Singapore’s HIV stigma awareness campaign developed by the National HIV Programme (NHIVP) and distributed by the Health Promotion Board is everywhere once again for the third year now.
Train stations, YouTube, Facebook, bus stops… they’re going all out.
On the surface, it’s a commendable effort. It acknowledges that stigma can prevent people from getting tested, seeking treatment, and talking openly about the risks of HIV.
In a society that still holds conservative values, encouraging openness about a once-taboo topic is no small feat. In this light, the campaign’s attempt to inform the public that anyone can contract HIV and that testing is crucial is useful.
Yet, for all its strengths, it falls short in addressing the full picture of HIV transmission—and the behavioural choices that significantly impact it.
HIV Doesn’t Differentiate? Not Quite.
The campaign’s central message is that HIV does not discriminate and can affect anyone, regardless of age, relationship status, or lifestyle. It frames HIV transmission as a universal risk, discouraging stigma by emphasising that no group is inherently more at risk than another.
It presents HIV as a non-differentiating virus, using binaries such as:
- Younger or Older – Emphasising that age is not a factor in HIV risk.
- 21 or 61 Years Old – Suggesting that both young and old are equally at risk.
- Single or Married – Implying that marital status does not confer immunity.
- Casual or Serious – Indicating that all sexual encounters carry similar risks.
- A Fling or more – Reinforcing that short-term relationships are just as risky.
Encouraging widespread testing and treatment is sound public health policy in modern sexual mores. However, in deploying this framing, the campaign avoids addressing key behavioural differences that significantly impact transmission rates, ultimately presenting an incomplete picture of HIV risk.
If NHIVP wanted to run a truly effective nationwide campaign, it would provide not just broad awareness but also a values contrast—one that highlights the behavioural differences between low-risk and high-risk groups.
Instead, by presenting HIV transmission as something that affects everyone equally without distinction, the campaign entrenches the idea that premarital sexual promiscuity is a neutral behaviour, and normalises casual sex as an unavoidable feature of modern life.
This is misleading. The reality is that premarital promiscuity carries significant psychological, relational, emotional, and physical harms, beyond just the risk of HIV. Studies consistently show that individuals with multiple sexual partners before marriage experience higher rates of depression, relationship instability, and lower marital satisfaction.
Yet, the campaign does little to challenge these risks. If public health campaigns explicitly warn against overeating for diabetes prevention, why does HIV prevention avoid discussing sexual behaviour?
Setting the Record Straight: The Missing Comparisons
Since the campaign seems to have conveniently overlooked key behavioural contrasts, we at Regardless decided to do what needed to be done—make it more comprehensive.
After all, if the previous campaign could personify HIV as a neutral, non-discriminating entity, we figured we’d give it some much-needed personality by pointing out what it actually does differentiate between.
To that end, we’ve developed five posters that correct the imbalanced narrative, injecting a dose of reality into the messaging. These additions highlight the clear distinctions between low-risk and high-risk behaviours—an aspect the official campaign overlooked by focusing on identity rather than conduct.
A more reality-based approach would include binaries that truly impact transmission risk:
- Chaste vs. Sexually Active – Abstinence eliminates risk entirely.
- Faithful vs. Promiscuous – A lifelong, monogamous relationship with an uninfected partner prevents HIV.
- Drug-Free vs. Druggie – Avoiding shared needles eliminates a major transmission route.
- Sex Work vs Real Job – Some jobs pose a greater HIV exposure risk than others.
- Rubber Used vs Refused – Condoms reduce HIV risk; refusing them increases vulnerability.
HIV doesn’t just waltz around randomly infecting people like some egalitarian disease with no preferences. It’s got a type—and that type is risky behaviour.
HIV differentiates. It doesn’t care if you’re young or old, single or married—it cares what you do. So if public health campaigns want to be honest, they shouldn’t pretend otherwise.
Public health messaging that downplays the link between promiscuity and HIV risk doesn’t just misinform individuals—it has wider social consequences. When society is led to believe that HIV is an equal-opportunity virus with no behavioural risk factors, it weakens personal accountability and public health strategy. This misrepresentation affects education, policy-making, and resource allocation, ultimately making it harder to reduce transmission rates.
Inconvenient Statistics (Made Easy for You)
Singapore reported 209 new HIV cases in 2023, with 62.7% linked to men who have sex with men (MSM), including 5.7% from bisexual men. 31.6% of cases were attributed to heterosexual transmission. This marks an increase in the proportion of MSM cases compared to 2022, where 51% of infections were from homosexual transmission and 37% from heterosexual transmission.
