The Medical Talk Series is a public health education programme jointly initiated and organized by Tzu Chi Free Clinic and the Medical Group. The first talk was organized in September 2006. As part of the series, a medical talk on "AIDS Awareness" was held on 11 August 2007. This talk aims to improve the home visit volunteers' understanding of AIDS, and to educate these volunteers on self-protection when interacting with the AIDS patients. The talk was opened to all volunteers as well as the public.

Dr Ooi Say Tat, senior doctor from the Infectious Disease Department of Tan Tock Seng Hospital, expressed gratitude for the moral and financial support given by Tzu Chi Singapore to AIDS patients, which enabled the patients to continue to control their conditions with medicine.

In November 2006, the World Health Organization announced that a total of nearly 40 million people were infected with AIDS worldwide, and 2.9 million of whom died of the disease during the year.  Since the first case of AIDS came to light some 25 years ago, AIDS remains a communicable disease with 100% mortality.  To date, there is no known cure or an effective vaccine for AIDS.  Added to this is the public’s fear of this disease from ignorance.  The HIV/AIDS patients are thus discriminated.

At present, 64 of Tzu Chi's aid recipients are HIV/AIDS patients.  Although the home visit volunteers do not know much about AIDS, they have treated these patients without discrimination extending them gratitude, respect and love.  In order to improve the home visit volunteers' understanding of AIDS and to educate them self-protection while interacting with these patients, Tzu Chi Singapore organized a medical talk on "AIDS Awareness" on August 11, 2007 for the volunteers.  The talk was also open to the public.

An audience of 86 persons gathered at the Dharma Hall of Jing Si Hall at 3 p.m., and the talk began with a speech video by Master Cheng Yen entitled "The African Seed".  The video told of the loving care and comfort given by the Zulu volunteers to the AIDS patients at Africa Durban's AIDS care centre.  Master Cheng Yen lamented that AIDS is a potential social problem, and hoped that everyone would exercise self-discipline in order to eliminate this disease of the century.

Dr Ooi Say Tat, a senior doctor from the Infectious Disease Department, Tan Tock Seng Hospital was the speaker at the talk.  He said that care and concern are key elements in the battle against AIDS.  He was very touched by what Tzu Chi's team has done for the AIDS patients in South Africa.  He was also grateful for the moral and financial support given to the AIDS patients by Tzu Chi Singapore, which enabled the patients to continue to control their conditions with medicine.

Three main routes of HIV transmission

Generally speaking, it may take 2 years or up to a maximum of 10 years for the appearance of signs that could lead to AIDS in a person infected with HIV.  When that occurs, the virus would have weakened the immune system of the patient to the extent that the body could no longer fight severe infections.  Clinically, the patient is considered to have contracted AIDS.  Dr Ooi explained the 3 main routes of HIV transmission.  As we all know, having unprotected sex with someone infected with HIV/AIDS is the most common way of HIV transmission.  Mother-to-child direct transmission is another transmission route.  The HIV virus is transmitted by mother to child either at the foetus stage in the womb during pregnancy, during delivery or through breastfeeding.  This would result in the child becoming an AIDS patient in 2 to 10 years' time.  Getting infected via injection is a rare but possible way of transmission.  This usually happens to drug addicts who share needles and syringes or to medical staff who are accidentally poked by needles stained with HIV infected blood.

With regard to the question on whether a person is exposed to higher infection risk when living under the same roof with an HIV/AIDS patient, Dr Ooi said that transmission amongst family members living under the same roof did happen.  However, such cases are rare.  It is safe to be under the same roof as an HIV/AIDS patient so long as everyone takes the necessary precaution.  The key precaution is to avoid direct contact with the mucous membrane and blood of the HIV/AIDS patient.  Dr Ooi encouraged all to wear gloves whenever necessary to get in contact with blood or other fluids (such as urine, stool and vomited fluid) which may contain blood of a HIV/AIDS patient.  In the event of cuts, swelling or broken skin, the affected area must be covered with plasters to prevent blood infection.  Sharing of shaver or toothbrush will increase the risk of blood contact and should be avoided.  Dr Ooi stressed that it is safe to share a meal, and have a chat with a HIV/AIDS patient at close distance.

