An update on Human Immuno Deficiency Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS) (July 1, 2010) Ministry of Health Thimphu: Bhutan
A. Background Total HIV cases as of December 1, 2009 185 Total new cases detected as of July 1, 2010 32 Total cases detected in Bhutan to date 217 B. Summary of new cases since December 2009 From December 2009 till June 2010, a total of 32 cases have been detected out of which, 16 are Females (1 minor) and 16 are Males. HIV/AIDS has had a multi sectoral approach since 2001, which has helped increase awareness on STIs and HIV/AIDS immensely. Increased awareness, improved mechanisms and access to Counseling and testing facilities on STIs and HIV/AIDS have enhanced the detection of HIV infection. The UNAIDS estimates that Bhutan would have more than 500 HIV infection cases though the official reported cases now stands at 217. Therefore, the 32 HIV infections reported since December 2009 till June 2010 does not necessarily give us the number of new infections but many of them may be old HIV infections that have been detected late. On an average the CD4 count is 356 per cmm of blood, which means they could have been infected few years ago. The following table shows the details of 32 cases: Table 1: Modes of diagnosis of HIV/AIDS 1 Medical checkup/screening 5 2 Contact Tracing 15 3 Voluntary Testing 11 4 Mother to child 1 TOTAL 32 Table 2: Occupational backgrounds of detected cases: 1 Civil Servants 1 2 Corporate/Private Employee 10 3 Farmer 1 4 Business community 8 5 Housewife 10 6 Minor 1 7 Student (Trainee) 1 Total 32
Table 3: Mode of Transmission Sexual Route 31 Mother to Child 1 Total 32 Table 4: Distribution by sex 1 Male 16 2 Female 16 Total 32 Table 5: Distribution by Age Age Groups Male Female Total < 5 years 0 1 1 5-14 years 0 0 0 15-19 years 0 0 0 20-24 years 3 4 7 25-29 years 4 5 9 30-39 years 6 6 12 40-49 years 3 0 3 50+ 0 0 0 Total 16 16 32 97% of the cases are within the age range of 15-49 years According to the CD4 count the cases were infected 7-8 years ago. Table 6: On Antiretroviral Therapy (ART) a) Total no. of cases put on ART treatment 09 b) Total death after ART 01 Total on HAART out of 32 cases 09 Table 7: Causes of deaths in HIV infected people out of 32 cases Death due to HIV/AIDS: 1. Female 2 2. Male 0
Total 2 B. Summary of the Epidemic The Nation currently has 217 people reporting HIV infection, 107 Females and 110 Males. These figures also include 18 children ranging between 1 to12 years, who have acquired the infection from their infected parents (mother to child transmission). Almost 91% of HIV infections are attributed to unsafe sexual practices such as multiple partners, casual sex and low condom use. The infected population cuts across all sections of the society and they are inclusive of government and corporate employees, to business men, farmers, uniformed personnel, religious bodies, housewives and sex workers. The young people are one of the highly vulnerable groups to the HIV epidemic in Bhutan and currently account for 50% of the infected population (age ranging from 15-29). In efforts to provide support and care to the people living with HIV/AIDS, Anti-retroviral therapy has been introduced since 2004 and till date we have 46 on treatment. So far a total of 43 people infected with HIV/AIDS have died since the first case was detected in 1993. The following tables shows the details of the total 217 Cases detected to date: Table 1: Modes of diagnosis of HIV/AIDS 1 Medical checkup/screening 45 2 Blood Donor Screening 24 3 Survey/sentinel 37 4 Contact Tracing 60 5 Voluntary Testing 33 6 Mother to child 18 TOTAL 217 Table 2: Occupational backgrounds of detected cases: 1 Civil Servants 14 2 Corporate/Private Employee 28 3 UN Employee 01 4 Business community 31 5 Housewife 61 6 Farmers 14 7 Commercial Sex Workers 10 8 Religious groups 05
9 RBP 10 10 RBA/RBG 14 11 Minor ( 1 Non National) 18 12 Unemployed 02 13 Prisoner 02 14 Laborers (National 3,Non National 2) 05 15 Student/ Trainees 02 Total 217 Table 3: Mode of Transmission Sexual Route 195 Mother to Child 18 Intravenous Drug use (Probable) 02 Blood Transfusion (outside) 02 Total 217 Table 4: Distribution by sex 1 Male 110 2 Female 107 Total 217 Table 5: Distribution by Age Age Groups Male Female Total < 5 years 3 12 15 5-14 years 2 1 3 15-19 years 0 8 8 20-24 years 9 26 35 25-29 years 33 24 57 30-39 years 46 27 73 40-49 years 16 8 24 50+ 1 1 2 Total 110 107 217 91% of the cases are within the age range of 15-49 years Table 6: On Antiretroviral Therapy (ART) a) Total no. of cases put on ART treatment 59 b) Total death after ART 13
Total cases living on Anti Retroviral Therapy 46 Table 7: Causes of deaths in HIV infected people in Bhutan a. Death due to HIV/AIDS: Age Groups Male Female Total < 5 years 0 1 01 5-14 years 0 0 00 15-19 years 0 0 00 20-24 years 1 4 06 25-29 years 4 2 06 30-39 years 14 7 20 40-49 years 5 1 06 50+ 1 0 01 Total 25 15 40 b. Death due to other causes: 1 Male (Cerebral Malaria & Road accident 02 2 Female (Suicide) 01 Total 03 Total deaths: 43 8. Total people living with HIV/AIDS: a) Bhutanese national living with HIV/AIDS 164 (2 left the country) b) Bhutanese national living with HIV/AIDS in the country 162 Total people living with HIV/AIDS in the country 162 D. Action taken The following areas summarize the actions taken:
1. Prevention: Various interventions are taken through a multi-sectoral approach. 2. Care & Treatment: a. Providing psychological support- stabilization of crisis to cope with the disease. b. Providing psychosocial support- to educate on social stigma c. Providing medical support and nursing care, etc. d. Initiation of PLHA network as self help group for HIV prevention, care and treatment.