Mes­sage from Hon’ble Sowai Ly­onpo Hon’ble Min­is­ter of Health

‘Pre­vent, Test & Treat All’ – Fast-Track­ing re­sponse to End AIDS!

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Hav­ing ex­pe­ri­ence of over three decades since the evo­lu­tion of HIV/AIDS epi­demic in the world, tremen­dous progress against AIDS have in­spired a global com­mit­ment to end the epi­demic by 2030. The United Na­tions Gen­eral As­sem­bly agreed in June 2016 that end­ing AIDS by 2030 re­quires a Fast–Track re­sponse to reach three mile­stones by 2020:

■ Re­duce new HIV in­fec­tions to fewer than 500 000 glob­ally by 2020.

■ Re­duce AIDS-re­lated deaths to fewer than 500 000 glob­ally by 2020.

■ Elim­i­nate HIV-re­lated stigma and dis­crim­i­na­tion by 2020.

To­day there are al­most 36.7 mil­lion peo­ple liv­ing with HIV/AIDS with 2.1 mil­lion new in­fec­tion in 2015 alone. Glob­ally we are wit­ness­ing de­clin­ing trend in AIDS re­lated deaths due to im­proved treat­ment cov­er­age and easy ac­ces­si­bil­ity to safe and af­ford­able med­i­ca­tions, the to­tal AIDS re­lated deaths recorded in 2015 was 1.1 mil­lion. Glob­ally there are 1.8 mil­lion chil­dren (<15 years of age) cur­rently liv­ing with HIV/AIDS and in 2015 al­most 150,000 chil­dren were newly in­fected with HIV/AIDS. Al­most 50 per­cent of the global HIV/AIDS cases are re­ported from Eastern and South­ern African Re­gion (19 mil­lion), fol­lowed by Western and Cen­tral African Re­gion (6.5 mil­lion), and Asia & Pa­cific Re­gion (5.1 mil­lion). In 2014 there were 3.5 mil­lion peo­ple liv­ing with HIV/AIDS in South East Asia Re­gion, out of which 230,000 are new in­fec­tions re­ported in 2014 alone, trans­lat­ing into 640 peo­ple get­ting in­fected ev­ery day. HIV con­tin­ues to ex­act its toll, with an es­ti­mated 230 000 AIDS-re­lated deaths ev­ery year and cur­rently there are 1.2 mil­lion peo­ple ac­cess­ing Anti-Retro­vi­ral Treat­ment in the re­gion. Five high-pri­or­ity coun­tries in the Re­gion ac­count for 99% of the HIV bur­den. These are In­dia, In­done­sia, Myan­mar, Nepal and Thai­land. Given the con­sid­er­able progress achieved both at the global and re­gional level, End­ing the AIDS epi­demic and leav­ing no one be­hind in the re­sponse will pro­foundly af­fect the en­tire life­span of mil­lions of peo­ple around the world, for gen­er­a­tions to come. The post AIDS world will be very dif­fer­ent from the one we know to­day—and it is one we can cre­ate. It will be a world in which ev­ery child is born HIV-free to healthy par­ents, and any child liv­ing with HIV re­ceives the treat­ment, pro­tec­tion, care and sup­port to sur­vive and thrive into adult­hood and old age. The world has com­mit­ted to end the AIDS epi­demic by 2030 as part of the Sus­tain­able De­vel­op­ment Goals. This am­bi­tious yet wholly at­tain­able ob­jec­tive rep­re­sents an un­par­al­leled op­por­tu­nity to change the course of history for ever—some­thing our gen­er­a­tion must do for the gen­er­a­tions to come. More than decade ago, the first known cases of HIV/AIDS sparked a con­cern in Bhutan - ush­er­ing in a time de­fined by how lit­tle we knew about it and in which those af­fected by it faced were com­pletely left with no clue. We have made ex­tra­or­di­nary progress in the fight against HIV since that time, but much work re­mains to be done. On World AIDS Day, we re­mem­ber those who we have lost to HIV/AIDS, cel­e­brate the tri­umphs earned through the ef­forts of scores of ad­vo­cates and providers, pledge our sup­port for those at risk for or liv­ing with HIV, and reded­i­cate our tal­ents and ef­forts to achiev­ing our goal of an AIDS-free gen­er­a­tion. To­day, there are 515 peo­ple de­tected with HIV virus out of which 396 are cur­rently liv­ing with the virus in the coun­try with equal pro­por­tion of male to fe­male ra­tio. Among the to­tal re­ported cases, al­most 7 per­cent of the cases are at­trib­ut­able to ver­ti­cal trans­mis­sion from their in­fected par­ents. As al­ways Het­ero­sex­ual con­tin­ues to re­main the pre­dom­i­nant mode of HIV trans­mis­sion and pro­mo­tion of safe sex still re­mains the great­est chal­lenge given the un­safe sex­ual prac­tice. Even though, Bhutan