Numerous factors that are often intertwined such as low socioeconomic status, hidden nature, low societal acceptance, risky behaviours, stigma, violence, and difficulties in accessing health service heightens the HIV risk of key populations (KPs). In Bhutan, the engagement of KPs in HIV response and KP-targeted programming is limited. Most related programs are funded through non-domestic sources. To promote sustainable services for KPs at scale to stop HIV transmission and AIDS-related deaths by 2030, Bhutan Country Office as a sub recipient is implementing the Global Fund’s multi-country Sustainability of HIV Services for Key Populations in Asia (SKPA) Program. The program is designed to strengthen strategic information and community systems, mitigate service delivery gaps, increase financial sustainability, and support enabling environment. The implementing partners include the National HIV/AIDS and STIs Control Programme (NACP), and three KP Organizations (KPOs) namely Lhak-Sam, Pride Bhutan, and Chithuen Phendhey Association.
One of the main achievements of this program is the successful implementation of the community-based HIV Self-Testing (HIVST) demonstration project among key and vulnerable population groups in the country. The findings showed high acceptability of HIVST and recommended scale-up of HIVST. The NACP is planning to scale up this innovative approach initially in six priority districts in SKPA 2 Program. The expansion is expected to enhance access and uptake of HIV testing that can potentially contribute towards bridging the current case detection gap. Similarly, an interactive web-based application was designed to facilitate the booking of HIV testing and link users to key services, and help users assess their HIV risk.
A comprehensive advocacy strategy that can help reduce stigma and discrimination faced by the KPs was developed and some key advocacy interventions were undertaken in 2021. Twenty-one participants from the KPOs attended a legal literacy training that was aimed to empower the KPs of their legal rights and means to seek legal protection and secure equality in life. Additionally, in order to raise the understanding of the health workers on the needs and priorities of KPs, around 42 health workers (medical doctors, nurses, voluntary counseling and testing (VCT) focal, health counsellors) from the health facilities across the country were sensitized on Sexual Orientation, Gender Identity and Expression and Sex Characteristics (SOGIESC), HIV and related issues, high-risk women groups, substance abuse and related issues, and stigma and discrimination faced by KPs. Furthermore, 15 media persons from various media houses attended a media advocacy training intended to build capacity in correct and ethical reporting of HIV and SOGIESC that also helped raise interest and strengthen collaboration needed to highlight issues on HIV and SOGIESC. Awareness messages aimed to increase issues and needs of KPOs were also disseminated through radio and TV spots, communication materials, and other social media platforms.
Considering the increased vulnerability of KPs in developing mental illnesses, around 22 participants from KPOs were trained on Basic Mental Health and Counselling. The training emphasized on equipping the participants with basic knowledge and skills that can help them identify common signs and symptoms of some mental illnesses, provide basic management including counselling and psychological first aid, and link those in need with health services. Eighteen children living with and affected by HIV attended a five-day long HIV Treatment Literacy training. Through this program, children learned how to take care of themselves and their parent’s health and were taught about treatment adherence, safe sexual practices, nutrition, confidentiality, and VCT. Moreover, 22 participants including health counsellors, outreach workers, and members and staff of KPOs were trained on the revised service package for KP and HIVST protocol.
The organizational capacity and institutional needs of KPOs were assessed and most of the recommended capacity building and institutional strengthening interventions were undertaken. For instance, 34 participants from KPOs were trained on project management and proposal writing. The policy documents of KPOs such as governance and human resource policies, were developed and/or revised. The country office also supported Pride Bhutan in its CSO registration process. Pride Bhutan has submitted its application to the Civil Society Organization Authority (CSOA) and is currently awaiting for approval. Finally, community-based monitoring aimed to assess HIV service quality was implemented for the first time in the country. Similarly, the program also supported the development of the community feedback mechanism which can contribute towards the delivery of KP-friendly health services and reducing stigma and discrimination faced by the KPs and People living with HIV (PLHIV) in health care settings.