| Kinzang Namgay, Thimphu
1993 may be remembered for many reasons. From the prism of health, it is remembered as the year when the first HIV/AIDs case was detected in Bhutan. This may not have shaken the people, most of whom were not really aware of the menace, that time. Slowly, the virus became a subject talked, debated and deliberated.
The roles played by His Majesty the Fourth Druk Gyalpo and Her Majesty, Queen Mother Sangay Choden Wangchuck in our fight against HIV/AIDs is unparalleled. While His Majesty issued a royal edict about HIV/AIDs, since becoming the UNFPA goodwill ambassador, Her Majesty has made HIV/AIDs a personal fight. She has been to every nook and corner of the country advocating and educating. Multi-Sectoral Task Forces were formed and the National HIV/AIDs Commission established. A nonprofit organization, Lhak-sam is actively working to prevent, and take care of those affected with HIV/AIDs.
However, observing the World AIDs Day on December 1, 2017, we were told that in the last six months alone, 22 new cases were detected. From 1 in 1993, the number has reached 570. Is it an indication that we are losing the battle? Or is the increasing number because of the fact that more people are being tested? These are difficult questions.
In terms of advocacy, it could be claimed that the message has reached several people, especially those very vulnerable. And the dissemination continues. Above all, almost everyone seems to understand that the virus can be transmitted only through blood transfusion; unprotected sex and sharing syringes amongst drug abusers. This is important, as stigmatization cannot be contained without diffusion of these core messages.
The use and need for using condoms has seeped into the dark alleys of urban Bhutan. At the capital here, commercial sex workers and those with multiple partners are very conscious. In the words of a reporter, even girlfriends “refuse” to indulge in sex without a condom. “I took her on a long drive. But when I solicited sex, she asked if I was carrying a condom. I did not have one and I had to drop her home,” he said.
A 19-year-old commercial sex worker says she does not forget to carry at-least four condoms. “We are like taxis. Sometimes, we get three to four clients, and none at other times. Occasionally, I come across clients who do not carry condoms. And sometimes, clients come with just one condom,” she mentioned. According to her, the possibility of getting the virus through unprotected sex is the highest. “Blood transfusions are conducted in hospitals, where health workers will check for the virus. Drug abusers resorting to the use of syringes in Bhutan is low. So, unprotected sex becomes the main cause.”
A businessman who admits “sleeping around” says that “accountability for catching the virus” falls on both the partners. “And I have noticed that women are now accepting this. They carry condoms and force us to use it, though I do not enjoy using it. Some even tell me to be careful and not to take risks.” This, he says, indicates that women now cannot say that they were infected by their partners. “The same applies to us. Every individual should take responsibility. If you are unaware about the virus, it is a different story. But in Bhutan, I think everyone now knows about it.”
Meanwhile, we are informed that from the 570 cases, 130 are housewives and 115 farmers. Of the 22 new cases, housewives and farmers are among the infected groups with eight cases each. This indicates that the virus is not a predominantly urban phenomenon, with those travelling beyond Bhutan acting as agents. This was what many thought and continue to do so. If the above two groups emerge as the most vulnerable, measures to address this should be adopted.
The health ministry’s studies show that young age sexuality, multiple sexual practices, low-risk perception, sex under the influence of alcohol, increased mobility, and low condom use are some of the key factors contributing to acquisition and transmission of HIV here. Through this we can surmise that advocacy is still the magic bullet. And its importance is augmented as those at high risk appear to be farmers and housewives.
We also ought to appreciate and acknowledge the likes of Lhak-sam’s Executive Director, Wangda Dorji, who was one of the first to go public with his status. On December 1, 2017, we saw Tashi Pelzom, 35, a health worker from Dewathang, Samdrup Jongkhar and Lhosem Zangmo, 34, from Shumar, Pemagatshel going public with their status.
They are not doing this for media attention or other reasons. They are doing it with the hope that others may not contact the virus like they did. They are telling their stories to ensure that others do not have tell similar stories.
They want to change the HIV/AIDs narrative. And together, we can do it.