The first case of HIV in Bhutan was reported in 1993 and, as of July 2010, the Ministry of Health had a total of 217 reported HIV cases among the population of about 700,000 [1]. This figure includes 18 children between 1 and 12 years of age who acquired HIV through mother-to-child transmission. Among the reported cases were 107 females and 110 males, and the majority (73) were in the 30-39 year old age group [1].  Bhutan is considered a low HIV prevalence country, with an estimated prevalence of 0.2% among adults aged 15-49 as of 2009 (up from less than 0.1in 2001) [2]. Among young people aged 15-24, prevalence is estimated to be less than 0.1% among women and 0.1% among men [2].

Most (90%) HIV infections are attributed to unsafe sexual practices such as multiple partners, casual sex and low condom use, followed by mother-to-child transmission (8%), and intravenous drug use and blood transfusion (1% each) [1]. While it is acknowledged that 90% of reported HIV cases are attributable to sexual transmission, little is known about the heterosexual vs. homosexual nature of this transmission.  This is largely due to strong social and cultural taboos that stigmatize male-to-male sex in Bhutan, making this group difficult to monitor [3].

There are no official estimates of the number of drug users or injecting drug users (IDUs) in Bhutan.  Although injecting drug use is not presently a widespread problem in the country, border towns of neighbouring countries such as Nepal, India and China are all areas of concern. For instance, a 2004 study along the Bhutanese border with West Bengal State in India found that HIV prevalence among IDUs (n=228) was almost 12% [4]. Thirty-six per cent of those IDUs had shared needles with a partner and 52% had visited sex workers within the last year. Another significant finding was that almost 50% of the IDUs included in the study had Hepatitis C [4].

Sex workers remain largely hidden in society thus making it difficult to define the true magnitude of sex work in Bhutan [3]. Anecdotal evidence reveals the increasing number of sex workers primarily in urban areas along border towns, while they also operate in the interior districts of the country [3].  According to an HIV and Mobility in South Asia report, sex workers on both sides of the border were reluctant to visit health facilities to seek treatment, collect condoms, or use testing services [5].

Given the surveillance limitations, very little is known about HIV transmission and infection among sex workers and their clients.  Among the 217 HIV cases detected as of July 2010, 10 (around 5%) were among individuals reporting sex work as their occupation [1]. One small study in Phoensoling (n=60) found that 3.3% of sex workers tested positive for HIV, 72% for syphilis and 3.4% for Hepatitis [6].

Bhutan has a large youth population – almost 52% of the total population is below the age of 25 years [7]. A survey of high school students in 2006 revealed that misconceptions about HIV persisted among young people:  48% thought that HIV could be transmitted by mosquito bites; 66% believed that donating blood was risky; 69% HIV/AIDS was curable if treated early; and 76% felt that people living with HIV and AIDS should be isolated to avoid spreading the risk of infection [8].

Sources:

[1] Ministry of Health (MoH), An update on Human Immuno-Deficiency Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS), July 1, 2010

[2] UNAIDS. Report on the Global AIDS Epidemic, 2010

[3] Royal Government of Bhutan, National Strategic Plan for the Prevention And Control of STIs and HIV and AIDS, 2008

[4] Sarkar K.; Bal B., Mukherjee R., Chakraborty S., Niyogi S. K.,   Saha M. K., Bhattacharya S. K. Epidemic of HIV Coupled With Hepatitis C Virus Among Injecting Drug Users of Himalayan West Bengal, Eastern India, Bordering Nepal, Bhutan, and Bangladesh. Substance Use and Misuse, March 2006;41(3):341-352

[5] UNDP, UNAIDS, ILO, HIV and Mobility in South Asia, 2010

[6] The World Bank. The World Bank in South Asia: Bhutan, August 2008

[7] National Statistics Bureau of the Royal Government of Bhutan, Statistical Yearbook, October 2009

[8] WHO/UNFPA/UNICEF, Fact Sheet on Young People and HIV/AIDS in Bhutan, 2007