"Singapore is an absolutely, absolutely terrifying country," says Hetty Vosselman.
"When you need to be afraid of revealing who you are, what you are, and what you did in your past, it's absolutely terrifying."
Having journeyed with people living with HIV and ex-convicts in Singapore for the past 12 years, the 58-year-old knows a thing or two about stigma, especially when it comes to HIV and AIDS.
People used to think that AIDS was a gay disease
Vosselman first heard of the Acquired Immunodeficiency Syndrome (AIDS) when she was still living in the Netherlands in 1985.
That year, she had to undergo an operation on both knees and needed a blood transfusion. But before that, the hospital said that she needed to go through some tests.
"They told me, 'oh you need to be tested for AIDS, but it's OK because it's a disease from America and it's only for gay people. So I thought, pfft, no issue."
A "gay disease". This misconception back then when the world was just starting to hear about AIDS was not entirely unfounded. At that time, young gay men appeared to be the most susceptible to this new phenomenon which made them fatally ill when exposed to harmless viruses and bacteria.
Vosselman didn't think much about the tests and when the results came back (negative, thankfully), any thought of the disease slipped out of her mind.
A few months later, her sister's best friend, a gay man, fell seriously ill with pneumonia after returning from America.
"Nobody really knew what was going on and he was suffering terribly," says Vosselman, adding that her family and the man's family came together to care for him.
Unfortunately his condition did not improve and he passed away soon after. Postmortem tests later confirmed that he died of AIDS.
Because no one knew at that time how contagious AIDS was or how it was passed between humans, Vosselman, along with everyone else who came into contact with the man had to be tested for the disease.
It was a long wait for the test results — about three months — but within that time, she learned that there were a lot of men, like her sister's best friend, who were sick with AIDS.
Of course, the world later learned that AIDS is the end stage of the Human Immunodeficiency Virus (HIV). This virus attacks the immune system, leaving its sufferers — male or female, gay, straight or any other inclination — vulnerable to opportunistic infections.
But then, back in 1985, AIDS was the silent, deadly killer that swept through the world, leaving in its wake a slew of dead bodies, fear and confusion.
"I thought what can we do about people like (her sister's best friend) because it's sad if it's contagious. We need to do something," she says earnestly.
Vesselman's thoughts led her a year later to COC Netherlands, an LGBT-friendly organisation in Amsterdam where she volunteered as a befriender to people living with AIDS.
The happiest person living with AIDS
She remembers one particular man from the centre up to this day.
Despite being diagnosed with AIDS, he was the friendliest person to everyone who visited the centre. Outgoing and positive, he was always trying to comfort those around him.
So when a TV crew came to the centre looking to make a documentary about people living with AIDS, the man was the perfect candidate.
Vosselman remembers him explaining to the crew his vision of his own funeral, which was going to be a gorgeous affair.
There was going to be a white carriage, filled with flowers and drawn by white horses. It would transport his coffin to a canal where it would be transferred onto a flat boat and ferried downstream to the graveyard.
He then turned to his partner and said, "You — you're going to be in the carriage, while we're going there."
And then all of a sudden, he cocked his head and said, "Where am I? Where am I sitting?"
"I'll never forget that moment," she said.
"That was when he realised he was the one who was going to die. He was not the director of someone else's funeral. And in that moment, he broke totally. He was a wreck."
"Of course, it was also a disaster for the team making the documentary," Vosselman adds wryly.
Sick, dying and alone
And then there were those who were terribly sick, so sick that they couldn't even get out of bed.
Many of them suffered from chronic diseases. Some had shrunk to half their original weight. Others were afflicted with Kaposi Sarcoma, a cancer that produces ugly lesions all over their bodies.
For every person who died from the disease, there were more who died from the medication they took to suppress its effects — some took up to 100 pills a day, says Vosselman.
While the medication prolonged their lives, it severely damaged their livers and kidneys. As such, some opted to forgo treatment.
"It's like if you get cancer and you know you're going to die. You can say hey, I can go on with the chemotherapy but I don't want to do that anymore because it makes me sicker. So some people say, 'just let me go'."
At first, because of the lack of knowledge about the disease, these people could not be touched directly without protection.
Vosselman was instructed to cover herself from head to toe in plastic before she could touch them. Watching her brows furrow, it is clear that this is a memory which pains her:
"They never had affection. People never dared to touch them. They never had skin-to-skin touch, there was always a layer of plastic in between."
It was only after people found out that HIV and AIDS cannot be transmitted through skin contact that Vosselman began to hug her patients liberally and with abandon.
It was her way of showing them that they were still cared for and loved. But also just as important was that it showed their family and friends that it's perfectly OK to touch people living with AIDS.
"So now, that's one of the reasons why I came to Singapore. I thought I don't want to be on the other side. I want to educate people that HIV is just a disease that you get from using (contaminated) needles or unprotected sex. That's it."
Talking to Singaporeans about sex and HIV
In 2000, Vosselman's mother passed away.
