Ministry of Health Detects 40 New HIV Cases in 2022

June 2022 THIMPHU-BHUTAN: In the last six months from January to June 2022, the Ministry of Health
has detected 40 new HIV cases (19 male and 21 female). This is one of the highest cases detected in the
six-monthly reports until now. Out of 40 newly diagnosed cases, the majority (70%, n=28) are between the
ages of 25-49 years old and 20% (n=8) of them are above fifty years old while 5% are between the ages of
20-24 years and another 5% are below 5 years. Among the new cases, 13 are diagnosed through medical
screening, 12 through contact tracing, 10 through Voluntary Counseling and Testing (VCT), and 5 through
screening of pregnant mothers attending the Antenatal Care (ANC) services. Out of 40 new cases, 38 of
them have contracted HIV through unsafe heterosexual practices and 2 from Mother to Child Transmission
(MTCT). Regarding the two MTCT cases, it was learned that both the mothers were found HIV negative
during the first ANC visit in 2016 and 2017 respectively. However, these two pregnant mothers may have
been exposed to HIV infection after the first HIV test and during the latter stage of their pregnancy (after
the first ANC visit, before delivery, or during breastfeeding) and then transmitted it to their children. These
mothers went undetected during the later stages of their pregnancy checkups because back then there was
no policy of mandatory two-time HIV testing for pregnant mothers. The policy of two-time HIV testing
(first visit and before delivery) was introduced in 2018 to prevent such risk of mother-to-child transmission.
The cumulative number of cases reported from 1993 until June 2022 is 835 (433 male and 402 female).
Sporadic cases appeared between 1993 and 2000. From 2000 to 2013, the number of new HIV diagnoses
rose from 9 to 51. Since 2013, the case detection has plateaued, fluctuating between 49 and 58 annually. At
present, about 628 people are living with HIV (PLHIV) in the country. Out of 628 PLHIV, 608 are on
antiretroviral treatment (ART) resulting in 97% treatment coverage among the living cases. Despite the low
prevalence of HIV in Bhutan, the need to intensify HIV Counseling and Testing is being accorded high
priority by the Royal Government to bridge the current case detection gap of 35.8% of the estimated 1300
HIV cases in the country. The Ministry of Health updates the HIV epidemic in the country every six months
and informs the nation through appropriate media channels.
Concerning the current HIV case detection gap, the hon’ble health minister Dasho Dechen Wangmo said;
“Although we are struggling to find those untested and undiagnosed sexual and drug-injecting partners of
people living with HIV owing to existing stigma and discrimination, we are making great strides to bridging
the current case detection gap of 35.8% of the estimated 1300 HIV cases in the country.” Hon’ble Lyonpo
added, “Case detection gap has been reduced from 47.6% in 2019 to 35.8% in June 2022 resulting in
overall reduction by 11.8% in last four years but it is not enough to meet the national and global target to
end the AIDS epidemic by 2030”. Hon’ble Lyonpo also mentioned that in addition to the existing facility-
based and mobile HIV testing services, the Health Ministry has also introduced HIV Self-Testing (HIVST)
in six high-risk districts to ensure enhanced access to HIV testing services for early diagnosis and
treatment. Concerning mother-to-child transmission of HIV, Hon’ble Lyonpo explained that to achieve an
AIDS-free generation all our pregnant mothers must avail of two-time HIV testing during their entire
pregnancy period and avoid any risky behaviour during breast-feeding to prevent mother-to-child
transmission of HIV. Hon’ble Lyonpo also urged all expecting parents to take additional responsibility for
the prevention of mother-to-child transmission of HIV to ensure that every child has a right to be born free
from HIV.

The Ministry of Health is currently in the process of carrying out the pre-validation assessment to check
Bhutan’s readiness for the triple elimination of Mother-to-Child Transmission of HIV, syphilis and hepatitis
B by 2025.
On the coverage and accessibility of HIV testing services in Bhutan, the Officiating Director for the
Department of Public Health, Mr Rixin Jamtsho, said: “The Ministry of Health has expanded its HIV testing
program like never before and it is available in all the health care facilities across the country, standalone
community testing centre called health information and service centre (HISC) in six major urban areas,
namely, Thimphu, Phuentsholing, Gelephu, S/Jongkhar, Lobesa and Trongsa including the private
diagnostic centres”. The Officiating Director also reiterated the importance of coming forward for HIV
testing to know your HIV status for timely care and treatment. He explained that unlike in the past, now
there are scientifically proven effective HIV medicines that can reduce the viral load in the body and
improve the immune system of the PLHIV. However, he cautioned it is important to know that timely testing
is the only means to know your HIV status to initiate early treatment and that good adherence to the
treatment is indispensable for achieving an effective treatment outcome.
As a part of the national HIV and AIDS response, the Ministry of Health will continue to strive hard to
bridge the current case detection gap to achieve sustainable development goals to end the AIDS epidemic
by 2030. Four key strategies will be implemented to enhance the case diagnosis; i) phase-wise scaling up
of the HIV self-testing and counselling services across the country, ii) implementing the targeted index
testing (contact tracing) and partner notification services as a core intervention to efficiently and effectively
identify HIV-positive individuals, iii) provider-initiated HIV counselling and testing services will be
streamlined and strengthened across the health facilities to enable healthcare providers to provide HIV
testing to any persons attending health care facilities as a standard component of medical care, iv) strengthen
the routine surveillance systems in the hospitals across the country to meet the requirement of the
elimination of Mother to Child Transmission of HIV, Syphilis and Hepatitis B by 2025.
In terms of care and treatment, the Ministry of Health will further decentralize the provision of antiretroviral
therapy (ART) drugs for the people living with HIV from the district hospital to the primary health centres
and other community testing centres for enhanced accessibility. The MoH will also decentralize the viral
load testing services from the national referral hospital to eight more district hospitals (Gelephu RRH,
Mongar RRH, Phuentsholing, Trashigang, Nagalam, S/Jongkhar, Samtse and Wangdue Phodrang). Viral
load tests are used to diagnose acute HIV infection, guide treatment choices, and monitor response to ART.
Similarly, CD4 testing services will be scaled up from the existing five districts (Thimphu, Phuentsholing,
Gelephu, Mongar and S/Jongkhar) to three more districts (Wangdue Phodrang, Trashigang, and Samtse).
CD4 count testing helps assess the progress of the infection and enables health care providers to know
whether the infection is under control or at risk of complications. Most importantly, the HIV confirmatory
test will be also decentralized from the Royal Center for Disease Control (RCDC) to the regional referral
hospitals for timely provision of the HIV confirmation result.

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