Professor Leo Yee Sin
Professor Leo Yee Sin joined the Communicable Disease Centre (CDC) in 1989 to train as an infectious diseases specialist. In the early 1990s, she expanded her knowledge on HIV through the clinical training she received in Australia and the US. During this period, HIV had become a serious issue in Singapore, with an increasing number of patients being diagnosed and admitted to the CDC. With stigma and discrimination affecting patients, Professor Leo was among the first few doctors in Singapore to take up the challenge to provide comprehensive treatment and care to patients with HIV. |
What drew me to HIV was not only what I could see from the patients but also the science of it. How a virus could erode the immune system and cause so many complications – it was intriguing to me.
I was very fortunate that my family never questioned me on my choice to treat patients with HIV. When I started out with my training in infectious diseases, I did not intend to train to be a HIV specialist. My training was for infectious diseases in general like measles, mumps, rubella, cholera, tuberculosis, and malaria. HIV was just one part of that whole field but it became a significant part of my life.
In the 1980s, HIV was a virtually unknown disease. We had to refer to the World Health Organization (WHO) for a lot of information and guidance through their own research. The UNAIDS was formed specifically to handle HIV and AIDS related issues. In 1991, I participated in a WHO-sponsored programme, spending a few months in Australia's Kirby Institute in New South Wales. This is where I learned the very basics of HIV medicine.
In 1992, I went to Los Angeles to do a one-year clinical fellowship at the UCLA Cedars Sinai Medical Center. The HIV epidemic was still at its peak and half of the patients I saw were patients with HIV. While there I was exposed to acute hospital care and trained to take care of acute HIV conditions such as acute illness, malignancy or opportunistic infections.
When I returned to Singapore in 1993, things hadn't changed much at CDC. However, we were beginning to see more patients with HIV who are heterosexuals and MSMs. They were rejected and ostracised by society and many were abandoned by their family. Some didn't have the courage to tell their family about their condition. HIV was a terminal illness at this time as there was no medication for it.
| In 1995, Professor Leo Yee Sin became head of the HIV Programme at the Communicable Disease Centre (CDC). At this time, treatment was still unsustainable and because of social stigma and societal issues, community support was minimal, if non-existent. |
When the HIV epidemic hit the US in the 1980s, hospitals there were set up for acute care but subsequently, there were many community projects that took care of hospice patients. In Singapore, it was not like this. Instead we faced the question of where to place patients with HIV after they were discharged from the hospital. Their families didn't want them at home, some didn't want to go home as they didn't want to burden their elderly parents. Patients with HIV in terminal stage were not even able to get into hospice care. The patients were stuck and had nowhere to go.
When I took up the challenge to head the HIV Programme, community support was virtually non-existent. At a time when there weren't many treatments available, I realised that we had to give patients with HIV comprehensive care from the point of diagnosis all the way to their last breath.
I felt that the HIV Programme couldn't be just about treating patients with acute episodes of illness, it had to go beyond hospital treatment. This was our commitment and it continues today.
Beyond treatment for HIV, patients were engaged in activities to liven up and decorate their surroundings at the main HIV ward, Ward 76.
(Photo taken after closure of CDC)
When the first patient with HIV in Singapore was diagnosed in 1985, there was little to no treatment available. Singapore, like the rest of the world, waited for the much needed medical breakthrough in HIV medicine, that would only happen a decade later.
Professor Leo and the team of dedicated doctors and medical social workers at the Communicable Disease Centre (CDC) continued to deliver as much comprehensive care to patients with HIV as they could in the late 80s to mid-90s, at a time when HIV was considered a terminal disease. |
The younger doctors these days missed the crucial period of the HIV outbreak to fully understand what the disease can do to a body. In front of my very eyes, I saw how quickly my patients' condition deteriorated and what HIV could do to a person's body. Today, we do not see a lot of HIV complications because of the treatment available.
It is phenomenal how the entire field of HIV medicines evolved within a short period of time. When I first joined the CDC in 1989, only AZT (azidothymidine) – the very first HIV medication – was available but the effect was short-term. Patients received single therapy or the dispensing of a single drug to treat their condition. They would improve for about three to six months but after that, their condition would recur and they would deteriorate very quickly.
Coming into the mid-90s, we administered dual therapy (two-drug combination), which was a better option for treatment. Even so, it was not highly effective and there was very little progress. The condition of patients would improve for a while and then deteriorate. This was a really sad time in terms of HIV medicine and history in Singapore.
