Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." This Bill seeks to amend the Infectious Diseases Act (Chapter 137 of the 1985 Revised Edition) and the Infectious Diseases (Amendment) Act 1992, to strengthen the public health control of Acquired Immune Deficiency Syndrome (AIDS) in Singapore. The Infectious Diseases Act was passed in 1976 to prevent the introduction and spread of all infectious diseases in Singapore. AIDS, which is caused by the Human Immunodeficiency Virus (HIV), became a notifiable disease under the Infectious Diseases Act in 1985. In 1992, the Act was amended to include provisions to tighten the control of AIDS and to provide for the confidentiality of infected persons. However, changing trends of HIV infection in recent years require us to make further amendments to the Act in order to strengthen the public health control of AIDS in Singapore. Before I go into the details about the Bill, let me brief the House on these trends and therefore the need for changes to the existing law. HIV/AIDS situation in Singapore The number of HIV infected Singaporeans has been increasing over the years since 1985 when the first case was reported. Between 1985 and 1990, a total of 61 cases were reported. The rate of increase has accelerated since then. In 1991 alone, 42 new cases of HIV/AIDS were reported, as against the total of 61 cases between 1985-1990. Over the last four years, the number of cases shot up to more than 100 per year. Last year, 1998, the number climbed to nearly 200. The exact number was 199. In total, there were 930 Singapore residents notified to be HIV infected between 1985 and 1998, of whom 423 had asymptomatic infection, 196 had full blown AIDS and 311 had passed away. In addition, a total of 2,813 foreigners had been tested to be HIV positive while they were in Singapore. About 80% of such foreigners were work permit holders and applicants. They have already left Singapore. The pattern of transmission of the HIV infection has changed over the years, from a predominantly homosexual infection to one that is mostly spread by heterosexual transmission. Over the last three years, heterosexual transmission accounted for an average of 78% of all new cases. Most of these cases had unprotected sex with prostitutes and casual acquaintances in Singapore or abroad. The pattern of heterosexual infection itself has also changed. The proportion of married men among new cases of HIV infection among male Singaporeans has increased from 10% in 1991 to 30% in 1998. With this shift of the infection to the married population, infected men are bringing the infection home to their wives. A further tragic consequence is that there are more reports recently of children with HIV infection. The first HIV infected child was reported in 1991. Since then, eight more cases have been reported between 1997 and l
998. All of them have been infected perinatally. Families have been devastated by the HIV infection. We have had at least two families where all members were infected. This emerging trend needs to be addressed. Another major concern that has arisen recently is HIV transmission through blood transfusion. In 1997, my Ministry reported the first case of HIV transmission through blood transfusion. Two persons became infected after they received blood from a donor who was in the window period of the HIV infection. This is despite the stringent measures taken by the Singapore Blood Transfusion Services (SBTS) to exclude donors with risk factors because the donor had lied in this case. The HIV infected donor admitted to a total of six offences under section 182 of the Penal Code. He was charged in court early last year and given a sentence of 12 months. This penalty is hardly commensurate with the harm the donor had caused to the two recipients who received his blood. In 1997, my Ministry was also notified of a health care worker who was HIV infected. All the health care worker's patients, who were exposed to the risk of acquiring the infection through clinical procedures that were carried out on them, were informed, counselled and offered HIV screening. This look back programme to trace the contacts of the health care worker cost my Ministry $400,000. Fortunately, none was infected. Sir, with the changing pattern of transmission of HIV infection in Singapore, we have to address these new and emerging issues pertaining to the HIV infection here. My Ministry has reviewed the law and put up new strategies to ensure that the health of our people is not compromised. Timely actions need to be taken to prevent further spread of the disease within the population. My Ministry has studied the existing Infectious Diseases Act and has proposed several amendments to the existing Act to tighten the control of HIV infection in Singapore. Several countries responding to the AIDS epidemic, like the United States, Britain and Australia, have legislation to protect the public. Legislation in these countries has been enacted to allow for the disclosure of the HIV status of a patient to the spouse, sexual partner or contact. Provisions have also been made for disclosure to health care providers and other personnel who had come in contact with blood or body fluids of an infected person, and to the next of kin upon death of the infected person as well as in the interest of public health if it is threatened. Even in the United States where there were earlier laws to protect the civil liberties of HIV infected persons, new legislation has been introduced more recently to identify, notify and make it an offence for those who intentionally place others at risk of contracting the infection. Infectious Diseases (Amendment) Bill Sir, I will now deal with the main provisions of the Bill. Currently, a person who furnishes false information at the Blood Bank is charged under section 182 of the Penal Code. This carries a maximum penalty of $1,000 and/or a maximum jail sentence of six months. My Ministry proposes to make this an offence under the Infectious Diseases Act so that the appropriate penalty commensurate with the severity of the offence can be meted out. In the Amendment Bill, under a new section 10A, it is an offence to furnish false or misleading information