Clarifying misconceptions of HIV transmission

Brother Zhang Zheng Chang, a Tzu Chi home visit volunteer, posed the following question during the Q&A session – "Will HIV be transmitted via coughing?  If not, how is it that it is possible to detect whether a person is HIV positive through a saliva test?".  Dr Ooi explained that a saliva test actually targets at checking a body's immunity against HIV, and not at virus detection.  Although there is the presence of a very low quantity of HIV in the saliva and tears of some HIV/AIDS patients, contact with their saliva, tears or sweat has never resulted in HIV transmission.  Nonetheless, Dr Ooi added "Nevertheless, if a patient's CD4 index (immunity index) is very low and he is also having a bad cough, it is likely that the patient might be suffering from tuberculosis which can be transmitted through saliva.  Home visit volunteers are thus advised to wear masks."

"To date, there has only been a case of HIV transmission through open-mouth kissing (French kiss) worldwide.  This could have been due to blood contact with the HIV/AIDS patient while kissing.  However, the risk of being infected through French or open-mouth kissing is still very low, and there is no risk of transmission associated with close-mouth or social kissing.  Therefore, it is safe to be kissed on the cheek by an HIV/AIDS patient." 

Dr Ooi attended to all queries relating to HIV transmission.

"Dengue has been a popular topic in Singapore recently as quite a number of people were hospitalized due to dengue fever.  This raised the question on whether HIV can be transmitted via insect bites.  There is no need to worry since HIV could only live for a short time inside an insect, and the virus does not reproduce in insects.  Further, when an insect bites a person, it does not inject its own or its former victim’s blood into its next victim.  Rather, it injects saliva, which acts as a lubricant or a decoagulant.  Therefore, there is no risk of transmission from insect bites." Dr Ooi's explanation brought much relief to the audience.

Knowledge brings understanding

Since the emergence of the first type of AIDS treatment drug in 1986 or 1987, there are now more than 20 types of drugs for AIDS in the market.  Unfortunately, there is no drug or treatment which can cure AIDS and such patients can only reduce the virus quantity and control the virus reproduction through the use of drugs on a long term basis.  The current gold standard of AIDS treatment is a cocktail consisting of a combination of 3 types of antiretroviral (ARV) drugs.  However, not all ARV drugs can be made available globally.  They are also very costly and must be used under supervision.  Hence in general, doctors would first prescribe patients cheaper drugs and make such prescription changes as may be necessary in accordance with the patients' conditions.

As HIV/AIDS virus can only be controlled by drugs, it is very important that HIV/AIDS patients take their medicine regularly.  The HIV/AIDS virus can multiply rapidly and the CD4 index can drop rapidly if the patient were to skip his medication even once or twice.  Further, it is possible that the virus may develop resistance against the drug, resulting in the drug losing its effectiveness and the patient having to use a stronger drug to control his condition.  Therefore, Dr Ooi encouraged all home visit volunteers to impart the correct knowledge on the use of drugs, and to remind the patients to take their medicine regularly.

At an interview following the talk, Sister Qiu-Wei Qin Ji, who has been a home visit volunteer for 3 years, related that she once wanted to suggest a change of drug to a patient whose CD4 index has risen after taking the AVR drug and was then in a stable condition.  Sister Qin Ji had wondered whether it was possible for the patient to change to a cheaper drug to lighten his financial burden.  She was glad to have attended the medical talk which improved her understanding of the use of HIV/AIDS drugs and prevented her from causing unnecessary trouble to the patient with the suggestion for a change in medication.  She felt that gaining more knowledge on AIDS is definitely helpful to home visit volunteers.

The talk ended at 4.30 p.m. with the song "Gratitude, Respect and Love" following the Q&A session.  Even so, Dr Ooi was approached by some audience after the talk, and he answered all their queries on HIV/AIDS.  Dr Ooi said that it was very encouraging to receive so many questions as this showed that everyone was very concerned about the issues on AIDS.  He was of the view that raising public's awareness on hygiene is instrumental in the elimination of AIDS.

Mr Zhang Ai Zhong, a Tzu Chi member who saw the poster about the talk at Jing Si Books & Café located at Chinatown, attended the talk, and said that he benefited much from the talk.  Although Mr Zhang, who works in the information industry, has no medical background and has no need to be in contact with HIV/AIDS patients, he felt necessary to understand this disease of the century.  Mr Zhang admitted that he had discriminated AIDS patients before he attended the talk.  But he will no longer do so now that he has a better understanding of the disease.  He was of the view that there was a need for more of such educational talks for the public.  This disease of the century can only be eliminated with better understanding and everyone's co-operation.

At the start of this 21st century, we hope that everyone will have a more in-depth understanding of AIDS, set aside discrimination, be caring and work jointly to eliminate this lethal disease of the century.