Between 1997-98, a different class of drug was introduced – what we know today as Protease Inhibitors. It changed the entire history of HIV treatment, turning HIV from a deadly condition to a treatable disease.
Because of this, some of the patients I've been seeing for the last 20 years are still alive. They still need to take this medication…but they are still alive!
Prof Leo (front row, middle) with Infectious Disease doctors at the CDC.
In 1997, Professor Leo Yee Sin and her team set up the Patient Care Centre (PCC) at the Communicable Disease Centre (CDC), a day care centre for patients with HIV.
Strongly committed to providing continual care from the time of diagnosis to death, they effectively addressed the lack of community support and provided on-going care for patients who were not required to stay in the hospital. |
Set up in 1997, the PCC had a 'homely' feel for patients to feel safe and comfortable.
(Photo taken after closure of CDC)
More facilities were added to the PCC over the years. The library in PCC was filled with books that were donated by staff and volunteers.
(Photo taken after closure of CDC)
The Patient Care Centre (PCC) was a unique hospital-based community project, which demonstrated how a hospital could integrate clinical management and a community care service for patients with HIV.
In 1997, when I started the PCC, one of the challenges we faced was trust.
This was a period when patients were afraid to even come into the PCC. We had to break through a lot of fear, which were imposed by the patients themselves – self-stigma. They did not want to be a part of the PCC and activities.
So, I told the patients, "you cook, we eat together." The kitchen was set up and from then on, became an important part of the PCC.
A lot of patients with HIV could not be accepted back in the community and many of them faced financial issues. All these issues gave birth to the Red Ribbon Project – another means to reduce stigma and discrimination.
We encouraged the patients to carry out simple activities, like handicrafts. This gave them skills so that they could generate funds from their products to become self-sustainable.
We also did many donation drives and set up a food ration system so that people could contribute funds towards buying food. Because nutrition was an important part of the treatment, we would package these supplies for the patients with HIV to take home.
This same care model gained recognition in several countries and was used in Thailand and Indonesia. Subsequently, officials from China came to Singapore to study it so they could implement it in their own hospitals, including their version of the Red Ribbon Project.
The simple kitchen in PCC where patients could prepare and cook meals and eat together.
(Photo taken after closure of CDC)
The activity area in PCC where patient volunteers made handicrafts.
(Photo taken after closure of CDC)
Patient volunteers made a range of handicrafts like notebooks, pouches and keychains.
(Photo taken after closure of CDC)
In mid-December 2018, the historic Communicable Disease Centre (CDC) on Moulmein Road closed. Its legacy of healthcare in Singapore spans over a century and it was here that the country's dynamic medical professionals combatted a wide range of diseases from smallpox to malaria to cholera, the Nipah virus and SARS.
The battle against HIV was also an important milestone in Singapore's medical history, in which Professor Leo played an integral role as clinician, head of the HIV Programme and subsequently in setting up the Patient Care Centre.
Here, she relives key moments during the challenging days of HIV in Singapore. |
Ward 76
In the early days, nobody wanted to share the same ward with patients with HIV so we put them here in Ward 76. This was the main HIV ward and only patients with HIV were admitted here. We decided to place acutely ill patients in the first two rooms close to the nursing counter. This way, the nurses could get to them quickly.
Inside Ward 76 – The main HIV ward in the late 1980s.
(Photo taken after closure of CDC)
While this was an adult hospital, there were instances where we had to care for children. There was a whole family – father, mother and son who were infected with HIV. After the father died, the mother had to frequently be admitted and she was the only caregiver to the son, who was barely two years old. This was their favourite spot, they were always outside here, mother and son. Both of them were very skinny but they always came to take their walks out here.
There was a room set aside in Ward 76 for intravenous therapy including outpatient eye infusion.
Outpatient Parenteral Antibiotic Therapy (OPAT) was conducted in Ward 76.
Operating Theatre
In the past, with limited treatment advances, many patients with HIV developed eye infections during the later phase of their condition. The standard treatment for this type of debilitating eye infection was to give daily intravenous infusion indefinitely. Without treatment, patients would soon lose their eye-sight. The medication called ganciclovir cost about $300 per vial and this was beyond the means of almost every patient. Prof Lim Tock Han, then a young ophthalmology surgeon bravely set-up an eye procedure to directly inject the medicine into the infected eye of patients with HIV. Because only a fraction of the dose was needed for this procedure, one vial of this expensive medicine could be given to 20 to 30 patients at a time. This procedure required a sterile environment. Hence, the Operating Theatre built next to Ward 76 was used for the eye treatment. We would line up patients each time and he would inject the medicines directly into their eyes.
