Singapore recorded 422 new HIV infections last year, the highest number in a single year since records started in 1985, the city-state of 4.5 million people said Tuesday.

More than half of the new cases already had late-stage HIV infections when they were diagnosed, as happened in previous years, the Health Ministry said. It urged people who are at high risk of contracting the virus to go for tests.

"There is thus an urgent need for persons who engage in high risk behavior such as unprotected casual sex, sex with prostitutes, and intravenous drug abuse to go for regular HIV testing," the ministry's Web site said in an update of the HIV/AIDS situation in the prosperous Southeast Asian country.

Ninety-three percent of the new infections were among men and 95 percent were transmitted through sex, it said.

Nearly two-thirds of the sexual transmissions occurred during heterosexual sex, the update said.

It said the number of intravenous transmissions fell last year to seven, half of the number recorded in 2006.

The new cases bring the total number of known HIV-infected Singaporeans to 3,482 as of the end of last year, the ministry said. More than 1,100 of them have died.

The ministry also noted that Parliament last week passed an amendment to the law to tighten regulations on HIV transmissions.

The existing law penalized anyone who knows he or she is infected with HIV but is found to have failed to tell a partner about it before sex. The amendment includes individuals "who have reason to believe" that they have been exposed to a significant risk of contracting HIV or AIDS.

The amendment says those individuals must take "reasonable precautions" — such as using condoms or being tested — to protect their sexual partners. Otherwise, they must inform their partner of the risk of contracting HIV from them and leave it to them to accept the risk if they wish. If the partner accepts, no legal offense is committed.

A person found guilty of not informing a partner or of failing to take such precautions faces a maximum penalty of a 50,000 Singapore dollar ($36,735) fine and 10 years' imprisonment.

HANOI (AFP) - Vietnam has launched a methadone drug substitution programme to help injecting heroin users beat the addiction and reduce the spread of HIV/AIDS, the United Nations said Monday.

Two new methadone clinics in the northern port city of Haiphong, a heroin and AIDS hotspot, will treat 700 users with the substitute drug from now until December, said the United Nations mission in a statement.

The UN congratulated Vietnam and said it was pleased to work with the country on "effective harm reduction approaches ensuring a comprehensive response to HIV in Vietnam," said UNAIDS country chief Eamonn Murphy.

Methadone substitution programmes reduce illegal drug use, crime, mortality and the spread of HIV/AIDS and hepatitis C, said the UN statement.

Methadone clinics are also due to open by May in Vietnam's largest urban centre, Ho Chi Minh City, which has the highest infection rates in an HIV epidemic driven in Vietnam by injecting drug users sharing needles.

Almost 300,000 Vietnamese are believed to be living with HIV.

Intravenous drug users, prostitutes and homosexual men still make up the largest number of infected people here, but health experts warn that the virus is now spreading fast into the wider population of 86 million.

Heroin, most of it from the 'Golden Triangle' countries of Myanmar and Laos, is the most popular illegal drug in Vietnam, UN experts say.

Vietnam has a centuries-old history of opium use, and cultivation was vastly expanded under French colonial rule. During the Vietnam war, heroin flows from the Golden Triangle rose sharply, to US troops and Western markets.

The post-war communist government mostly eradicated large-scale opium cultivation and in 2004 estimated that little more than 30 hectares of poppy fields remained, mostly grown by remote and poor ethnic minorities.

However, Vietnam's proximity to Myanmar and Laos -- the second and third largest opium producers after Afghanistan -- and its porous borders and long coastline have made it a major transit country, say UN experts.

Domestic drug abuse in Vietnam has risen sharply since the 1990s, especially in the cities, where "heroin continues to be the preferred drug among younger drug abusers," according to the UN Office for Drugs and Crime Control.

Opium smoking has long given way to heroin smoking and increasingly injection, which now causes about 60 percent of Vietnam's known HIV infections.

In the last two months of 2007, Vietnamese courts sentenced at least 43 people to death and jailed scores more in several group trials against heroin smuggling syndicates, often extended family and clan networks.

Russia will undo good progress in combating HIV/AIDS and miss the chance to stem the epidemic if it does not offer more help to people who inject themselves with drugs, U.N. AIDS chief Peter Piot said on Saturday.