con­tin­ues to main­tain the preva­lence rate <0.1%, HIV/AIDS still re­mains one of the pri­or­ity pub­lic health prob­lem, given the in­creas­ing mo­bil­ity of our peo­ple, por­ous border with our neigh­bor­ing coun­tries, low de­mand for con­dom use and high sex­ual promis­cu­ity na­ture. As we ob­serve this spe­cial day, I on be­half of the Min­istry of Health and the Royal Gov­ern­ment of Bhutan would like to sub­mit our sin­cere thanks and gratitude to His Majesty the Kings for their guid­ance in re­shap­ing the poli­cies and pro­grammes for the pre­ven­tion and con­trol of HIV/AIDS in the coun­try. Fur­ther, we also would like to sub­mit our hum­blest ap­pre­ci­a­tion to Her Majesty the Gya­lyum San­gay Cho­den Wangchuck for her un­wa­ver­ing com­mit­ment and sup­port to the cause, Her Majesty Gya­lyum has been the true pi­o­neer for the en­tire suc­cess that we have achieved over last one decade in our re­sponse to HIV/AIDS. As a key high­light of the day, Bhutan is proud to an­nounce that Anti-Retro vi­ral treat­ments will be made avail­able for all the peo­ple di­ag­nosed with HIV ir­re­spec­tive of their body im­mu­nity count (CD4 count), and this pol­icy shift is ex­pected to bring a pos­i­tive change in our fight against this dis­ease. As a sig­na­tory mem­ber to the UN con­ven­tion in en­dors­ing the Sus­tain­able De­vel­op­ment Goals (SDG), Bhutan will also be pledg­ing to ‘fast track’ our re­sponse to end AIDS by 2030, while mit­i­gat­ing the ill ef­fects of so­cial stigma and dis­crim­i­na­tion associated with the dis­ease. While treat­ment scale-up can be one of the most thought awaited achieve­ments for us, we would also urge the in­di­vid­u­als in­fected with HIV to closely ob­serve their com­pli­ance to med­i­ca­tion. Early ini­ti­a­tion of ARV med­i­ca­tion and good com­pli­ance will im­mensely im­prove the health out­come of the in­fected in­di­vid­u­als and will re­duce the trans­mis­sion from source through sup­pressed vi­ral load, how­ever there are also equal risk of drug re­sis­tance. Now the onus is with ev­ery in­di­vid­ual to ad­dress the is­sues con­cern­ing the spread of the virus, thereby we urge ev­ery­one not to be ig­no­rant to the grow­ing menace of HIV/AIDS, though in rel­a­tively small scale. With the widen­ing de­tec­tion gap (42%), we are con­cerned that there are on­go­ing trans­mis­sion of HIV virus in our so­ci­ety, as peo­ple are un­aware of their HIV sta­tus. This year the theme for the event is ‘Pre­vent, Test & Treat all’ is very timely with the launch of our new pol­icy to treat all the peo­ple liv­ing with HIV/AIDS in the coun­try. The Min­istry of Health will strive hard to pre­vent the spread of HIV while ex­pand­ing HIV test­ing ser­vices to a com­mu­nity level through tar­geted in­ter­ven­tion pro­grammes. Link­age to care af­ter di­ag­no­sis and re­ten­tion on care will re­main our pri­mary fo­cus and this will be achieved through a stronger col­lab­o­ra­tion and part­ner­ship with the civil so­ci­ety or­ga­ni­za­tions like Lhak-sam (Net­work of Peo­ple Liv­ing with HIV/AIDS in Bhutan). In Bhutan, the na­tional theme for the day would be ‘to bridge the de­tec­tion gap’, as we see that we still have high de­tec­tion gap de­spite the in­te­gra­tion of HIV pre­ven­tion ser­vices in to core pri­mary health care pack­age. There­fore, one of our key strat­egy would be to scale-up HIV di­ag­nos­tic ser­vices and in­tro­duce com­mu­nity led HIV test­ing ser­vices to reach out to the most-at-risk and vul­ner­a­ble pop­u­la­tion groups. To­day, as we ob­serve World AIDS Day, I on be­half of the Min­istry of Health and the Royal Gov­ern­ment of Bhutan would urge ev­ery cit­i­zen of our coun­try to be re­spon­si­ble to part­ner the gov­ern­ment in re­al­iz­ing our goal of cre­at­ing AIDS free so­ci­ety and con­trib­ute pos­i­tively to our na­tion build­ing. I also would like to take this op­por­tu­nity to ac­knowl­edge the sup­ports that get from our de­vel­op­men­tal part­ners, na­tional stake­hold­ers, NGOs/CBOs and in­di­vid­u­als to our fight against HIV/AIDS. To­gether we can de­feat AIDS, we shouldn’t leave any space for com­pla­cency.

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