At least five people are detected positive for HIV every month in the country. Yet, the prevalence of the infection is considered low compared with countries in the region.
Comparisons are important but not to the extent that it skews the context and understanding of the disease burden. Records with the health ministry do not indicate low prevalence. It indicates low detection.
By UNAIDS estimates, Bhutan is expected to detect 1,100 cases by today. But since the first case in 1993, the country has detected 570 to date, leaving a case detection gap of about 48 percent. That almost half of the cases remain undetected is a matter of public health concern.
This indicates that advocacy efforts made to educate the public on HIV are not reaching them or are ignored given the stigma attached to the infection. The ministry and Lhak-sam, the network of people living with HIV/AIDS, must target its audience and gain their confidence to persuade them to get tested.
About 10 percent or 40 HIV positives are not complying and defaulting on their treatments. The health ministry must take the lead in re-educating a literate society and go beyond observing World AIDS Day.
Figures show that housewives and farmers top the list of HIV positives among occupational groups. Of the 570 cases, 130 are housewives and 115 farmers. That about 44 percent of HIV positives are from informal occupational groups suggests that they are among the vulnerable population most prone to HIV infection. This group must not fall on the blind spot of advocacy programmes.
It was also found that females are exposed to HIV at a younger age than men.
At the time of detection, a majority of men are in the age group of 30-40 years, while females are in the 15-29 years age group. This highlights the need for our education system to stress on the importance of sex education. Young age sexuality is among the key factors that contribute to acquisition and transmission of HIV in Bhutan.
Other factors include multiple sexual practices, low-risk perception, sex under the influence of alcohol, increased mobility, and low condom use.
While the issue problematises private moments of the public, the public health risk of unsafe sex cannot be undermined. After 24 years and 570 cases later, the society must accept that we have not done enough to change the behaviour. We must accept that there are still many people who do not know enough or care to know enough about HIV infection. And it is this behaviour that has caused those living with HIV face prejudice and discrimination, which is one of the main reasons that keep people from getting tested.
This cycle must be broken. Against this situation, we are told that HIV infection from mother to child has reduced drastically with zero cases in recent times. This is a significant achievement for the health sector and it must ensure that Bhutan is able to maintain this status.
But there is more to do. If the society still fears the infection, we have normalised fear. Not done better.
Kuensel, December 4, 2017