Since the first detection of HIV in Bhutan in 1993, sporadic cases have been emerging with an average detection of 60 – 65 new cases every year. So far, 835 cases have been detected, out of which 171 died of AIDS-related complications. 

The UNAIDS estimate that the total HIV cases in Bhutan can be around 1350. Every year once new cases a compiled, it is near UNAIDS estimate narrowing a case detection gap every year. Looking at the current trend of Voluntary Counselling and Testing, it will take at least 10 years to close the case detection gap of 1350.  

However, with no robust HIV prevention intervention in place a reverse worst case scenario might occur. 

Ending Stigma and Discrimination Against People Living with HIV

In addition to the serious health issues they face, people living with HIV may often experience stigma and discrimination because of their HIV status. Stigma is an attitude of disapproval and discontent towards an individual or group from other individuals or institutions because of the presence of an attribute perceived as undesirable. Discrimination is often a consequence of stigma, occurring when unfair actions are taken against individuals on the basis of their belonging to a particular stigmatized group.

Stigma and Discrimination: Complex Barriers to Health Care

HIV stigma and discrimination can pose complex barriers to prevention, testing, treatment, and support for people living with or at risk for HIV. Some examples of stigma include being shunned by family, peers, and the wider community; receiving poor treatment in health care and education settings; and experiencing judgmental attitudes, insults, or harassment. Some individuals with HIV have been denied or lost employment, housing, and other services; prevented from receiving health care; denied access to educational and training programs; and have been victims of violence and hate crimes. HIV-related stigma and discrimination prevents individuals from learning their HIV status, disclosing their status even to family members and sexual partners, and/or accessing medical care and treatment, weakening their ability to protect themselves from getting or transmitting HIV, and to stay healthy. HIV-related stigma is made more complicated when individuals also experience stigma related to substance use, mental health, sexual orientation, gender identity, race/ethnicity, or sex work.

Experienced stigma and discrimination

As per the Quality of Life PLHIV study Report carried out by Lhak-Sam 2022

Discriminatory attitudes towards people living with HIV remain alarmingly common across all regions, despite decades of advocacy and education. Study also confirms that in 34 of 55 countries with general population survey data in 2017-2021, more than 50% of people surveyed reported discrimina-tory attitudes towards PLHIV. The goal of Zero discrimination still eludes the world. In 25 of 36 countries with recent data, more than 50% of people aged 15-49 years displayed discriminatory attitudes toward PLHIV.

In the present PLHIV STUDY 1, two items were used to assess whether the participants have experienced stigma and discrimination or not. In response to the statement “ In the last 12 months, how often have you been excluded from social gatherings or activities?”, 89.1% (n=212) participants have never been excluded from social gatherings or activities. Around 11% reported having being excluded from social gatherings or activities

FGD on Stigma and Discrimination

When discussing stigma and discrimination, they reported that they don’t ever disclose their HIV status to anyone in the first place unless very necessary to avoid unnecessary harassment, stigma, and discrimination. Most of them have many stories and anecdotes of stigma and discrimination to be shared. One respondent expounded, “My sister and her husband knew about our HIV status when I got sick. Her husband would make us eat using different plates thinking that they’d contract the disease from us by sharing plates”.

Another participant said, “When my husband became seriously ill, I told his brother about my husband’s HIV status, who in turn got the word out and spread the gossip to others. And it was during that time that we faced severe discrimination. His brother’s family wouldn’t let our kids mix with theirs and would always give us separate plates, cups, and spoons to use”.

And yet in another incident, a doctor in JDWNRH refused to check a referred case on the pretext of missing documents and information. “After reaching Thimphu, we were not treated well. Instead of helping us, the doctor scolded us for not having all the letters and would not check the patient” reported one of the participants.

In another bizarre incident in a remote area, the health assistant of the local BHU disclosed his HIV status to the project manager who terminated him from the project.

Those handful of people who had not faced any stigma or discrimination were due to the fact they did not disclose their HIV status to anyone. On a hopeful note, one participant said, “Back then things were different because the disease was new, and people didn’t know much about it. And then, there were too many scary advertisements on HIV/AIDS. But now everybody knows about it and people don’t stigmatize it. We are all treated the same”