believe we’ve come a long way in treating patients with HIV, but more can still be done. One of the things I’m looking forward to is to have more medications being included into the standard list, so that patients can enjoy drug subsidies without needing to go through a Medical Social Worker.

I think we also need to push for more of those infected with HIV to be diagnosed, and for those at risk to be protected through Pre-Exposure Prophylaxis. We’re already doing quite well with treating diagnosed patients, so if we can get these other two parts right, ending HIV can be a reality.

When I first joined the CDC in the mid-90s, I didn’t have any preconceived notions about People Living with HIV (PLHIV). Today, after more than two decades of working with PLHIV, I can say, with some degree of authority, that they are just like any other person. There are extremely beautiful people with HIV, and there are also people with challenging personalities. However, who they are as human beings has nothing to do with their diagnosis.

I think a lot of the stigma about HIV stems from fear and are, often times, without basis. For instance, there used to be a regulation that bodies of deceased patients with HIV needed to be removed within a period of 24 hours. We found that there was no scientific basis for that, so we pushed for the regulation to be removed and it has since been removed. Together with organisations such as Action for AIDS Singapore, we try and campaign for the removal and change of regulations that have a non-scientific basis. The latest de-stigmatisation measure that has been implemented is the removal of the requirement to have HIV listed on a person’s death certificate. If the person does not die from an HIV-associated condition, there is no need to indicate HIV on the death certificate.

There’s also a lot less stigma and fear for People Living with HIV (PLHIV) to seek treatment. This can be seen in changes such as how overseas patients with HIV are now allowed to enter Singapore for treatment and haemodialysis for PLHIV is done together with other patients at regular dialysis centres.

We are certainly on the right path towards de-stigmatisation of the disease. We cannot completely remove the stigma, because there will always be some who refuse to accept logic or science. But, what we can do is to try and impart to people the right knowledge about HIV. We want people to know that patients with HIV do not require special precautions in healthcare. If they require special precautions, it’s because of other infections such as tuberculosis or diarrhoea, which someone without HIV would also need to take.

Much of what remains today is self-stigmatisation. This is where peer support can really help. Recently, we had a newly diagnosed patient who felt very lost and was not engaging well with our healthcare initiatives. I then introduced him to another patient in the same ward who had been diagnosed with HIV several years earlier. It was the support from this fellow patient that helped him to make a breakthrough. This was something that even I as a doctor could not do.

The volunteers at the NCID Cares (previously known as Patient Care Centre at CDC) form one of the largest volunteer groups under Tan Tock Seng Hospital . They’ve been around for many years since the days at CDC and play an important role in supporting our patients with HIV. Even though I do not officially belong to any of these volunteer groups, I am a firm supporter and often join in their activities.

At NCID Cares, we have different groups of volunteers who come regularly to sit and interact with our patients, bring them food, and provide grooming services such as cutting their hair and shaving.

One of the members of a volunteer group also started a Touch Therapy initiative. Under this initiative, massages are offered for patients to help relieve their joint stiffness and improve mobility. Many of the patients with HIV think that people do not dare to touch them. So, in addition to the comfort they feel from being massaged, they also feel a sense of acceptance through the Touch Therapy.

Outside of the NCID wards, volunteers are also involved with visits to patients’ homes and nursing homes which house patients with HIV. They even organise outings for the children of patients. Many of these children come from financially-challenged homes, so they don’t often have the opportunity to visit places like Universal Studios Singapore and the Singapore Zoo.

We also have various support groups to provide support for women, gay people and newly diagnosed patients. They conduct talks and workshops on areas such as grooming and self-improvement which has proved to be very helpful as well.

Something that is close to my heart is the biennial Embrace Charity dinner, which I have been the chairman since 2013. Through this dinner, we have been able to support PLHIV by raising funds for those that do not qualify for subsidies. The money that we raise helps them with medication, blood tests and to provide monthly food rations for about 200 needy families.

I believe that one of the reasons why I have been able to continue in this field for so many years is because of the sheer amount of support that we have experienced. You get to meet and speak with people who are passionate about the cause and I find this inspiring. Nowhere else in medicine will you see this level of advocacy going on.