Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

Autor: R. Van den Bergh, D. Wangmo, Rony Zachariah, Srinath Satyanarayana, Ramya Ananthakrishnan, L. Khandu, D. Wangchuk, Thinley Dorji, N. Tshering
Rok vydání: 2014
Předmět:
Zdroj: Public Health Action. 4:22-27
ISSN: 2220-8372
Popis: At the end of 2012, three decades into the HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) epidemic, approximately 35 million people were living with HIV/AIDS, another 2.3 million were newly infected, and there were an estimated 1.6 million HIV/AIDS-related deaths.1,2 HIV counselling and testing (HCT) is a critical gateway for people to access HIV treatment, care and the full range of prevention options, including pre-exposure prophylaxis and microbicides. The rational design of HCT services is needed in low- and middle-income countries. Many studies have shown the beneficial effect of introducing HCT services. Studies from Africa and Thailand have shown its effectiveness in HIV prevention and as an entry point to access care.3,4 India has over 5000 standalone VCT (voluntary counselling and testing)/HCT centres and more than 1500 integrated VCTs centres with health centres.5 Bhutan is an Asian country with a low HIV prevalence, of below 0.1%.6 In the context of low prevalence, most at-risk populations (MARPs) are important in the transmission dynamics of HIV and sexually transmitted infections (STIs) – the latter of which enhance HIV transmission. In Bhutan, MARPs are defined as those groups at higher risk of being infected by HIV and who play a prominent role in HIV transmission. They include groups such as female sex workers (FSW), clients of sex workers, injection drug users (IDUs), men having sex with men (MSM), transgendered individuals, partners of people living with HIV/AIDS, and individuals with multiple sex partners. MARPs are predisposed to acquiring and transmitting HIV and STIs. For example, clients can infect FSWs, who will in turn transmit the infection to other clients and from them to their sex partner. Preventing infection among MARPs has the potential to slow HIV and STI transmission to the general population, and this has been observed in Brazil, India, Kenya and Thailand.7 In Bhutan, HCT has primarily been located in health care facilities, to which MARPs have limited access due to operational, logistic and social barriers, including stigma and discrimination. To bridge this gap and to enhance general HCT access among urban populations, the Ministry of Health established free-standing HCT centres in 2006 in the country's two largest cities whereby individuals are offered a package of HIV, hepatitis B and syphilis testing. To minimise stigma and to promote an appropriate environment for MARPs, these centres were termed ‘health information service centres’ (HISCs). There has been no formal assessment of whether or not this initiative has increased the uptake of HCT services by MARPs. Such information would be useful before the expansion of this initiative to other districts in the country with higher proportions of MARPs. Other countries in the region may also benefit from the lessons learnt in trying to reach out to this relatively excluded and vulnerable group through free-standing HISCs. In two urban HISCs in Bhutan, 1) we assessed the trend in HIV, hepatitis B and syphilis testing in both the general population and MARPS, and 2) in the latter, we determined if socio-demographic and characteristics of risk behaviour were associated with HIV, hepatitis B and syphilis seropositivity in MARPs for the period 2009–2012.
Databáze: OpenAIRE
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