The Bhutanese Leading the way.
HIV/AIDS is still treated as a taboo in the country, and people living with HIV (PLHIV) are stigmatized and discriminated against, which is why a very few people go to health centers for HIV tests. So, in order to make it convenient for the people, the Ministry of Health (MoH) introduced the HIV self-test kit in six districts.
HIV self-test (or rapid self-test) is an antibody test that can be used at home or in a private location. The only FDA-approved HIV self-test is an oral fluid test. With an HIV self-test, individuals can get their test results within 20 minutes.
For an HIV self-test, the individual must swab their gums to collect the oral fluid sample and then test their sample.
An official from MoH shared that more than the social stigma, individuals have self-stigma which can lead to feelings of shame, fear of disclosure, isolation, and despair, as unlike other diseases, HIV has stigma and discrimination attached to it. And people don’t usually come to health centers for HIV tests. That is why the ministry is giving the option to those people. It is similar to a pregnancy test kit.
People can go to health centers to get the HIV self-test kit or they can do the test assisted and unassisted. For instance, in assisted, the health worker will help them do the test. There is also the choice of doing the test at home, and informing the health worker about the test result and getting the right care and treatment for it.
However, the HIV self-test kit is a rapid test kit, and it does not mean that if the test is reactive then the particular person is HIV positive, so therefore, there is a confirmatory test, called the ELISA test. ELISA stands for enzyme-linked immunoassay to detect antibodies in the blood.
Out of 10 reactive tests, maybe one or two will be HIV positive. Usually, individuals who have done a rapid test for HIV may not be positive, said the official.
In 2021, the ministry has done a self-demonstration project for the key population and the vulnerable population to see the feasibility of HIV self-testing in Bhutan and it was a success since people are coming forward.
Based on the findings of the self-demonstration project, the HIV self-testing kit was rolled out in six priority districts mainly looking at the key population and the vulnerable population. However, the official said that testing those groups does not mean that they are undermined since HIV is a sensitive issue and one has to be mindful of it.
“We are still yet to do the evaluation for HIV self-test where we will know which groups have taken the HIV self-test kit or the age category or the area wise then the ministry can plan on rolling out the kit in the remaining districts in phase wise,” said the official.
The challenge that they are facing right now is the shortage of human resource, which is why they are not able to complete the evaluation of the HIV self-test kit, said the official.
The HIV self-test kit is effective, and in terms of taking up HIV self-test kit, people are taking up and providing positive feedback.
MoH has also advocated for the HIV self-test kits to the local pharmacies, and also discussed if they could also supply if interested so that people can purchase the test kit from the local pharmacies in the country. There is dual testing for pregnant mothers as well.
The official also said that more people are coming for HIV tests, and the numbers have also increased compared to the past. Earlier about 80,000 people come for tests in a year, but now more than 130,000 people test within a year.
Meanwhile, MoH will be doing a Stigma Index Study, a first study of its kind to learn about the level of stigma. “We know that there is stigma and discrimination, but we don’t have any data for now unlike the key population, where we have the data,” said the official.
