The nation of Bhutan on the edge of the Himalayas is known for its stunning landscapes and philosophy of Gross National Happiness. Bhutan is currently facing a complex public health challenge as it grapples with how to ensure sustainable HIV services for key populations. Key populations in Bhutan include sex workers, transgender women, and men who have sex with men (MSM).
Health Equity Matters’ (SKPA-2) program, in partnership with Save the Children Bhutan and the country’s National HIV/AIDS & STI Control Program (NACP), have been supporting the community-led response to HIV. Specifically, SKPA-2 has been working to build systems that are not only effective, but inclusive and enduring.
Bhutan’s first and only community group representing sex workers, The Red Purse Network, is a small, informal support group for female, male and transgender sex workers. With support from SKPA-2, the network is providing a bridge between sex worker communities and vital health services.
Additionally, peer outreach workers operate throughout the country with the purpose of providing education. The peer workers link people, including sex workers, to HIV testing and PrEP – the latter being available in the country since late 2024. This is another initiative supported by SKPA-2.
Despite positive steps forward, challenges remain. Stigma and criminalisation of sex work continues to deter people from seeking care. PrEP uptake, though a national priority, remains slow. As of March 2025, only 67 individuals had commenced PrEP, which is just over 6% of the national target. Misinformation, fear and structural barriers still hold people back. Getting people connected to PrEP isn’t just about pills and policies, it’s about trust, safety and dignity.
To respond, SKPA-2 has focused on empowering key populations through knowledge and advocacy. Community-led Monitoring (CLM) has been introduced to allow key population communities to gather and use their own data to influence HIV programs and policy. Bhutan’s online CLM dashboard gives real-time insight into service quality and barriers, which can be used to inform decision-making.
In 2024, a need was expressed for wrap-around support including legal assistance, counselling, skills training and gender-based violence services. SKPA-2 responded by deepening its partnership with RENEW, Bhutan’s leading organisation on gender-based violence prevention, who extended Rainbow Help Desk services to key population groups including female sex workers, transgender women, and men who have sex with men.
Another approach to enhance sustainability has been to bolster the organisational strength and capacity of key population-led organisations. This prepares them to generate, receive and manage funds. These organisations have shown out-of-the-box thinking regarding diversified income streams such as LGBTIQA+ tourism ventures and the production of healthy foods.
Systems won’t change overnight but by strengthening local organisations like Red Purse Network and Pride Bhutan, increasing community demand for PrEP and advocating with solid data, foundations are being laid to help Bhutan build a community-led system that can stand on its own.
If approved by the Global Fund, the program’s next phase (2026–2027) aims to consolidate these gains. It will support the Red Purse Network to professionalise its peer workforce, continue to build data systems and advocacy capacity, and promote key population inclusion in policy design. It will also continue to address legal and social barriers through targeted legal literacy and human rights training.
Above all, it will keep the voices of communities at the centre.