Social stigma and discrimination, greatest challenge for People Living with HIV and Key Populations

Globally there are 37.7 million People Living with HIV (PLHIV), and in Bhutan there are 795 PLHIV of which 414 are male and 381 are female. Bhutan detected 55 HIV cases each in 2019 and 2020, and the case detection came down to 44 cases, a decrease by 9 cases, in 2021.

From the detected positive cases, the highest number of cases are seen in housewives at 188 cases, followed by farmers with 176 cases. There are 40 minors who were infected. Likewise, there are unemployed, prisoners, students/trainees, SWs, religious body, armed forces, private/ business, civil servants, minor, local government, corporate employees and drivers who are HIV positive.

The record shows a total death of 164. The maximum cases are detected in the border districts of Chukha, Sarpang and Samdrupjongkhar. In addition, cases are also detected in Thimphu.

HIV/AIDS continues to remain as a major public health threat in many parts of the world, especially in Africa and Asia-Pacific. HIV/AIDS is increasingly becoming more of a social issue rather than a disease-specific issue.

The Ministry of Health’s goal is to achieve 90-100-90 national targets for HIV response by 2020, and continue through the planning period, towards ending of the HIV epidemic by 2030.

In addition, the Key Populations (KPs) are at risk of contracting and transmitting HIV in the community. KPs are Men having Sex with Men, Sex Workers, Transgender, Drug Users and PLHIV.

The Executive Director of Lhaksam, Wangda Dorji, highlighted that with time, the acceptance from the society is increasing, which is a good thing to see, however, the issue of discrimination and stigmatization still exist.

In the beginning, he said, “The PLHIV were forced to leave their homes. We were treated as a threat to other lives, got neglected and some got kicked out from their jobs, but with more of advocacy and media engagement programs, we are now being accepted as who we are. Nevertheless, there is more we can do to make KPs an inclusive society.”

Everything is going great for now, however there are numerous associated challenges,

like issues of human resources, lack of collaboration and coordination, funding issues and challenges in terms of not getting the projects, he added.

The greatest challenge they still have is discrimination and stigmatization, he said, adding that these are two things which are more dangerous than the disease, itself. It is understandable to see illiterate people discriminating the KPs but it is disheartening to see highly educated people not wanting to support them, he further added.

Though they see a behavioral change towards them there is still a fear in general population.

Meanwhile, he said, though their target is to eliminate the HIV/AIDS by 2030 , it would be difficult to achieve it as it is a big aim. He said, “In 28 years, Bhutan has 795 positive cases detected, and if we are to detect another 600 cases, it might probably take more than 15 years. So, the doable is questionable.”

Moreover, he said that they would need sufficient budget and enough resources HIV/AIDS by 2030, they will have to build a capacity.  

They would need support from the policy maker, and likewise, there is lot more they will have to look at, which is why they will find it difficult to meet their target. However, they will try to achieve the target, he added.

Every year, on average the case detection is 50 to 60 percent.

As a prevention measures, they have counseling and testing services, awareness, behavioral change communication, condom promotion, STI treatment and resource mobilization.  

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