Piot also warned Russia and Ukraine of a rise in the proportion of women infected with the HIV virus who neither inject drugs nor work as prostitutes -- a segment of the population previously considered less vulnerable.

After Sub-Saharan Africa and South Asia the former Soviet Union has the highest number of people who carry the HIV virus which transmutes into the deadly AIDS infection, although the infection rate in the region has slowed over the last few years.

"They are on the right path, the right trajectory but some difficult decisions have to be made," Piot told Reuters in Moscow during a conference on AIDS in the former Soviet Union.

"The region is at a critical point."

Russia and the Central Asian states lie on the main heroin trafficking route from Afghanistan to Europe and drug users injecting themselves with infected needles account for up to 80 percent of people with the HIV virus.

The former Soviet states have ploughed millions of dollars into combating HIV over the last few years and boosted partnerships between civil society and the government with positive results.

Despite a 150 percent increase in people infected with HIV since 2001 to around 1.6 million, the rate of annual new infections slowed to about 150,000 in 2007 from 210,000 in 2001.

In Sub-Saharan Africa around 22.5 million people are infected with HIV and in South Asia about 4 million people live with the virus.

"Here the big difference is that injecting drug use is so widespread compared to other countries in the world, millions of people are doing it," Piot said.

ECONOMIC COLLAPSE

Drug usage is high partly because of an economic collapse after the 1991 fall of the Soviet Union which cost millions of people their jobs and livelihoods across the region and the relative cheapness of heroin as it is smuggled to Europe.

New figures showed a third of drug users in Uzbekistan are infected with HIV.

But Russia has declined to invest in clinics where heroin users can take the opiate substitute methadone in a clean, controlled environment -- a technique which has reduced HIV infections in Europe and North America.

"If you don't supply clean needles, if you don't supply methadone you can't control the epidemic," Piot said.

A stigma against people infected with HIV remains strong in Russia and both the public and the government are unwilling to invest in methadone and needle exchange clinics for drug users.

Some experts also argue that introducing methadone will increases the number of drug addicts.

And a new characteristic of HIV infection in the ex-Soviet states is the rise in the percentage of women among newly infected people -- doubling to around 40 percent in Russia and Ukraine in 2007 from 2000.

"The question for me is: Is this the beginning of the generalization of HIV, is HIV getting out of the classic high risk groups?" Piot said.

These women typically contract HIV through sex and often only discover they carry the virus when checking for infections during a pregnancy, Piot said.

"Women here have the illusion that they are not at risk, that HIV is just for gays and drug users," he said.

(Editing by Richard Balmforth)

The waiting room at the anti-retroviral clinic in rural Kwazulu-Natal, South Africa, is bustling, as patients clutch their files patiently awaiting their life-saving medication.

Smiling shyly, a 51-year old woman clasping a brown paper bag upends her medicines in front of Nokubonga Potelwa, who explains how to take the drugs that were long snubbed as toxic by the South African government.

Potelwa hands the woman a photocopied calendar, with a picture of a sun and a moon drawn in each day where she has to mark off that her medicines were taken, and uses a red crayon to indicate with an X, the day she should return.

Emmaus hospital, nestled among the majestic Drakensberg mountains in the AIDS-stricken province is one of several rural hospitals recording astonishing successes in ARV-treatment, having already hit ambitious targets set for 2011.

After the cabinet adopted on May 4 2007 a five-year AIDS plan which aimed to halve new infections by 2011 and have 80 percent of patients on treatment, South Africa's once sluggish and embarassing AIDS response has taken new shape.

"I am happy, because I am going to live a healthy life," the woman says quietly in Zulu.

With five and a half million HIV infections, in a population of 48 million, South Africa has the world's worst AIDS rate.

From President Thabo Mbeki's questioning of the link between HIV and AIDS, and a long battle by activists to see the provision of anti-retroviral treatment, government was reluctantly prodded into rolling out ARVs in 2004.

The slow rollout, and constant conflict between activists and health minister Manto Tshabalala-Msimang reached its zenith in 2006 when the minister's promotion of vegetables over ARVs saw her displaying beetroot, garlic and lemons at the world AIDS conference in Toronto, Canada.

