May 5, 2025
THIMPHU – When a 50-year-old woman walked into the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) last month for a routine check-up, she expected professional care. Instead, what she experienced was a stark reminder of the enduring stigma faced by people living with HIV (PLHIV) in Bhutan.
“After I told them I was HIV-positive, their behaviour changed immediately,” she recalled, visibly uneasy. “Other health workers were told to be careful around me. I felt like I was being treated as a threat, not a patient.”
Her story is not unique. Despite decades of awareness campaigns and inclusive health policies, many PLHIV still encounter discrimination, especially in places where they should feel safest—hospitals and clinics.
Fear lingers, stigma remains
While access to testing and treatment has improved, social acceptance has not kept pace. Many PLHIV speak of being judged, isolated, or avoided, which leads to emotional distress and deepens their sense of exclusion.
A 33-year-old woman described her experience during a surgical procedure. “I was the last case scheduled in the operating theatre,” she said. “I overheard staff refer to me as a ‘B20 case’ and the doctor instructed everyone to wear full protective gear. It was humiliating.”
Even routine tasks like picking up medication can be daunting. “If a familiar staff member isn’t at the pharmacy counter, I get nervous,” said one man. “There’s always that fear of being stared at, of being treated differently.”
One HIV-positive advocate pointed out that even educated individuals can perpetuate discrimination. “But the worst part,” he said, “is when we begin to look down on ourselves. That’s the real stigma.”
Beyond hospital walls
The discrimination does not end in medical settings. In villages and towns alike, many PLHIV face rejection from neighbours and friends.
One woman said her parents were advised by villagers not to let her return home. “They said I must have got HIV from being unfaithful,” she shared.
In cities, the exclusion is more discreet but no less painful. “People avoid being seen with us,” said another woman. “Some friends just stop talking to you—they are afraid others will judge them too.”
The stigma often spills into the workplace. One woman said she was subtly discouraged from attending a work gathering. “Eventually, I quit. It felt like I wasn’t welcome anymore.” Others have lost jobs entirely after their HIV status became known.
To protect their mental wellbeing, some PLHIV choose isolation. “I have learned that staying home shields me from harsh words,” said a 30-year-old woman. “Sometimes, being alone is easier.”
The weight of internal stigma
The stigma is not always external. Many PLHIV grapple with internalised shame. A survey by Lhaksam, a civil society organisation, revealed that 52 percent of respondents felt guilty and 51 percent felt ashamed of their status. These figures far exceed the 10 percent target set by the Global AIDS Strategy (2021–2026) for internal stigma reduction.
Cultural perceptions also contribute. Terms like tramaship—a derogatory reference to sexual behaviour along with religious beliefs and notions of karma, reinforce harmful stereotypes. These discourage people from getting tested and silence those already diagnosed.
Wangda Dorji, Executive Director of Lhaksam, explained that the roots of this stigma trace back decades. “When HIV was first detected in Bhutan in 1993, it was described as deadly and incurable. That perception has lingered,” he said. “We need consistent public education, and the Ministry of Health must take a more active role.”
He also stressed the importance of involving religious figures, media, and social media influencers. “But no one wants to talk about HIV and stigma. People fear public backlash.”
More than medicine
Bhutan has made significant progress in treatment and control. But many argue that medicine alone will not solve the problem. The focus must now shift to changing attitudes.
“Until the stigma is gone, no medicine will make us feel safe or accepted,” said one PLHIV. “We don’t want pity. We want respect and dignity.”
Lhaksam’s study also sheds light on the economic and educational challenges faced by PLHIV. While 54 percent had studied up to higher secondary level, 38.1 percent never attended school.
Employment figures show that only 36.8 percent are employed, with 41.4 percent unemployed and 21.8 percent self-employed. Monthly household incomes range from Nu 3,000 to Nu 200,000, with most PLHIV living with immediate family.
Many also feel there is little support for awareness efforts. “While we go around raising awareness, some dzongkhags and agencies support us, but others don’t even respond,” one advocate said.
The road to 2030
Bhutan has set an ambitious target: to eliminate HIV/AIDS, viral hepatitis, and other sexually transmitted infections as public health threats by 2030. The goal is to achieve the 95-95-95 targets—95 percent of people living with HIV knowing their status, 95 percent of those diagnosed receiving treatment, and 95 percent of those on treatment achieving viral suppression.
As of June last year, Bhutan had recorded 980 HIV cases, with 196 deaths.