Nima Wangdi 

Bhutan is already geared up to achieve the national goal of ending HIV endemic by 2030.

The national goal is set at 95-100-95 and it is slightly different from UNAIDS’s goal of 95-95-95, which mandates the country to diagnose 95 percent of the estimated positive cases in the country, treat all the 95 percent diagnosed cases on treatment and achieve 95 percent of viral suppression.

Bhutan’s goal, however, is to diagnose 95 percent of the estimated 1,300 HIV positive cases, treat all the patients and achieve 95 percent of viral suppression.

This was discussed during the showcase forum on the sustainability of HIV Services for Key Populations in Asia (SKPA) programme on June 7 in Thimphu.

Key partners, the National HIV or Hepatitis and STIs Control Programme (NACP) under the Ministry of Health, Pride Bhutan, Lhak-Sam, Chithuen Phendey Association, and Queer Voices of Bhutan presented their achievements and the work progress.

Officials attending the meeting said that Bhutan has 795 HIV positive cases so far and there is 39 percent of case detection gap against the estimated 1,300 cases.

He said as the country detects more cases, the case detection gap would narrow.

The programme manager of NACP, Lekey Khandu, said of the three components in the target, the country is facing challenges in achieving the first 95, that is to diagnose 95 percent of the estimated case number. “We are doing fairly good in the second and third targets with treatment coverage of 97 percent and viral suppression more than 95 percent.”

According to him, Bhutan has been able to set the goal of treating all the diagnosed cases because of the “Treat All” policy. “Any person living with HIV will be treated irrespective of their cd4 count.”

He said there was a threshold of cd4 count to qualify for the treatment before. “It increased from 200 to 350 to 500 periodically. Today, there is no threshold and everybody is given treatment the moment they are diagnosed.”

Lekey Khandu said the ultimate aim of having the treat all policy is to take advantage of treatment as prevention.

He said if people diagnosed with HIV are put on treatment and if their HIV virus counts decrease below 1,000 copies per envelope blood means they achieved viral suppression.

“This will help them improve the quality of their lives helping them live long like any other uninfected people and also make sure that they don’t transmit the virus even if they don’t use condoms,” he said.

Leki Khandu also said they are now trying to implement differentiated HIV testing services like strengthening their facility-based testing services. “We are also instituting the provider initiative HIV testing services for all the units in the hospital. All the service providing units in the hospital will have the facility to test HIV.”

Mobile van testing service, community-based testing services, and targeted community outreach activities (peer outreach workers for MSM and transgender) have also been initiated to detect more cases.

The officiating director of Department of Public Health, Rixin Jamtsho said the country has worked hard towards achieving the goal but needs to work harder.

He said stigmatisation and discrimination is one of the main challenges, which need to be addressed. “Going by our Covid-19 experience, it is possible to fight against any disease if we worked in the way did for Covid-19.”

Meanwhile, NACP and Save the Children organised the meeting.

Save the Children’s senior health programme manager, Tashi Dendup, said the SKPA is committed to promoting sustainable HIV and related services for key populations at scale to stop HIV transmissions and AIDS-related deaths by 2030.

He said through the SKPA programme, they want to ensure that key population community members have access to sustainable HIV and related health services by providing practical support and assistance in close collaboration with all the stakeholders.