The international backlash spurred the development of a new National Strategic Plan driven by a restructured AIDS council that has seen civil society relentlessly driving the fight against AIDS.

"More people are coming in and testing, there are many more on ARVs. Ay its a big difference," says Potelwa who has seen the hospitals' ARV rollout go from zero to on-target in her three years as an AIDS counsellor.

To Dr Bernhard Gaede, who heads up the AIDS clinic at Emmaus, the trick to wading through the pitfalls of rural healthcare, such as doctor shortages and long distances is decentralising, empowering nurses to perform more functions.

The initial guidelines for implementing ARV treatment from initiation to adherence at central hospitals resulted in chaos, with long waiting lists around the country.

"Very quickly, with a small amount of space and small number of staff we became very congested. We could only put five people a week on ARVs," said Gaede.

By training nurses at the five Primary Health Care clinics around Emmaus to do testing and adherence, and sending doctors there to initiate patients, 80 percent of the HIV positive community -- 20,000 people of a population of about 150,000 -- is now on treatment.

Government figures at the end of February showed that 420,000 people were now receiving ARVs nationwide, a sharp rise on the figure of 273,000 at the end of 2006.

"We improved transport to clinics, and by having doctors there the goal (in the NSP) of strengthening the health care system actually began to happen."

Denise Hunt, executive director of the AIDS consortium networking organisation, who is on the plenary of SANAC, said while there was not yet statistical evidence to measure the targets that had been set, the signs were positive.

"There is a lot of anecdotal evidence that we have come quite far in the journey. I think we have made a lot of progress, it is very exciting to see there are the success stories."

She said rural hospitals like Emmaus showed that with "creative thinking, when it is applied, the targets are ambitious but they are reachable."

Both Gaede and Hunt agree the civil society component of SANAC made a huge difference in the progress that had been made, even when the renewed goodwill between government and activists faltered.

Hiccups at the end of 2007, such as when deputy health minister Nozizwe Madlala-Routledge -- who played a big role in the development of the NSP -- was fired, sparked fears that politics could see the AIDS plan backslide.

"We all had a space last year around the deputy minister of health being fired. We all became very anxious and probably quite depressed," said Hunt.

"If government starts losing momentum civil society has to keep up the pressure."

One of the other successes has been the recent release, after many delays, of new guidelines allowing for the use of dual therapy to treat pregnant women before going into labour and their newborn babies, shown to drastically decrease chances of the HI virus being passed from mother to child.

There was an outcry when government in February charged a rural doctor, Colin Pfaff, for misconduct, when he raised donations to provide dual therapy before the protocols were officially implemented.

Gaede said it was "absurd", and added that comments by a local government minister that antiretroviral drug AZT, used in dual therapy, was toxic showed "lots of people are still completely in the way."

While many areas of the NSP still had a way to go, such as getting more people to test and improving prevention messages, Hunt said the work that had been done was inspiring.

"Although sometimes it's shaky, it's inspiring to see the plans that are been made. We are still speaking the same message.

A new, viral web site conceived by U.S. college students challenges stereotypes about who might be infected with HIV using a model pioneered by a campaign to raise awareness about Darfur.

The site, www.PosorNot.com, was unveiled on Wednesday by mtvU, the Kaiser Family Foundation and POZ Magazine and presents viewers with photos of people of different ages, colors and genders, challenging them to guess whether the person has tested positive for the virus that causes AIDS.

mtvU is MTV's Emmy Award winning college network.

A number of celebrities are supporting the educational campaign including Wyclef Jean, Fall Out Boy, Will.i.am, Alyssa Milano, Say Anything, Angels & Airwaves, Atmosphere, The Spill Canvas, 30 Seconds to Mars, Aesop Rock, Motion City Soundtrack, All Time Low and Rise Against.

The site is considered viral because users can share it with everyone in their e-mail address books with a few clicks.

It was inspired by a nationwide competition asking college students to propose a viral, web-based game on the topic.

"Pos or Not" follows "Darfur is Dying" (www.DarfurisDying.com), another MTV student-developed videogame that has been played more than three million times by 1.5 million people, the groups behind "Pos or Not" said in a news release.