Transgender people, sex workers, men who have sex with men (MSM) and drug users are considered as Key Populations (KP) groups as they are particularly vulnerable to Human Immunodeficiency Virus (HIV) and lack adequate access to health and social services. KPs are also sometimes referred to as ‘at-risk groups’.
KPs usually remain highly hidden due to discrimination and stigmatization from family and society as a whole. Due to stigmatization and legal barriers, they tend to experience mental health problems and high level of stress that sometimes lead to drug and alcohol dependency.
On average, as per the study conducted globally, MSMs are 27 times more likely to acquire HIV than the general population, sex workers are 13 times more likely to become infected with HIV than adults in the general population and transgender are 49 times more likely to be living with HIV.
Deyon Phuntsho, Program Manager with Lhak-Sam shared, “In every setting, KPs are disproportionately affected by HIV, and have higher morbidity and mortality rates than the general population. Most of the KPs use alcohol and drugs as a coping mechanism.”
MSM are referred to a male person who engages in sexual activity with the same sex. Bhutan’s religion considers men having sex with men as immoral and unnatural and regards such persons as mentally sick.
Criminalization of sex workers in many countries drive the KPs underground, he said, adding that sex is illegal by law, hence, sex workers are not known and cannot be reached to provide health services although they are considered at risk of contracting and transmitting HIV.
Transgender people experience high levels of stigma, discrimination, gender- based violence and abuse. They are also more likely to have dropped out of school, leading to discrimination at workplace given educational and employment opportunities.
Transgender refers to people whose gender identity and expressions are different to their biological sex at birth.
He said, “Despite the increased risk of contracting HIV for people who use drugs, they are among those with the least access to HIV prevention, treatment and healthcare. They are considered not deserving and they are looked down by health workers for which they do not avail health services.”
People living with HIV are usually isolated and depend on health workers to discuss their problems. With all issues, it is difficult for them to disclose their status.
Though HIV no longer means certain death due to the tremendous advancement made in science and medication, stigma and discrimination continue to remain exceedingly high among the general population, he added.
Stigma has become more dangerous than HIV itself where stigma deters access to HIV testing and treatment services, making onwards transmission more likely, he added.
Meanwhile, 49-year-old Samten is living with HIV. She was detected to be HIV positive in 2015. She has two school going children, and despite the hardship she is facing right now, none of her family members, including her own siblings, have come forward to help her. She is rather black listed by them.
She said, “It is disheartening to see that I can’t visit my 84-year-old father because he is influenced by my sister. Even to send a parcel to my father, I do it through my daughter as I have the fear that he may not accept if he knows I have sent it. I stopped visiting my village due to stigmatization.”
Discrimination is everywhere, she said, adding that no one is ready to accept people like her anywhere, even though she has the strength to do all kinds of manual work. She went everywhere but rejection was all she got just because she is HIV positive.
She does not bother about what is said about her, however, her only worry is her children’s careers, which she thinks would be ruined because of her. “I am fine being looked down upon, but I can’t see my children being dragged down because of me. I have faced numerous challenges, I cried for months and was into alcohol, but I wanted to live for my children,” she added.
Nothing positive can be expected from the society as a whole, but there are some people who understand them and help them, she said. She is working as a gardener and all she expects from the society is acceptance and equal treatment, irrespective of the HIV status.
Ogo Dorji is a 25-year-old transman, He underwent a lot of hardship since his school days as he did not get equal treatment from the school management, and this is the reason why many transgender people are school dropouts.
He said, “Getting accepted by the society was one challenge, however, we (transgender people) managed to overcome and got accepted, though not at a larger scale. In school, we were forced to keep long hair, forced to wear girls shoe and discrimination went to the extent that our school management made us perform Pa-Cham in one of the school functions.”
Transgender would go and use the washroom when no one is around due to the excessive teasing. They would choose not to go to the hospital as health staff would make fun of their gender identity.
He shared that his family supports him, which is the reason why he has the confidence to face the harsh reality.
He said, “We want to study, like any other student, but we are indirectly forced to leave our education half way. Education starts from school, however, in terms of acceptance, I think education system is lacking behind.”
He has managed to overcome all the challenges and now leads a normal life. He feels that the perception of the people towards KPs is changing with time, but still there is room for improvement so all kinds of people can coexist harmoniously.