HIV stands for Human Immunodeficiency Virus. An HIV infection weakens the body's immune defences by destroying CD4 (T-cell) lymphocytes, which are white blood cells that protect us against attacks by bacteria, viruses and other harmful pathogens. When these white blood cells are destroyed or weakened, they will no longer able to defend the body effectively against infections. This increases the risk of severity of some common diseases and conditions, as well as a higher risk of getting some cancers.

With advancements in science, early and effective treatment can suppress the viral load, allowing a person living with HIV (PLHIV) to lead a life no different from others. If someone infected with HIV does not seek effective treatment early enough, their immune system can become weak. The disease then progresses to a condition called Acquired Immunodeficiency Syndrome (AIDS). This is the most advanced stage of HIV; it can take up to 10 years to develop into AIDS. Without treatment, people with AIDS can be susceptible to opportunistic infections and become very ill.

HIV/AIDS is one of many sexually transmitted infections (STI). Click here to find out more about other types of STIs.

HIV is transmitted:

• during unprotected sexual intercourse (vaginal or anal) with an HIV-infected partner
• through the sharing of contaminated needles and sharps
• from an infected mother to her baby during pregnancy, at birth, or through breastfeeding
• by receiving infected blood and blood products (e.g. organs, plasma)

In recent years, about 200-400 new HIV cases are diagnosed every year in Singapore. Sexual transmission remains the main mode of transmission. Visit this link for the latest updates.

HIV does not spread via:

• shaking hands, hugging or touching
• saliva, tears or sweat
• sharing of food or drinks
• toilet seats
• touching of common surfaces
• mosquitoes, ticks or other insects
• air or water
• kissing
• drinking fountains
• coughing or sneezing

In Singapore, almost all HIV infections have been transmitted through sexual intercourse with a person who is infected with HIV and has unknowingly passed it on to their sexual partner.

Anyone who participates in high-risk behaviours such as sexual activity without using a condom, casual / commercial sex, or sex with multiple partners is at risk of becoming infected with HIV. HIV does not discriminate or select who to infect based on a person's gender identity or the genders of those they participate in sexual activity with. In 2022, 37% of all cases were from heterosexual transmission, 51% from homosexual transmission and 4% from bisexual transmission.

You can protect yourself from HIV by:

• not engaging in casual sex
• being faithful to your partner and being honest about your sexual history. If you are both unsure of your HIV status, do go for HIV screening
• practising safer sex with a condom, especially if you have multiple sex partners
• always remembering to use a new latex condom during each sexual intercourse, and following the manufacturer's instructions. While not 100% safe, they provide at least 90% protection from HIV
• avoiding the consumption of alcohol and drugs as these can affect your judgment, causing you to engage in risky sexual behaviour
• using only clean, sterile needles and choosing a reliable service provider when getting a piercing, tattoo or an injection
• accepting only HIV-screened blood for blood transfusions
• asking your doctor about preventive medicines

There are preventive medications that can be used for potential exposure to HIV. Medication taken after exposure is called PEP, or Post-Exposure Prophylaxis, and can reduce the risk of becoming infected with HIV. This medication may be recommended after a rape, needlestick injury (injuries caused by needles that puncture the skin) or if a condom has broken during a high-risk sexual activity.

To learn more about exposure prophylaxis, click here.

Usually, an HIV-infected person may not notice any symptoms. However, some people may experience the following symptoms:

• tiredness
• weight loss
• prolonged fever
• night sweats
• skin rash
• persistent diarrhoea
• lowered resistance to infections

The only way to be sure of your HIV status is go for a test. The National HIV Testing Recommendations by the National Centre for Infectious Diseases recommend that every adult at the age of 21 years and above should get tested for HIV at least once in their lifetime regardless of risk factors, and people at higher risk of HIV infection should be tested more frequently.

You should get tested if:

• you have engaged in any sexually risky behaviour in the past, such as having multiple or casual sexual partners, not using condoms consistently, or being serviced by commercial sex workers
• you are not sure of your partner's sexual history, or when there is a change of your sexual partner
• you had yourself pierced or tattooed at an unhygienic or unlicensed parlour, or when there is sharing of needles or sharps
• you had a blood transfusion or an operation performed overseas, where blood testing regulatory requirements may not be stringent

This list is by no means exhaustive. If you feel you may be at risk, getting screened for HIV is the crucial first step to knowing your HIV status. Get yourself tested more frequently (or every 3 to 6 months) if you are engaging in any sexually risky behaviour. Knowing your status enables you to receive treatment early and prevent others from getting infected.

You can get yourself tested for STIs or HIV/AIDS at most GP (General Practitioner) clinics, polyclinics, Department of the Sexually Transmitted Infections Control (DSC) clinic, and hospitals in Singapore. Most clinics offer routine HIV screening services, while some also offer rapid HIV testing. Rapid HIV tests produce very quick results. In approximately 20 minutes, you may be able to know your HIV status. To learn which clinics offer rapid test services, click here. HIV self-test kits are also available under the HIV self-testing pilot programme. For more information on the self-test kits, please visit this link.