He did thousands of eye injections and achieved an excellent success rate. His method and outcome were published and taken up by other resource-limited countries like Vietnam.
The PCC fundraised to buy the medication. This together with Prof Lim’s eye procedure enabled us to provide a cost-effective treatment for our patients.
The unassuming entrance of the Operating Theatre, next to Ward 76..
(Photo taken after closure of CDC)
The room in the Operating Theatre where patients with HIV received treatment for their eye infections.
(Photo taken after closure of CDC)
Ward 76A
By the mid-1990s, there were an increasing number of HIV cases especially those needing long-term care and we realised we did not have enough beds for acute patients. That is why we opened Ward 76A. However, it operated for only one year because Protease Inhibitors had become available and we didn’t need so many inpatient beds for patients with HIV.
Ward 76A opened in the mid-1990s to cater for long-term care.
(Photo taken after closure of CDC)
We renovated this ward as it was old and rundown. We decided that this ward should have more of a community hospital set up feel. We created a therapy area with a small gym. Although it closed down after a year, we kept the gym open.
Ward 76A was renovated with a small therapy area for patients.
(Photo taken after closure of CDC)
I once had a patient who refused treatment, his bed was at the far end of this ward. He was diagnosed around 1993 with lung infection and I could foresee two years of having to go through the sequential events of pain before he passed on. Once he got through the initial infection, he made his life plan in preparation for his death. He did not want expensive treatment because he only had a few thousand dollars in his CPF. He wanted to save that money for his aging parents.
He was very resistant to treatment even though we tried to encourage him to take his medication. He suffered from multiple infections and this eroded his lungs. Then, his eye was affected and the course of eye injections rendered him partially blind. He suffered more chronic bacterial infections, including multiple episodes of fever and mouth ulcers, which were very common in the end-phase of the disease.
When the Protease Inhibitors became available, we had to persuade him to take these. His condition turned around and the recovery process took about one to two years. He recovered and is still alive today but he's partially blind, extremely skinny, and with much damage to his body.
Ward 71
Over time, we concentrated all our manpower here and patients with various infections were all housed here.
Ward 76A was renovated with a small therapy area for patients.
(Photo taken after closure of CDC)
Patients with HIV were put at the very end of the ward, together with patients suffering from other acute infectious conditions. There wasn't a need to tell other patients that they were housed with patients with HIV as the information was confidential. Also we practiced good infection control and the staff knew what they were doing.
Inside Ward 71 – This ward had an old architectural design with high ceilings.
(Photo taken after closure of CDC)
Mortuary
The greatest story I have about the mortuary is my encounter with the late Minister Dr Balaji Sadasivan. This was in the early 1990s. At that time, HIV treatment was still not readily available and many patients died of conditions we really did not know much about or why.
There was a particular patient with multiple complications, including neurological disorder. He could not use his legs in the latter part of his life, and eventually succumbed to HIV. We were puzzled about his neurological manifestations and wanted to understand more about the disease pathology. So, we challenged the system to find someone who would do a post mortem for us. Up to that point, we could not get any post mortem done on patients with HIV because nobody wanted to do it.
Dr Balaji, a neuro-surgeon in Tan Tock Seng Hospital at the time, volunteered to do the biopsy on this patient. He came to this very mortuary with his own equipment from his neuro-surgical theatre. I was also present at the biopsy. He took a portion of the spinal cord and sample tissues for examination.
This was a significant incident because it was the first case to have a partial post mortem and the only time we ever had a partial post mortem, right here in this room. What the patient had was HIV related neurological complications, what we call Vacuolar Myelopathy. The spinal cord just hollowed out because of HIV. Clinically it manifested with many disabilities. While it wasn't a unique case, this post mortem gave us answers we didn't have before.
The exterior of the Mortuary which ceased operations in 2003.
(Photo taken after closure of CDC)
The very first post mortem on a patient with HIV was conducted in the CDC Mortuary.
(Photo taken after closure of CDC)
Last Updated on 14 May 2026
