There have been some challenges with respect to my work here which have delayed the start of our project. Consequently, much of my time has been spent on administrative and program issues that don’t involve actual “hands on” HIV/AIDS outreach at the moment. So, why engage in HIV outreach in Mongolia at all when there are more immediate HIV/AIDS concerns elsewhere? While it is true that Mongolia has few reported HIV cases, between 25-35, UNAIDS estimates that approximately 500 people are currently living with the virus in the country. 500 cases is still an infinitesimally small number relative to the estimated 33 million cases of HIV worldwide, however that number is estimated to exist almost exclusively among particularly vulnerable populations in which the spread of HIV can occur explosively and exponentially, particularly with commercial sex workers.
Between 1990 and 1994, when Mongolia was making the transition to democratic governance and a market economy, unemployment and homelessness escalated as social programs collapsed. People migrated into the capital city, Ulaanbaatar, without jobs or prospect of employment. This period saw the advent of what is now a serious problem of street children, which I will address in a later post, and a significant increase in women who were turning to commercial sex work (CSW) to support themselves and their families. Currently, the estimated number of sex workers in Ulaanbaatar exceeds 4000. Many of them engage in their profession in massage parlors or “saunas”, of which often 1 or 2 can be found in every street block. Sex work is also commonly carried out in many of the city’s hotels and, additionally, sex workers ply their trade on the city streets at night. Studies carried out by researchers from Vanderbilt University in the US have shown that, while the incidence of HIV in sex workers in Mongolia is low, the incidence of sexually transmitted infections (STIs) is exceptionally high. Specifically, 67% of the sex workers were positive for at least one STI and 17% were multiply infected. This tells us a couple things: First, at least as recently as the 2006 study, “100% condom use” programs targeting CSWs were not working effectively. Second, because we know that having an STI makes one significantly more vulnerable to HIV infection, we subsequently know that the CSWs in Mongolia are an extremely vulnerable population.
If the story ended there, we might be looking at a long period in which HIV rose almost imperceptibly in the general population; however, we can add a couple additional variables that lead to an inevitable and devastating future if we don’t act aggressively and immediately. Mongolia lies snugly between 2 locations that are experiencing some of the highest HIV growth rates in the world. Since 2001, so we are talking about just 7 years, incidence of HIV cases in Eastern Europe and Central Asia has increased 150%, from 630,000 to 1.6 million. Russia, which comprises our extensive northern border, is estimated to have over 400,000 cases of HIV with an expansion rate that reached as high as 3000 new cases in one month (December 2007, PEPFAR data). China, to the direct south of Mongolia, experienced an estimated 45% increase in HIV cases in 2006 and, although obtaining accurate figures from the Chinese government is difficult, officials admit to an approximate 700,000 people living with HIV. The China Daily news service reported 3000 new cases/month over the course of one year.
Traffic across Mongolia from China to the South and Russia to the north is common. Trading occurs across both borders and Mongolians are reliant on imported goods. Men from both countries come to Mongolia and solicit Mongolian prostitutes and Mongolian prostitutes actively “work” the trade routes across the two borders. Given all of the above data, it is only a matter of time before we see what will seem like an almost overnight increase in HIV rates in Mongolia. This may be one of the few places in the world where we may have the opportunity to actually engage in “HIV prevention” activities. If we do not act now, and if we do not enlist the support of the CSW population, this group of people who can act as our frontline defense against the disease, in less than 10 years time we will be spending billions of dollars doing crisis intervention and damage control.
Make no mistake, this is important work.
In the meantime, I have had the 
wonderful opportunity to go hiking in two of Mongolia’s national parks near Ulaanbaatar.
Terelj National Park 
lies about 80 km northeast of UB and is comprised of over 1 million acres of seemingly inhospitable land and high dirt mountains. If I am not mistaken, we hiked to one of the highest peaks in the park, a grueling hike led by a man m
uch more experienced at hiking and far more physically fit than myself. We blazed our own trails, going essentially straight up in parts and traversing dangerous rockslide areas on the way down. It is only through sheer grit and determination that I am not still up there, curled up in a ball and unable to go on.
My second hike took me to Bogd Khan, the first green area I have
seen since my arrival in Mongolia- complete with white pines, moss, and grass underfoot. My hiking companion, a UN Environmental specialist for many years now, informed me that Bogd Khan is t
he oldest National Park in the world, protected since the 1770s. You can drive to just below the monastery, Manzshir Khiid 
which, after 200 years of serving Buddhist monks, was destroyed by the Soviets in the 1930s and is recently being rebuilt. The mountain, Bodg Khan, 
was officially declared sacred by Chingis Khan, known to westerners as Genghis Khan, and is considered the most sacred mountain in the country. Because it is likely I will make this trek again (I understand it is only a 12 hour hike from Ulaanbaatar), I will simply post some pictures now and describe in more detail at a later date.