Estimating the percentage of homosexual males within Singapore’s population is challenging due to limited data. A 2018 study estimated the number of Homosexuals in Singapore to be 90,000 while a 2019 NUS study more than doubles that number to about 210,000. The wide range in estimates is telling—activists push for the higher number, but the actual prevalence remains uncertain.
Given that MSM individuals make up only 1.6% – 3.7% of Singapore’s population at the time the studies were published, an MSM in Singapore is estimated to be between roughly 36 and 85 times more likely to contract HIV than a heterosexual person.*
Global Public Health and the Avoidance of Hard Truths
Despite this, Singapore’s public health messaging downplays this reality, portraying HIV as an equal-opportunity virus that affects all groups in similar ways.
This echoes global trends in public health messaging, particularly in the way the World Health Organization (WHO) and the US Centre for Disease Control (CDC) handled monkeypox (mpox).
When mpox cases surged in 2022, the overwhelming majority of transmissions occurred among MSM. A WHO report found that nearly 90% of cases were in men, with 96% of the 87,189 infected contracting the virus through sexual contact, primarily affecting men aged 29 to 41.
Despite clear data showing that sexual transmission—particularly among MSM—was the dominant mode of infection, public health messaging downplayed this fact. Instead of issuing targeted warnings, authorities framed mpox as a general public health threat, echoing the same pattern of obfuscation seen in HIV awareness campaigns.
Consider the examples below using data from the US CDC and The WHO.
Yet, to avoid ‘stigmatising’ the gay community, WHO messaging downplayed this fact and framed the virus as a general risk to the public. The result? Confused messaging that did little to protect or encourage behavioural change among those most at risk while unnecessarily alarming those who were not.
Stigma: A Double-Edged Sword
Academics argue that stigma can be both a motivator for health behaviour change and a source of harm. While it can encourage individuals to avoid high-risk activities, shame-induced stigma often affects the most vulnerable, reinforcing health disparities and discouraging those at risk from seeking medical care.
This perspective, while valid, assumes all stigma operates in the same way. In reality, not all stigma is harmful.
Some forms of social disapproval have effectively reduced risky behaviours without alienating those already affected. We accept that social disapproval can reduce smoking and reckless driving without ostracising smokers and drivers. Why is sexual risk behaviour treated differently?
Singapore’s HIV campaign takes an uncritical approach to destigmatisation—it seeks to remove any deterrent against casual sex and promiscuity, primary drivers of HIV transmission, without counterbalancing this with messaging that discourages reckless sexual behaviour. Instead of promoting both awareness and prevention, it focuses solely on removing stigma, missing an opportunity to meaningfully reduce HIV transmission at its source.
Public health messaging should distinguish between destructive stigma, which isolates and shames, and constructive stigma, which discourages harmful behaviours while still ensuring care for those in need.
By refusing to acknowledge the role of behavioural choices in HIV transmission, Singapore’s campaign inadvertently normalises casual sex, failing to provide the full truth about risk.
A More Honest Approach
Singapore deserves credit for addressing HIV stigma, but it must go further by telling the truth about risk. Encouraging responsible sexual behaviour should not be taboo. If we can acknowledge that poor dietary choices contribute to diabetes or that reckless driving leads to accidents, we should be able to state, without hesitation, that promiscuity increases the risk of HIV.
Public health messaging should not be sanitised to protect feelings at the expense of clarity. If we want real progress, we need campaigns that don’t just remove stigma—but one which doesn’t avoid difficult conversations about sex in the name of inclusivity.
*Calculation and Caveat
We arrive at these figures by calculating the HIV incidence rate among MSM and heterosexuals separately, then comparing the two. In 2022, 51% of Singapore’s 202 new HIV cases (≈103 cases) were linked to homosexual transmission, while 37% (≈75 cases) came from heterosexual transmission. Using MSM population estimates of 90,000 to 210,000, we get an HIV incidence rate ranging from 0.049% to 0.114% per year. For heterosexuals (about 5.49 to 5.61 million people), the incidence rate is around 0.00134%. Dividing the MSM rate by the heterosexual rate gives a relative risk of 36 to 85 times.
This is a rough but useful estimate. MSM are more frequently tested, which may inflate their numbers, and their population size is uncertain. Also, HIV risk is not evenly distributed—some heterosexuals have near-zero risk, while others (e.g., those engaging in high-risk behaviors) have much higher risk. Ideally, a more precise measure would adjust for these factors.
Even with these limitations however, the numbers highlight the vastly higher risk of HIV transmission among MSM. From the data, it’s clear HIV transmission is not evenly distributed but heavily concentrated among MSM.
