Investigator(s)
| Submitter |
Jamyang Choden Department of Public Health Ministry of Health Jamyang Choden 
|
| Principal Investigator |
Jamyang Choden Department of Public Health Ministry of Health Jamyang Choden
|
| Co-Investigator(s) |
Kinley Dorjee HIRD, Ministry of Health Kinley Dorjee
|
| Co-Investigator(s) |
Dechen Wangmo Department of Public Health Ministry of Health Dechen Wangmo
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| Co-Investigator(s) |
Dorji Zangmo Department of Public Health Ministry of Health Dorji Zangmo
|
| Co-Investigator(s) |
Indra Prasad Sharma Independent Consultant Indra Prasad Sharma
|
| Co-Investigator(s) |
Philip N Kumar Independent Consultant Philip N Kumar
|
| Co-Investigator(s) |
Deepika Adhikari Independent Consultant Deepika Adhikari
|
Title(s) and abstract
| Scientific title | Mapping and Population Size Estimation of Key Population (Female Sex Workers and High-Risk Women, Men who have Sex with Men, Transgender persons) in Bhutan |
| Public title | Understanding the Size and Distribution of Vulnerable Communities in Bhutan |
| Background | Bhutan reported its first HIV case in 1993 and has maintained a low-level HIV epidemic since then. Although annual new HIV diagnoses increased gradually from 9 cases in 2000 to 51 cases in 2013, the number remained relatively stable thereafter. By December 2024, Bhutan had recorded a cumulative total of 1,020 HIV cases and 209 deaths, with 774 people living with HIV, of whom 98% were receiving antiretroviral therapy (ART). The adult HIV prevalence among individuals aged 15-49 years remains low at 0.2%. More than 80% of reported HIV cases occur among people aged 20–49 years, the country’s most economically productive population. Evidence suggests that heterosexual transmission involving multiple partners, sex workers, clients of sex workers, and their spouses remains the primary mode of HIV transmission. Other populations at elevated risk include men who have sex with men (MSM), transgender persons, and people who use drugs. Despite the low overall prevalence, factors such as under-diagnosis, increasing sexually transmitted infections, reduced condom use, multiple sexual partnerships, and stigma continue to pose risks for further HIV transmission. The 2019-2020 Mapping and Population Size Estimation (MPSE) study identified key populations at risk, including female sex workers, MSM, transgender women, transgender men, and other high-risk women. The study also highlighted barriers to accessing HIV services, including stigma, discrimination, criminalization of sex work, and concerns about confidentiality. Since the previous MPSE, changes in mobility, urbanization, and the growing use of online platforms have altered how key populations interact and access services, making many groups harder to reach through traditional approaches. Therefore, the 2026 MPSE study is needed to generate updated population estimates, identify emerging hotspots, assess HIV-related risks and service gaps, and provide evidence to strengthen HIV programming and support Bhutan’s HIV elimination goals by 2030. |
| Objectives | Broad objective To generate a list of hotspots and estimated the size of the key population groups including High Risk Women (HRW), Female Sex Workers (FSWs), Men who have Sex with Men (MSM), Transgender Women (TGW) and Transgender Men (TGM) at sub-national (town/ dzongkhags) as well as national levels in Bhutan. Specific Objective The specific objectives of the MPSE of KPs are: 1.To identify/update and map the hotspots which are either points for solicitation or provision of sexual services for high-risk sexual activities in specific geographies. 2.To profile each of the hotspots where high-risk sexual activities are going on. 3.To understand sex worker’s typology, operation (where, when, and how), health / HIV related services availability, needs of the KPs, any crisis or problems, etc. 4.To collect information to understand the mobility patterns within and outside the hotspot(s). 5.To validate or triangulate the estimated sizes by hotspot mapping through another alternative size estimation method in selected location(s). |
| Study Methods | This study will use a mixed-methods cross-sectional descriptive study design to conduct mapping and population size estimation (MPSE) of key populations (KPs) in Bhutan, including Female Sex Workers (FSW), high-risk women (HRW), men who have sex with men (MSM), transgender persons (TGW and TGM). The study will combine qualitative and quantitative approaches to generate updated evidence on the size, distribution, typologies, hotspot characteristics, mobility patterns, and service accessibility of key populations. The study will be implemented in selected intervention and non-intervention towns/dzongkhags in Bhutan where key population activities are known or suspected to occur. The study will primarily use hotspot-based mapping and rapid field assessment approaches through engagement with both primary and secondary key informants. The study will be conducted over a duration of 5 months between June to October 2026 |
| Expected outcomes and use of results | The study is expected to generate updated evidence on the size, distribution, hotspot typologies, mobility patterns, and service access of key populations in Bhutan. The findings will support validation and updating of existing population size estimates and improve understanding of emerging hotspot dynamics, including virtual and hidden networks. The study findings will contribute to strengthening evidence-based HIV prevention and response strategies in Bhutan. The updated estimates will support programme planning, prioritization of interventions, resource allocation, service coverage estimation, target setting, and monitoring of national HIV programmes. In addition, the study will help inform future strategic plans, Global Fund proposals, and targeted interventions for key populations in Bhutan. |
| Keywords | Population Size Estimation, Geographic Mapping, Key Population,HIV Infection, Bhutan |
Research Details
| Student research | No |
| Start Date | 30-Jun-2026 |
| End Date | 31-Oct-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | HIV/AIDS |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | No |