The fear of prosecution is one of the reasons why the LGBTI&Q community do not avail of the health services

Health: Almost three years since the HIV/AIDS prevention programme was launched to sensitize the third gender community in the country, not many have come forward to avail the service.

To date, only 20 people have come forward to become active members of the programme with Lhak-Sam, network of HIV positive people. The service is rendered to the LGBTI&Q community through Lhak-Sam. Another eight members are active but are yet to disclose their status.

Health workers said the Lesbian Gay Bisexual Transgender Intersex and Queer (LGBTI&Q) are 18 times more vulnerable to sexually transmitted infections than straight people.

Although it is not known how many of the 403 HIV positive people in the country belong to the community, Bhutan cannot afford to neglect the issue going by the regional prevalence where infections are high.

Assistant programme officer with the National STI and HIV/AIDS control programme, Jigme Thinley said the current programme is the only means to reach the LGBTI&Q community and sensitize them on the health issues.

However, its difficult to built a network with the community. In 2010 when the Multi-Country South Asia Global Fund HIV programme initially began, only about four gays and six transgender (TG) could be reached.

After Lhak-Sam took charge of the programme since 2013, the number of members increased. Yet it is not enough to make the programme have an impact on the community.

Main activities for the phase II (2013-2015) was to built capacity of health workers to cater to male sexual health, hold high level advocacy meeting with focus on equitable access to services, decriminalization, stigma and discrimination. Building strategic information through a formative assessment for integrated Biological Behavioral Surveillance was also among the main activities.

Jigme Thinley said, despite knowing about the programme, gender diverse people feared prosecution because of the legal barrier to avail the service.

Section 213 of the Penal Code of Bhutan states, “A defendant shall be guilty of the offence of unnatural sex, if the defendant engages in sodomy or any other sexual conduct that is against the order of nature.”  The grading of the crime shall be a petty misdemeanor.

Also, an assessment on stigma and discrimination impacting universal access to HIV and health services for MSM and transgender (TG) people in Bhutan by the health ministry in May 2013 found a significant level of homophobia, misconception about homosexuality, and layered stigma among health care providers.

To clear these misconceptions, the health ministry trained 13 lecturers and doctors on STI syndrome management, who will further train another 60 health workers. The health workers would then re-orient another 600 on STI management and sensitize on sexuality and & sexual orientation by July next year.

Another 14 peer educators were trained and are currently working with Lhak-Sam.

To empower the community, member of the LGBTI&Q community were recently sent to Nepal on an exchange programme. It was after the visit that a MSM (Men who have sex with men) came out of the closet.

The 20 active members working with Lhak-Sam meet regularly to mobilize discussions around issues affecting MSM and TG in Bhutan and also to identify more peer educators.

Jigme Thinley said, because of the strong religious belief in the country, involving the monk body to create awareness and stigma reduction toward the community is expected to have a greater impact.  For that about 13 senior monks have already been trained and 50 more will be trained by the end of next month. Similarly another 400 are expected to complete training by July next year.

“The unknown size of gender diverse people and their poor networking is a big challenge for us in getting to them,” he said.

Jigme Thinley added that although few studies were carried out to estimate the third gender population in Bhutan, the figures were irrational and was not accepted.

Meanwhile, programme manager with Lhak-Sam, Tshewang Lhamo said despite having less member actively involved in the programme, it is assumed that the active members are reaching out to the ones in the hiding.

She said it was learnt that most MSM and gay are married and that was the main reason that kept them in hiding and from availing service from the programme.

“Judging by their networking, we assume that the awareness level is effective,” she said.

To allow the gender diverse people in availing other health facilities, the health ministry has found the need to revise the existing STI guideline, which includes only MSMs in the gender orientation category.

By Nirmala Pokhrel