The United Nation Development Program (UNDP) initiated a municipal review report on HIV and rights programs for men who have sex with men and transgender people in Thimphu from 2014-2015.
The recently launched report is expected to prioritise support for key populations, such as people who use drugs, sex workers, men who have sex with men and transgender people to reduce risk and vulnerability to HIV in urban settings, thus aiding in informing and strengthening Thimphu’s municipal HIV and rights responses.
The program was conducted by UNDP in collaboration with the Ministry of Health and other relevant stakeholders.
According to the Ministry of Health there are an estimated 1,000 people living with HIV in Bhutan and 460 cumulative reported cases since 1993 where about 53 percent of HIV cases have been detected in the under 30 age group. The majority of the cases of HIV have been reported from Thimphu, Chukha, Sarpang, Wangdue Phodrang and Samdrup Jongkhar.
Through the UNDP mapping and size estimation of forthcoming individuals, it is estimated that 9,105 men have sex with men in Bhutan. The population of transgender people was still not available.
“Regional and global research demonstrates that HIV risk and vulnerability can be exacerbated by the mobility of populations and changing social norms in urban settings. The need for increased information and research in the cities of Bhutan is imperative given the steady rate of urbanisation in the country,” stated the Health Secretary, Dr. Ugen Dophu. He also said that with the increasing trend of rural urban migration, there is a need for health interventions to be prioritized, considering the growing vulnerabilities and increasing risk to HIV among men who have sex with men and transgender people.
The report also states that the transgender women who’ve been surveyed responded they only have sex with men and that they were economically challenged with lower literacy levels. “In contrast, men who have sex with men reported having higher levels of education and better socioeconomic circumstances compared to transgender people. They were less likely to disclose their same-sex behavior to others and reported having sex with women, as well as with men.
Meetings between men took place in streets, parks, cafés and other types of venues such as monasteries, prisons and places where uniformed personnel congregate,” states the report.
However, respondents expressed that such discussions still remained highly sensitive and felt that any more public emphasis through awareness or health campaigns could in turn instigate abomination from society.
To achieve the intended mission of the health ministry and its stakeholders, they instead recommended including HIV services and rights for men who have sex with men and transgender people in general health and hygiene education programs.
The review of the legal and socio-cultural situation in Bhutan highlights the need to improve health-seeking behaviors by creating a supportive, and more enabling environment. According to the report, although Article 213 of Bhutan’s Penal Code criminalizes sodomy, there has been no documented prosecution of men who have sex with men till date.
The Ministry of Health and the Royal Institute of Health Sciences recently established a supplementary service for newly diagnosed individuals with HIV, including men who have sex with men and transgender people to bridge the gap between HIV diagnosis and enrolment in HIV clinical care. It is said that the Ministry of Health is negotiating with Lhak-Sam, a civil society organisation, to provide care and support that can be integrated into this service.
The report, which was Thimphu based with an estimated population of 125,724, is expected to be relevant to government ministries and departments as well as municipal programmers in Thimphu.
The report will also be useful to regional and international agencies including the United Nations and other development organizations operating in Bhutan to improve the health and human rights of men who have sex with men and transgender people. Emerging community-based groups in Thimphu will also find the report useful for project planning and developing evidence-informed ideas for future projects and activities.