Then working as a psychologist and a jewellery designer, she decided it was time to leave the Netherlands together with her architect husband.
They tried living in Italy but after five years, decided that it was too European for their taste, and the couple found themselves in Singapore in 2005.
Vosselman took up a trauma psychology course with an American institute that required her to simultaneously do an attachment with an organisation.
Having had the experience with people living with AIDS, she chose to volunteer with Action for AIDS Singapore, where she helped to administer anonymous HIV testing, organise support groups for people living with HIV and provide sexual health counselling.
She says the work, that most Singaporeans may find awkward and uncomfortable, was easy for her:
"I can talk easily about sex, because, well, I'm a bit older, and I come from a very liberal country so that type of growing up makes it very easy to talk about sex. And whatever people do, I never judge. Talking about sex easily means I can educate people very easily."
Other things weren't as easy. Within the first month of her volunteer work here, Vosselman found herself having to break the news to a client who tested positive.
"I thought, 'Oh sh*t'", she says. "Every time I do the test, I always hope that it turns out negative."
"We were sitting then and he already knew. He started to cry and the only thing I could do was hold him. And then he said, 'you cannot touch me anymore.'"
Vosselman says her heart broke at that moment, and she cried as she held him.
"He had unprotected sex, and he told us that he was forced to do it," she says while shaking her head.
"I always say if you're forced, it means you're raped. He said no, he wasn't raped. He just didn't say no."
And the sad thing is, she adds, this client's story is more common than you might think.
"We have a lot of young people at the moment who just live, they just go for it. They don't use condoms. How many kids are using the pull-out method not to get pregnant? They don't have a clue that the pre-cum also has sperm. How do we reach these people?"
"I think that it's my responsibility because if the parents are not doing it, and the school isn't doing it, then someone needs to do it," she says.
"And when they come into my room, I'm the one who has to do it."
She also sees it as her responsibility to care for those who are newly diagnosed with HIV.
Whenever a person receives a positive test done at the anonymous test site, they will need to do another test, called the western blot, to confirm the diagnosis.
In the past, they would get their western blot results a few days later by calling AfA.
"We never knew if people were going to call back. Some people never called for their results," says Vosselman, who fears that they might do something silly, or worse, forgo treatment at a hospital.
"I want to know how they're feeling. I don't want them to feel lonely and dirty. But after that, they're out of my sight and that's difficult for me. I know the hospitals are providing good treatment, but I need to trust that they are going there."
Today, she makes an effort to exchange numbers with the newly diagnosed at AfA and check in on them from time to time.
Heartened by the impact of her work
And then there are the small victories that Vosselman treasures.
Just a day before our conversation, one of Vosselman's ex-clients (who tested positive two years back at AfA) turned up at the clinic to thank her personally for helping him through his own diagnosis back then.
It's a small gesture from one of the many that Vosselman has helped over the years but it made her happy to know that her work has impact, even if it reaches just one person.
"If I can only help one person, my whole week is good," she says, smiling.
Last year, a teenage couple came to AfA for a HIV test. They didn't know much about sex so Vosselman took the opportunity to explain pregnancy, sexual health, and the importance of using condoms.
One week later, the couple spotted her at a local mall and immediately they shouted: "We used condoms!"
"At least they learned from it!" Vosselman laughs.
"People in Singapore don't die from HIV anymore, but they can die from stigma"
What is worth celebrating too is the fact that the number of newly reported HIV cases in Singapore dropped to its lowest level in 14 years last year.
"There are less people with HIV today, that's the positive point. But the stigma and the education is not really better," says Vosselman.
She repeats something she remembers a doctor from Singapore's Centre for Disease Control saying:
"People in Singapore don't die from HIV anymore, but they can die from stigma."
The truth, she adds, is that people living with HIV can actually live healthier lives than those without because they visit their doctors every six months or so.
But the stigma of the disease often leads to psychological issues and stress which ultimately affects the immune system.
And a large part of this stigma is due to a woeful lack of HIV education in Singapore. It's been 34 years since Singapore saw its first reported HIV case and yet Vosselman still gets questions like these:
"Can I get HIV from sharing a cup with a HIV+ person?"
"I don't want to swim in the same pool as gay men because you'll never know if they have HIV."
"The basic education about HIV needs to be changed," says Vosselman who says that in this respect, Singapore is still a third-world country.
Perhaps this may change soon. Earlier in November, AfA released an ambitious Community Blueprint that aims to end HIV transmission and AIDS in Singapore by 2030.
Apart from reaching out to vulnerable populations such as heterosexual men with multiple sexual partners, men who have sex with men, and sex workers, the Community Blueprint promises to reduce the stigma of HIV by stepping up education programmes in the workplace and healthcare settings.
All these within slightly over 10 years. And maybe by then, HIV won't be such a scary thing for Singaporeans anymore.
Top photo by Janice Teo. Quotes were edited for clarity.