Removal of sodomy laws is neither a necessary nor a sufficient condition to achieve decrease in HIV prevalence in MSM
France decriminalized sodomy for all in 1791.
Since the Penal Code of 1791, France has not had laws punishing homosexual conduct per se between over-age consenting adults in private. However, other qualifications such as “offense to good mores” were occasionally retained in the 19th century (see Jean Jacques Régis de Cambacérès).
In 1960, a parliamentary amendment by Paul Mirguet added homosexuality to a list of “social scourges“, along with alcoholism and prostitution. This prompted the government to increase the penalties for public display of a sex act when the act was homosexual. Transvestites or homosexuals caught cruising were also the target of police repression.
In 1981, the 1960 law making homosexuality an aggravating circumstance for public indecency was repealed. Then in 1982, under president François Mitterrand, the law from 1942 (Vichy France) making the age of consent for homosexual sex higher (18) than for heterosexual sex (15) was also repealed, despite the vocal opposition of Jean Foyer in the National Assembly.
Singapore retained the buggery law for male homosexuals in 2007.
After the exhaustive Penal Code review in 2007, oral and anal sex were legalised for heterosexuals and female homosexuals only. The changes meant that oral and anal sex between consenting heterosexual and female homosexual adults were no longer offences but section 377A, which dealt with gross indecency between consenting men, remained in force. Kumaralingam Amirthalingam a Professor of Law at the National University of Singapore has argued that it may not apply to anal sex between males.
In his concluding speech on the debate over the repeal of Section 377A, Prime Minister Lee Hsien Loong told MPs before the vote that “Singapore is basically a conservative society…The family is the basic building block of this society. And by family in Singapore we mean one man, one woman, marrying, having children and bringing up children within that framework of a stable family unit.”
France and Singapore are developed countries with high GDP compared to Jamaica.In 2000 WHO stated that France provided “the best overall Health Care” in the World
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the “best overall health care” in the world. In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a figure much higher than the average spent by countries in Europe but less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.
The estimated community prevalence rates of HIV among MSM in Singapore is 2.6% whilst that for MSM in France is 17%. The ranges are in the articles below.
2.6% HIV prevalence rate among MSM in Singapore
Although figures from the Health Ministry showing new HIV cases among MSM in Singapore to be at an all time high, two sets of data are showing the HIV prevalence rate among MSM in Singapore to be relatively low.
The latest 2008/9 MSM community testing project showed the prevalence to be 2.6 percent, down from 3.1 percent a year earlier, Prof Roy Chan, President Action for AIDS (AfA), told Fridae when asked to comment on the record number of new cases. Some 1,200 men were tested in the latest project compared to 960 the year before. The voluntary, free and anonymous testing service was made available at selected MSM frequented venues including bars and saunas late last year.
The HIV prevalence rate among MSM at the anonymous test clinic run by AfA also saw a decrease from 5.7 percent in 2007 to 4.7 percent in 2008.
“Efforts to increase HIV awareness has not fallen on deaf ears. AfA believes that our efforts to stem the spread of HIV in Singapore in the last 21 years has been reasonably successful among MSM. HIV seroprevalence has remained stable… We have one of the lowest infection rates in any major metropolitan area in the world,” said Prof Chan.
“However we cannot be complacent. MSM individuals and groups must continue to mobilise to increase awareness and action to stop the spread of HIV in the community.”
According to statistics released by the Health Ministry (MOH) on its website last Wednesday, the number of new HIV infection cases among gay men and bisexuals recorded last year is at the highest since Singapore began keeping track in 1985.
Although the number of HIV cases from heterosexual transmission has fallen from 255 in 2007 to 248 last year, the number of new cases among gay men increased from 130 to 151 during the same period. The number of bisexuals who tested positive also increased from 15 to 34. About 93 percent of the total number of new cases detected were males.
In total, 456 Singapore residents were newly reported with HIV infection last year bringing the total number of HIV infected Singaporeans to 3,941 as of end 2008. If those, 1,799 are asymptomatic carriers, 914 had AIDS-related illnesses and 1,228 have died.
The statement further noted that 50 percent of the new cases last year already had late-stage HIV infection when they were diagnosed, mirroring a similar trend found in previous years.
