The first case of HIV infection in Mongolia was detected in 1992[2]. Since then, it has remained a low prevalence country with the estimated number of adults and children living with HIV at less than 500 [1]. However, the number of cases has been increasing, constituting 92% of all reported cases in the last five years, or a cumulative total of 62 reported cases [2].  

Mongolia’s population is young, with 40% under the age of 20 and 50% under the age of 25 [3]. Although the 2009 Second Generation Sentinel Surveillance (SGSS) found 0% HIV prevalence among young people aged 15-24 years old, the number of reported cases was high among key affected populations. Of the cumulative reported HIV cases, 68% were found among men who have sex with men (MSM) and 10% among female sex workers (FSWs); 21% of cases were transmitted via other heterosexual sex [2].

To date, no cases of HIV were found among injecting drug users (IDUs) but with the caveat that no standardized behavioural and serological surveys have been conducted among them.  The number of IDUs is small, but the latest round of SGSS found that, among groups sampled, injecting drug use ranged from 0.1% among young people and mobile men, 0.3% among male sexually transmitted infection (STI) clients, 0.5% among FSWs to 0.9% among MSM (down from 2.7% in 2007) [4].

Of the estimated 11,500-15,000 sexually active men with homosexual and/or bisexual orientation in Mongolia in 2006 [5], 86% of HIV-positive males reported themselves as MSM – making up 68% of all reported cases [2].  The 2009 serological surveillance showed that HIV prevalence among MSM had doubled from 0.9% in 2007 to 1.8% in 2009 [6], [7].  In the 2006 rapid assessment of sex work in six districts of Ulaanbaatar, the number of sex workers was estimated to be between 1,500 and 19,000 [8].  Half of all HIV-infected females reported being FSWs, making up 10% of all cumulative cases.  Despite this, the last three rounds of SGSS found 0% HIV prevalence among FSWs, which could be due to SGSS surveys being conducted at sentinel sites in only two cities (Ulaanbaatar and Darkhan) and sampled FSWs likely being more proactive in prevention measures [2].

While the total number of migrants is not known, nearly one million migrant workers and other mobile groups such as truck drivers and traders cross Mongolia’s borders with China and Russia each year [9].  A 2005 study conducted as part of the SGSS found that, out of 342 FSWs surveyed in Ulaanbaatar and Darkhan, 40.6% said that their most frequent clients were truck drivers/mobile traders [10].  Moreover, the 2007 SGSS – which surveyed mobile men from Ulaanbaatar city and five aimags (provinces) along major road and rail networks and/or within a large informal mining industry – reported that 45% of mobile men had had multiple sex partners, 49% had had non-regular, non-commercial partners, and 9% had had sex with a sex worker in the last 12 months preceding the survey [11].  

Among the vulnerability factors include: the intensified rural to urban migration owing to poverty [11]; lack of information and knowledge about sexual health and HIV transmission; shared borders with Russia and China – both of which have been experiencing fast growing HIV epidemics [11]; the likely increase in migration and mobility resulting from the 2009 opening of a new road linking Russia and China via Mongolia [12]; high rates of sexually transmitted diseases; geographical conditions and low population density that hinder effective health service provision, communication and transportation [13]; prevalence of stigma and discrimination and societal pressures against MSM [9], [13]; overall low comprehensive knowledge ( less than 20% in 2009), and risk behaviours of the young population. For instance, the 2009 SGSS found that 24% of young females and 43% of young males had sex with more than one partner in the past 12 months [14]; and 17% of young females and 29% of young males (15-24 years) reported consistent condom use with non-regular, non- commercial partner during last 12 months in 2009 [14].

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010

[2] Mongolia, UNGASS Country Progress Report, 2010

[3] National Statistical Office of Mongolia, (2007). Mongolian Statistical Yearbook 2006, Ulaanbaatar, as cited by the National Committee on HIV/AIDS

[4] Second Generation HIV/STI Surveillance Report, 2007 & 2009, cited in UNGASS Country Progress Report, 2010

[5] 2006 Rapid Assessment of Sexual Behaviour among Men who have Sex with Men (MSM), as cited by the National Committee on HIV/AIDS

[6] Mongolia, SGS 2007 and 2009 cited in Mongolia, UNGASS Country Progress Report, 2010

[7] Note that this serological surveillance data is limited to Ulaanbaatar.

[8] National AIDS Foundation, Mongolian Public Health Professionals Association, and Global Fund Supported AIDS & TB Project GFATM, (2006). Rapid Assessment of Sex Work in Ulaanbaatar City, as cited by the National Committee on HIV/AIDS

[9] Comprehensive Review of the National Response to HIV and STIs in Mongolia. October 2008

[10] Enkhbold S, Tugsdelger S, et al.  “HIV/AIDS related knowledge and risk behaviors among female sex workers in two major cities of Mongolia.” Nagoya Journal of Medical Science, 2007 Oct;69(3-4):157-65

[11] National Committee on HIV/AIDS, Comprehensive Review of the National Response to HIV and STIs in Mongolia. Mongolia, 2008. Available online.

[12] Global Fund to Fight AIDS, TB and Malaria, (2006). A Place Of Extremes - Fighting TB & HIV In Mongolia. Available online.

[13] Davaalkham J, Unenchimeg P, et al, “High-risk status of HIV-1 infection in the very low epidemic country, Mongolia, 2007” International Journal of STD and AIDS, 2009 Jun;20(6):391-4

[14] Mongolia, Preliminary Data, Second Generation Sentinel Surveillance, 2009, cited in UNGASS Progress Report, 2010