A HIV infection results in the presence of antigens (a part of the virus itself) in the blood and also causes the body to produce antibodies (infection-fighting proteins). Both antigens and antibodies can be picked up by HIV tests to indicate the presence of an HIV infection in the person. There are two main ways of which HIV screening can be done:

1. A conventional laboratory-based blood test is administered and the results are made available 2 weeks later.
2. Approved by the Ministry of Health since 2007, HIV rapid tests are available at most hospitals and clinics. HIV rapid tests are done with blood from a finger prick or with oral fluid, and the results will be ready in 20 minutes.
   
   HIV self-test kits are also available under the HIV self-testing pilot programme. For more information on the self-test kits, please visit this link.

A negative result does not necessarily mean you do not have HIV, because of the window period (the time between HIV exposure and when a test can give reliable results).

Different HIV tests have different window periods. Ask your healthcare provider about the window period for the HIV test you are taking.

In general, if you have a negative HIV test result and the last possible HIV exposure was:

• Less than 72 hours ago, you may need post-exposure prophylaxis (PEP);
• Less than 90 days ago, you will need to repeat the HIV test to confirm the result.

If you have a negative test result again after the window period, and have no possible HIV exposure during the time, then you do not have HIV.

To stay HIV negative, take steps to practice HIV prevention methods:

 

If the rapid test reveals a positive result for HIV, a confirmatory laboratory blood test is required, which involves drawing of a small tube of blood by a healthcare provider. Please repeat a HIV test at a healthcare facility (including anonymous testing sites).

If the confirmatory blood test is also positive, it means you have HIV.

• Go for HIV treatment early. HIV medicine (called antiretroviral therapy or ART) works by keeping the virus under control to manage the condition.
• If taken as prescribed, HIV medicine can suppress the amount of HIV in your blood to a very low level (called undetectable viral load). With an undetectable viral load, people with HIV can live long, healthy lives and have practically no risk of transmitting HIV to their HIV-negative sexual partners.
• Subsidies of HIV medications are available for eligible Singapore residents.
• To find out more about available HIV care services, click here.

While there is currently no cure for HIV, there are advancements in medical treatment which have shown that HIV can be suppressed effectively with early and consistent treatment. Knowing your HIV status early allows you to seek treatment and delay the onset of AIDS and further complications.

Yes, with early and effective treatment, people living with HIV can lead lives no different from others.

Although there is no cure for HIV, people living with HIV can be treated with antiretroviral therapy which is very effective at controlling the infection. With consistent treatment, the viral load can be kept low and HIV cannot spread or develop into AIDS.

If you require HIV treatment, subsidies for medicines for HIV treatment are available for eligible Singapore residents.

Under the Infectious Disease Act (IDA), unless you have maintained a stable undetectable HIV viral load (see below), you must inform your sexual partner of the risks of getting HIV from you before having sex. This is to allow your partner to choose to take appropriate precautions.  

You are considered to have maintained a stable undetectable HIV viral load if you satisfy the following criteria: 
• You have stable, consecutive undetectable HIV viral load test results (below 200 copies per millilitre of blood), for at least six months; 
• Your most recent HIV viral load test shows a result of undetectable (below 200 copies per millilitre of blood), and is dated nine months or less before when you have sex; 
• You have adhered to medical treatment for HIV infection up to the time of when you have sex; and 
• All the HIV viral load test results mentioned above are from a licensed laboratory in Singapore

If you satisfy the above criteria, you do not pose a risk of transmission of HIV to your sexual partner. Therefore, you no longer need to inform your sexual partner of the risks of getting HIV from you.

The words we use to talk about HIV can have a powerful impact on those living with HIV or those who may be considering getting tested for HIV. Being mindful of what we say and how we talk about HIV and people living with HIV goes a long way in encouraging those at risk to get tested regularly. Avoid probing about how a person got infected as that may be personal and has little value in how they manage living with the virus. They may feel like they are being judged. The focus should be on detecting the infection early and supporting them in their treatment journey to curb the spread of HIV and the impact HIV can have on their health.

Knowing and sharing information to combat misconceptions about how HIV is transmitted helps remove fear and stigma of living and working with someone who is infected with the HIV virus.

Singapore has no specific employment legislation regarding HIV/AIDS at the workplace. Employment should be based on merit. Candidates should not be discriminated against due to medical conditions including HIV/AIDS, and be considered fairly based on their abilities.

Workplaces play an integral role in reducing stigma and prejudice towards people living with HIV in Singapore. Without stigma and prejudice, people would be more amenable towards earlier detection and treatment, which in turn would reduce the spread of HIV in the community. Below are some resources that companies can reference in the management of HIV/AIDS related issues at the workplace:

• Guidelines on Managing HIV in the Workplace (2022 version)
• Implementation Guide on Managing HIV in the Workplace (2022 version)
• Understanding how misconceptions on HIV lead to stigma, discrimination & onward transmission