When asked to comment on the record number of new cases, Prof Chan told Fridae that it is “troubling that we continue to record increasing numbers of HIV infections in the country, despite increased funding and expanded and more intensive educational programming.”
He also highlighted that the increase in numbers may be the result of an increase in the number of MSM (men who have sex with men) who undergo voluntary testing as they are “more aware than others of the risks of contracting diseases through unprotected sex.” The Health Ministry’s press release noted that “a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (24 percent vs 3 percent), similar to 2007 (29 percent vs 5 percent).
“However we cannot deny that there are still significant numbers of MSM who indulge in unsafe sexual practices. The majority of MSM are educated and knowledgeable, and are well aware of the risks of such behaviour; however for a variety of reasons some have chosen to be reckless and careless.” Said Prof Chan who has been involved in the voluntary community-based organisation since the late 80s.
He further said that many MSM have multiple concurrent partners, which carry the highest risk of disease transmission if sex is unprotected, compared to having serial multiple partners.
Citing “ever increasing opportunities for meeting and having sex – whether it be in saunas, bars, clubs, parties or over the Internet,” Prof Chan urge venue and business owners to play their part to ensure that clients and customers are well informed, and behave in responsible manner when they are in their premises or communicating in cyberspace.
Experts recommend that sexually active gay men get tested for HIV every 12 months.
Action For AIDS Anonymous HIV Testing & Counselling Clinic
DSC Clinic, 31 Kelantan Lane, #01-16, S200031
Tue: 6.30 to 8.00pm
Wed: 6.30 to 8.00pm
Sat: 1.30 to 3.30pm
(except on public holidays) $20 per HIV test (blood or oral fluid)
$20 per Syphilis test
No personal particulars are recorded even with positive results. Results are returned in approximately 20 minutes.
For a list of six other clinics that provide anonymous HIV antibody testing in Singapore, click onto hpb.gov.sg/aids
For anonymous testing sites in other Asian cities, click onto fridae.com/kys and select
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High prevalence and incidence of HIV infection among men who have sex with men recruited in commercial gay venues in Paris, France: PREVAGAY 2009 Survey
A. Velter1, F. Barin2, A. Bouyssou1, J. Guinard3, S. Le Vu1, J. Pillonel1, A. Alexandre4, C. Semaille1
1Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint-Maurice, France, 2Centre National de Reference du VIH, Tours, France, 3Centre National de Reference du VIH, TOURS, France, 4Syndicat National des Entreprises Gay, Prevention, Paris, France
Background: In France, nearly half of new HIV cases among men are attributed to sexual contact among men who have sex with men (MSM). Until now, behavioural surveys provided a self-reported HIV prevalence among MSM ranging from 12 to 17%. In 2009, a survey was set up in order to estimate HIV prevalence and incidence based on biological results.
Methods: An anonymous cross-sectional survey was conducted in 14 Paris gay commercial venues with or without sex (saunas, backrooms and bars), during 6 weeks. MSM were invited to self-collect a fingerprick blood sample on blotting paper, then to self-complete a behavioural questionnaire.
Blood samples were screened using the Genscreen-ultra-HIV-Ag-Ab (Biorad) assay and confirmed by Western Blot. The enzyme immunoassay for recent HIV-1 infections (EIA-RI) was used to estimate cross-sectional incidence (180 days window-period, false recent rate of 1.6%).
Results: Of the 1578 men approached, 886 (56%) provided both blood specimen and completed the questionnaire. Participants’ median age was 38 years; 63% of them reported at least one HIV screening, and 51% over 10 sexual partners during the last 12 months. The estimated HIV sero-prevalence was 17.7% [95%CI: 15.3-20.4]. This prevalence increased with age: 8.9% [5.4-14.3] for 30 year-olds and under, 22.0% [15.5-30.4] for those above 50. The annual HIV incidence estimate was 7.5% person-years [95%CI: 4.5-10.5]. The highest incidence estimate was among the 40-49 age group: 9.4% [1.7-17.8].
Among the 157 HIV-positive men, 20% were unaware of their positive status, 69% reported over 10 sexual partners, 38% unprotected anal intercourse with partners of negative or unknown HIV status in the last 12 months.
Conclusions: This first French MSM community based survey provides both HIV sero-prevalence and incidence; it reveals an important HIV transmission in this highly infected population. These data call for effective emergency prevention programs targeting MSM.