The “untold stories” of key populations: Social stigma, discrimination and its consequences

43.1% of KPs were discriminated and 24.8% were stigmatized, while 14.7% were harassed and 17.4% were subjected to violence

Twenty-three years old Deyon Phuntsho, who is a gay, recalls being discriminated since he was four years old.

This was mainly because he grew up as a female child and was always viewed differently from his peers, and was also given name like chaka (faggot) as a result. During his school years, he was so traumatized that things got worse and worse. As a result, he would often scratch his skin or stab himself in the arms with a compass. His friends then reported him to the school counselor, who suspected depression and referred him to the JDWNRH, where the psychiatrist diagnosed him with major depression with high suicidal tendency.

However, Devon Phuntsho is not alone. A majority of the Key Populations (KPs) in the country share a similar story like him. They suffer, some severely and some mildly.

The UNAIDS considers gay men and other men who have sex with men, sex workers, transgender persons, people who inject drugs, and prisoners and other incarcerated persons as the top five KPs, who are particularly vulnerable to HIV/AIDS and often lack adequate access to services.

Tenzin Gyeltshen, the Executive Director of Pride Bhutan said the problems of discrimination and stigma will always be there.

 “With the new generation there will be new challenges. What we can do is to reduce the prevalence and impact. The best way to address the problem of stigma and discrimination is to raise awareness and put policies and systems in place that protect the marginalized populations,” he added.

The role of Pride Bhutan is to create an enabling environment for SOGIESC (sexual orientation, gender identity, gender expression and gender characteristics) members including other KPs.

Meanwhile, Article 7 (15) of the Constitution of Bhutan states that all people are equal before the law and are entitled to equal and effective protection under the law and shall not be discriminated against on the basis of race, sex, language, religion, politics or other status.

Although there are no clear figures on drug abuse (SUD) and alcohol abuse (AUD) in the country, the figures with the Chithuen Phendhey Association, a non-profit organization dealing with drug and alcohol patients in Bhutan, show that more than 1,000 people from all over the country have come to them for inpatient treatment.

The KPs feel otherwise. During the two-day conference on Media Engagement on HIV and Key Populations, organized by the LHAK-SAM in Punakha in May, some of the KPs shared their heartbreaking stories of how they faced discrimination and stigma. They said they are paying the price of being different.

According to Pride Bhutan, 43.1% of KPs were discriminated against and 24.8% were stigmatized, while 14.7% were harassed and 17.4% were subjected to violence.

What medical expert say

Dr. Chencho Dorji, the first qualified Bhutanese Psychiatrist with the JDWNRH, who recently retired, said that people with mental disorders and other disabilities are already physically, emotionally and psychologically impaired because of their condition. Stigma and discrimination further affect their condition through various factors, such as not seeking help, receiving less attention when they do seek help, or receiving less support from their family or service providers.

He said, “Every day we encounter many people with mental disorders and other disabilities who face stigma and discrimination. These people defy stigma and discrimination because they are either desperate to seek help for their problems or have overcome the fear, shame and discrimination associated with their disorders.”

“I am not sure if there is an Anti-Discrimination Law in Bhutan. Many states have laws to protect the rights and privacy of the people affected by mental disorders or disabilities,” he said.

Their stories

Some of the KPs shared their stories and many revealed shocking and painful incidents from their lives and how they were stigmatized and discriminated against by a section of society in the country.  

A retired major, Jimmy Tshering, recovering from AUD, said for people with substance abuse disorders, stigma can have dramatic consequences as it can create barriers for people seeking or receiving professional help to address their problem, lead to professional isolation of people or unfair dismissal, affect people’s ability to reconnect with their community and access employment and educational opportunities, and also have negative impact on mental and physical health.

“Negative attitudes of health professionals contribute to reduced empowerment of patients, hindering their chances of successful treatment, while we are seen as manipulators and potentially violent, which affects health care,” he added.

Deyon Phuntsho entered school at the age of four and was shunned because he was different.

 “Girls said I was a boy and not allowed to play with them and boys said I was too girly to play with them. Terms like “chaka” were attached to me and for the fear of bullying I isolated myself from others and grew up without friends,” he said.

He recounted being subjected to sexual and physical harassment in high school that severely affected him. He ran and hid during free periods to avoid being harassed. “I couldn’t do well in my exams, which led to poor grades, and slowly recovered with the help of my family and the LGBT+ community and took more and more offers from Lhak-Sam to build my skills,” he said.
The role of the media

The role of the media in social change can be a way to inform and educate the public to curb the problem of stigma and discrimination against the KPs.

Rinzin Wangchuk, the Dzongkha Editor of Kuensel, said it was difficult to educate people, especially for Dzogkha reporters, due to the lack of terminologies in Dzongkha as the issue is new in Bhutan.

He said the media can, however, educate the public, continue to advocate on the issue and inform people that discrimination and stigma has a great impact on these people. “Keep writing about the issue and keep reminding people. Among the media, TV and radio can play an important role in reaching the masses and promoting this issue,” he added.

Tshering Dorji, a consultant and former senior journalist of Kuensel, said all KPs face different levels of stigma and discrimination due to the social, cultural, religious, political and legal realities in Bhutan. “In terms of HIV, stigma and discrimination have become more dangerous than the virus itself. Science and medicine have made so many advances, but unfortunately not the minds of the people,” he said.

“Our findings indicate that stigma and discrimination are the biggest barriers for KPs to access health and social services, which increases their risk of contracting and transmitting HIV. It also pushes them to hide and as a coping mechanism, the use of alcohol and substances is also high. School dropout rates and unemployment are also worrisome, forcing some KPs to resort to sex work,” he added.

A study conducted by a media consultancy firm, OX, reveals various forms of stigma such as innate self-stigma, perceived stigma which is created due to myths and misconceptions people have and enacted stigma which is discrimination. Of these, self-stigma is widespread and yet there are few who have overcome it.

On the role of the media, he said that it is to dispel myths and misconceptions. To educate people and to advocate for change in policies and laws that promotes stigma and discrimination.

In total, there are 212 KPs in the country, including six lesbians, 39 gays, 18 bisexuals, 124 trans men, 26 trans women, three gender queers and one asexual (who is not sexually attracted to anyone) and one pansexual (who is attracted to people regardless of their gender).

 26 of them have no formal schooling, six of them attended primary school (PP -6), 66 secondary school (6-10), 83 secondary school (11-12), while 23 have completed university (12 and above).

As per the distribution by occupations in KPs, 40 of them are students/trainees, 10 are in the armed forces, seven in CSOs, 12 in the entertainment industry, one (contract work), 12 civil servants, 25 private employees, one in a company, 25 unemployed, three in business, one prisoner, janitor and in a religious institution, four overseas and one in others.

Chencho Dema from Punakha