in relation to the donation of blood. The maximum penalty under this section is a fine of $20,000 or a term of imprisonment not exceeding two years or both. Consequent to such a new provision, section 20C of the principal Act is amended to raise the penalty for a person who knows that he is HIV infected and yet donates blood or does any act that is likely to result in the spread of the disease from $10,000 to $50,000. Exceptions to Medical Confidentiality The identity of the person with AIDS/HIV infection is protected under section 20D of the existing Act, where disclosure of identity and HIV status is allowed only to specified categories of persons. To address the public health issues that have arisen over recent years which I have described just now, my Ministry proposes that new exceptions to medical confidentiality be included. The main objective of such new exceptions is to prevent transmission of the infection through irresponsible behaviour by persons who are infected and to allow those who have been exposed to the risk of the infection to be informed early, counselled and tested. With the availability of newer anti-retroviral drugs, early diagnosis will allow such victims to be treated to delay the progress to full blown AIDS. The treatment will also allow for a better quality of life on the part of the patients. Under clause 7(d) of the Amendment Bill, new provisions have been provided to allow the disclosure of the HIV status and the identity of the HIV infected person to his/her spouse and contacts. This amendment is to cater to the increasing incidence of HIV infection among married persons. From our experience, the infected person is sometimes reluctant to inform the spouse or contact despite numerous counselling sessions and advice from the doctors. Some have even refused to do so. Under the existing Act, my Ministry is unable to take any further action should the patient refuse to inform his or her spouse or contact. The new provision will allow the doctor to disclose the HIV status of the patient to the spouse or contact if the patient refuses to do so despite repeated counselling by the doctor. My Ministry strongly views that the spouse or contact who has been exposed to the risk of infection has a right to know so that they can be counselled and screened for the infection. Those who are not infected can take the necessary precautions to protect themselves against any further exposure to the HIV while those who may be infected will have a chance to undergo anti-retroviral therapy while they are in the early stages of the infection and make the relevant choices. For example, for infected wives who are pregnant, early diagnosis will allow a choice to abort the pregnancy or to take prophylactic measures to prevent transmission of HIV to the baby. My Ministry will continue to counsel those who are infected on the importance of disclosure so that they inform their spouses and contacts themselves and to bring them forward for counselling and screening. However, we will need to apply this legal provision if the counselling fails. Clause 7(d) of the Amendment Bill also enables the disclosure of the identity of a HIV infected person to the health care workers who have previously treated him/her, or to any other person who, in the act of rendering emergency assistance to a HIV infected person, has therefore been exposed to the risk of infection with the HIV. Other new provisions under clause 7(c) of the Amendment Bill would allow my Ministry to disclose the identity of HIV infected foreigners to the Controller of Immigration for the purposes of the Immigration Act, and the disclosure to the next of kin of the HIV infected person in the event of death, because special burial arrangements have to be made to ensure that public health is safeguarded. Under the Amendment Bill, the Minister is empowered to authorise the publication of information which may identify the HIV infected person in instances where the health or safety of the public is threatened. I would like to assure the House that this provision would only be evoked under extreme circumstances, such as when an infected person wilfully continues to place others at risk of contracting the infection, and the disclosure can only be done with the Minister's approval. Re-disclosure of information To ensure that there is no abuse despite the increase in the categories of persons to whom information on the HIV infected person can be disclosed to, the Bill has included a provision under clause 7, subsection 9, in which no person to whom any information on a HIV infected person has been disclosed, shall re-disclose such information to anyone except to persons stipulated in the Act. Unauthorised re-disclosure will be dealt with seriously. The penalty is a fine of $10,000 or imprisonment for a term not exceeding three months or both. In conclusion, with the increasing incidence and changing pattern of HIV infection in Singapore, the amendments to the Infectious Diseases Act are necessary to ensure that the health of our people is not compromised. All of us, doctors, neighbours and friends, members of the public, should continue to empathise with HIV patients and their families. AIDS is a dreadful disease that causes great suffering and social stigma to the victims and their loved ones. We must continue to help them and treat them humanely and with great compassion. My Ministry will ensure that the new provisions under the Infectious Diseases Act will not be abused and the rights and confidentiality of the infected person are protected as far as possible. At the same time, we will continue and step up our public education on AIDS, so that all Singaporeans will become fully aware of the danger of the infection and take preventive measures to avoid the risk of being infected. Sir, the proposed amendments to the Infectious Diseases Act will enable my Ministry to step up the public health control of AIDS in Singapore. It will help to prevent further transmission of the infection among the population, and allow those who may be innocently infected to seek screening and early treatment. It will also enhance further the safety of our national blood supply. Sir, I beg to move. Question proposed.