Chapter Three: Positive response
Part II: National HIV/AIDS Control Programme
Chapter 3 stories
National HIV/AIDS Control Programme
The National HIV/AIDS Control Program was initiated in 1988 by the Government of Bhutan, six years before the first ever HIV case was reported in the country. Since its inception, the programme’s focus has been on public education and capacity development of health workers.
In a feature unique to Bhutan, apart from the coordinated government efforts, a testimony of the commitment to respond to HIV is the explicit top-level initiative from the Royal Family. On May 24, 2004, the Fourth King, His Majesty Jigme Singye Wangchuk, issued a Royal Decree to participate in the HIV prevention and to respect the rights of PLHIV. During the same year, the Royal Edict broadened the scope of the organisational and individual-level participation in HIV prevention.
Bhutan received its first financial aid from the World Bank for period of five years, starting from 2004. The four major components of the intervention were: • HIV and STI prevention and promotive services • Scaling up of treatment and care services • Building institutional capacities and training health service providers • Strategic information—promoting research-based studies and surveys
In 2005, with the growing rate of infection among the younger generation, the Fifth King, His Majesty Jigme Khesar Namgyel Wangchuck, proclaimed to the nation, “HIV/AIDS is no exception. The youth will use their strength of character to reject undesirable activities; their compassion to aid those afflicted and their will to prevent its spread.”
Meanwhile, in 2008 Bhutan got more financial support from the Global Fund for HIV/AIDS, TB and Malaria. The major emphasis of the Global Fund support was to reach the most vulnerable sections of population including youth through coordinated multi-sectoral response.
Her Majesty, the Queen Ashi Sangay Choden Wangchuck also works with the grass-root communities for HIV prevention, substance abuse and reproductive health issues, especially pertaining to teenage pregnancy.
“Our achievements have been possible primarily because of the high level commitment, leadership and coordinated multi-sectoral response in combating the HIV epidemic in the country. Diagnostic facilities have been strengthened to enhance the case detection rate at all levels and treatment services scaled-up to treat all infected individuals who are in need of lifelong ART treatment. The success in our national response is partly attributable to the endeavours of the district based Multi Sectoral Task Forces in carrying out general awareness programmes in all the 20 districts and within its administrative blocks. Bhutan now needs to focus on detection through sustained logistical support to reach the optimum level of infections” says Namgey Tshering, the Programme Manager National HIV/AIDS Control Programme.
As stated earlier, Bhutan is one of the few counties in South Asia that continue to experience a low HIV prevalence of below 0.1 per cent. The programme’s cohort data on HIV status indicates that almost 90 per cent of the infection is attributable to unsafe sex and remaining 9 per cent to mother-to-child transmission. Hence, acknowledging the UNAIDS vision of ‘Getting to Zero” and “Millennium Development Goal”, Bhutan is embarking on achieving zero new HIV infections by 2015. To achieve this goal, Bhutan will scale up the HIV screening facilities to allow all ANC attendees to undergo voluntary testing for HIV.
Mr Tshering adds, “This would require reaching out to every ANC attendee and giving them a complete package of preventive, promotive care and treatment services. Our focus will be on community focused public health intervention, so that right things are delivered to the right people in the right time and the right way.”
However, the biggest challenges that still remain are the future financial sustainability of the programme’s interventions and shortage of manpower at the national programme level.
The World Bank project, which provided US$ 5.7 million for strengthening HIV related health care systems and capacities, ended in June 2011. The Global Fund Round Six brought US$ 2.9 million, which too is ending. The country needs more funds if it hopes to accomplish the goals it has set for itself.
Mr Tshering is hopeful of procuring financial support. “We are now exploring the support from all the multilateral and bilateral donor agencies. The National Strategic Plan–II has been developed with major emphasis on the target-based approach to ensure financial sustainability of programme interventions. The National Strategic Plan-II is also aligned with 11th Five Year Plan to achieve maximum outcomes within our capacity. Recently, we have also submitted a proposal under Global Fund Transitional Funding Mechanism, amounting to US$ 1.14 million for a period of 2 years. The primary objective of this proposal is to sustain the past gains and ensure that there is no major disruption in the delivery of essential services. We are hopeful that our collaboration with our UN development partners will be further strengthened and support from donor agencies will be mobilised with evidence based country proposals.”
The joint UN response to HIV in Bhutan
Chapter 1 stories
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