Mongolia

Alliance linking organisation: National AIDS Foundation (NAF)

Mongolia has a low HIV prevalence (less that 0.1%), with only 25 reported cases of HIV (by 2006) among a population of 2.6 million. However, the situation is changing rapidly with 15 of the 25 cases reported in 2005 and 2006. This suggests a dramatic shift since the first case was reported 18 years ago. More than 70% of the officially reported cases are among men who have sex with men, and many think that the country's vulnerability to the epidemic has been underestimated. According to UNAIDS estimates, at least 500 people are infected with HIV in Mongolia.

Although the numbers are small at present, there are a number of factors that make Mongolia vulnerable to HIV. These include: a high incidence of sexually transmitted infections (STIs), with 50% of all registered infectious diseases STIs, around 15,000 to 20,000 annually; the prevalence of high-risk behaviours; increasing numbers of sex workers; low condom use; poor access to and variable quality of essential services, particularly STI testing and treatment; increased levels of domestic violence and alcohol abuse; and high levels of poverty. There is also a rapid increase in HIV in Mongolia's neighbouring countries, Russia, China and Kazakhstan, where the epidemic is fuelled primarily by injecting drug use. There are high levels of international migration between these countries. Although programmes for STIs and HIV have been established, prevention efforts have also been hampered by insufficient enforcement of policies and procedures within the health care system.

What we do

In Mongolia, the Alliance linking organisation National AIDS Foundation (NAF) initiates and promotes community responses to STIs and HIV. The Foundation provides onward financial support to locally based NGOs and community based organisations, contributes to national and local policy development, and improves access to and use of quality information on HIV and STIs.

Our programme in Mongolia is currently being supported with funding from the Global Fund. Past donors have included the EC Tacis Programme, Comic Relief and the UK Department for International Development.

Since 1999, NAF has been working to generate interest and action on HIV within communities and to ensure that programmes are designed to meet the needs identified by these communities. NAF also supports non-governmental organisations undertaking prevention work with vulnerable and marginalised populations, such as sex workers, men who have sex with men, prisoners, children and young people, and mobile/migrant populations. NAF is currently supporting activities in areas of Mongolia considered to be most vulnerable to HIV, including Ulaanbaatar and border areas and towns such as Darkhan, Orkhon, Dornogovi, Umnogovi and Dornod aimags.

Through programmatic and organisational support, NAF mobilises and strengthens the community response to HIV and sexual health. Programmatic support includes training in areas such as sexual health, project design, monitoring and evaluation, fundraising and advocacy. Organisational support includes financial and administrative management. NAF also promotes the participation of civil society in the response to STIs and HIV, working with a wide range of partners to improve the institutional and policy environment.

NAF runs a national resource centre, developing and disseminating a wide range of up-to-date and targeted information throughout the country. It also develops information materials for the general public and for specific populations such as sex workers and mobile men. Information products include Information, Education and Communication (IEC) materials as well as toolkits and method guides. In addition to its own website, NAF also runs an award-winning website for young people.

What we have achieved

To date NAF has provided financial and technical support to 45 non-governmental and community-based organisations to work in the area of HIV and STIs.

Ongoing and intensive programmatic and organisational support has strengthened NAF's NGO partners and contributed to a number of new NGOs starting work on HIV/STIs. With support from NAF, NGOs initiated and run by men who have sex with men and by sex workers have been established. This is particularly noteworthy as these are the first of their kind in Mongolia. A number of NGOs have been successful in attracting alternative sources of funds and contributing to local and national policy initiatives.

Targeted HIV prevention efforts have had some positive influence on reducing unsafe sexual behaviour among sex workers and men who have sex with men. For example, in Darkhan, condom use has increased to 80% among sex workers and the STI rate has halved between 2000 and 2005.

NAF has recently introduced a new voluntary counselling and testing (VCT) strategy for vulnerable groups such as sex workers, men who have sex with men, injecting drug users and mobile traders. A mobile VCT unit was established in 2005 and provides testing and counselling. As a mobile clinic, the service offers a flexible and accessible option for people who are either hard to reach or who cannot access existing services. NAF also supports Mongolia's first group of people living with HIV, 'Positive Life'. The group was set up with an initial aim to provide peer support and counselling to people recently diagnosed with HIV. Due to the nature of the Mongolian epidemic this is a very nascent group.

The introduction of VCT work aims to link care and support and prevention services for vulnerable populations. NAF together with its partners has established excellent working relationships with key healthcare staff which has led to the development of referral services and links to STI clinics. These linkages with STI services will be built on further to develop the VCT aspect of the programme. NAF has also successfully forged partnerships with national and local government agencies, health structures and international agencies in Mongolia, contributing to local and national level policy.

Future plans

In 2007, the programme will continue to aim to strengthen the VCT component of the work and to play a key role in the development and implementation of the nationwide strategy for VCT, with a particular focus on the provision of services for marginalised groups. The programme will also work on defining and strengthening the links between sexual and reproductive health and HIV prevention work.