People living with the human immunodeficiency virus (HIV) will no longer need to disclose the risk of contracting the virus to their partners before sexual activity if they have maintained an undetectable viral load for at least six months.

This change comes with an amendment to Section 23(1) of the Infectious Diseases Act, along with other amendments to the Act, which were passed in Parliament on Mar. 7.

Previously, people living with HIV (PLHIV) were required, legally, to inform their partner of the risk of contracting HIV before they engaged in sexual activity.

What does it mean to have an undetectable viral load?

HIV is a virus that attacks the body's immune system.

If left untreated, HIV eventually progresses to Acquired Immunodeficiency Syndrome (AIDS) and can be life-threatening.

The virus is supressed with consistent use of medication. This serves to suppress the virus to an undetectable level in the blood.

A person living with HIV is considered to have an undetectable viral load when the amount of HIV viral particles per millilitre of blood is maintained at below 200 copies for a period of time.

As HIV is incurable, medication serves to bring down the viral load over time to an undetectable level, where the virus is virtually untransmittable through sex.

Conditions under amended Infectious Diseases Act

Under the amended Infectious Diseases Act, if a person living with HIV does not wish to disclose their HIV status to sexual partners, they need to meet a few conditions, said Senior Parliamentary Secretary for Health Rahayu Mahzam.

First, they need to maintain an undetectable viral load for at least six months.

Second, they need to get their viral load test results from a licensed laboratory in Singapore, and the most recent undetectable viral load test result should be nine months or less before the sexual activity in question.

Lastly, they must have adhered to medical treatment for HIV infection up to the time of the sexual activity.

A person with HIV who maintains a stable undetectable viral load over time as a result of consistent adherence to their treatment cannot transmit the virus to their sexual partner, Rahayu explained.

Rahayu added that more details will be set out in subsidiary legislation.

Responsibility now on individuals to get tested and treated for HIV

Rahayu said the amendment aligns with medical advancements as well as Singapore's public health objective to curb HIV transmission.

The amendment shifts the responsibility to individuals to get tested and treated for HIV in order to achieve and maintain a stable, undetectable viral load.

She highlighted how other jurisdictions like Sweden, Taiwan and the United States have similarly removed disclosure requirements for people living with HIV who don't pose a risk of virus transmission.

She emphasised that the Ministry of Health is “not relaxing public health safeguards against HIV transmission” with the amendment.

Instead, the amendment serves to encourage individuals who are at high risk of contracting HIV to get tested regularly and, when the need arises, to get treated early.  This allows them to achieve an undetectable viral load as early as possible.

"The intention of HIV laws is not to criminalise persons living with HIV, but to deter irresponsible behaviour,” she said.

Disclosure still required for some cases

Even with the amendment, the Infectious Diseases Act still requires that people who don't know if they have HIV, but have reason to believe they have contracted the virus, must tell their sexual partners of the risk of infection before engaging in sexual activity.

They must also obtain the partner's consent to accept this risk of transmission.

The same applies for people living with HIV who have detectable viral loads.

Doctors regularly inform patients of this legal obligation after they are diagnosed with HIV.

Those who fail to do so may be fined up to S$50,000, jailed for up to 10 years or both.

Related media:

https://mothership.sg/2019/01/openly-out-hiv-calvin-tan-2

@mothershipsg "Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner," said Senior Parliamentary Secretary for Health Rahayu Mahzam. #singapore #sgnews #sgnewsupdate #singaporeparliament #sgparliament #rahayumahzam ♬ original sound - Mothership

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