The Bhutanese Leading the way.
The Sustainability of HIV Services for Key Populations in South East Asia Program, a collaborative effort between Save the Children Bhutan and the Bhutan Media Foundation, brought together health officials to discuss progress and strategies in addressing HIV and other sexually transmitted infections (STIs).
Bhutan’s HIV program, established in 1988, has achieved significant milestones, including the introduction of antiretroviral therapy (ART) in 2004, comprehensive voluntary counseling and testing (VCT) services in 2006, and more recently, the implementation of the Access2care App and sentinel surveillance sites.
However, the focus remains on achieving ambitious targets, such as a 90% reduction in new HIV infections by 2030 and eliminating mother-to-child transmission of HIV, syphilis, and hepatitis B by the same year.
Nevertheless, the challenges noted is in reaching 95-100-95 targets—95% diagnosed, 100% treated, and 95% viral suppression. Health officials at the workshop presented data on HIV cases in Bhutan from 1993 to June 2024.
The report highlighted trends in recent years, with 67 cases detected in 2022, 61 in 2023, and 45 reported by mid-2024 itself. Since the first HIV case was identified, Thimphu has recorded the highest number of infections, with 245 cases, while Haa and Trashiyangtse remain free of reported cases.
Occupational data revealed that farmers represent the highest number of HIV detections at the time of diagnosis, pointing to rural communities as a critical focus for intervention.
Health officials emphasized the need for targeted awareness and testing campaigns to address these disparities, aiming to strengthen Bhutan’s efforts toward eliminating HIV by 2030
Stigma and discrimination against key populations (KPs) and those living with HIV continue to hinder progress, as does the low voluntary uptake of testing services. These issues are compounded by barriers extending beyond the health sector.
The workshop emphasized a multi-pronged approach to overcome these challenges, including the introduction of pre-exposure prophylaxis (PrEP), routine testing for high-risk groups, enhanced screening for pregnant mothers, and advocacy to combat misconceptions.
Bhutan is in the process of adopting pre-exposure prophylaxis (PrEP) as part of its multi-pronged strategy to combat HIV. PrEP, a preventive measure using antiretroviral drugs, has shown to reduce the risk of HIV by 99% when used as prescribed, making it a vital tool in prevention efforts.
PrEP is a preventive treatment for individuals who are HIV-negative but at high risk of contracting the virus, including key populations (KPs) such as men who have sex with men, transgender individuals, people in serodiscordant relationships (one partner is HIV-positive), and those who engage in high-risk behaviors like unprotected sex or sharing needles. . When used as prescribed, PrEP can lower the risk of HIV transmission through sexual activity by up to 99% and by 74% for people who inject drugs.
It is also suggested for people whose sexual partners belong to high-prevalence groups or who are unsure of their partner’s HIV status. To be effective, PrEP must be taken consistently as directed by a healthcare provider. Daily use is most common, but alternative dosing strategies may be considered based on individual circumstances.
Regular follow-ups, including HIV testing and monitoring for potential side effects, are essential to ensure PrEP’s effectiveness and safety.
Globally, PrEP adoption is on the rise, with 144 countries implementing its use by 2021 and 14 more expected to follow suit in the next two years. However, misconceptions remain, such as the belief that PrEP is a cure for HIV or only for those already infected.
The aim is toward achieving zero stigma and discrimination by 2025, enhanced awareness campaigns and need for sustained collaboration and innovation to meet Bhutan’s 2030 HIV and STI elimination goals. Stigmatising individuals living with HIV or those in high-risk groups only perpetuates fear and prevents people from seeking the care they need. Everyone, regardless of their HIV status, deserves dignity, respect, and the right to live a healthy life.
Controlling the spread of HIV requires a collective effort from both health authorities and the community. It is essential to promote regular testing, treatment access, and safe sex practices, including consistent condom use, to reduce the transmission of the virus.
Encouraging routine HIV screenings and fostering an environment where individuals feel empowered to seek care will be vital in achieving the goal of eliminating new infections by 2030.
