A Healthy and Wise Choice - Mongolia

Using public service announcements on radio and TV, billboard and bus ads, and 200,000 leaflets, the campaign worked to break down cultural taboos that make it difficult to discuss sexuality and to create a social atmosphere in which young people could feel more comfortable learning about, and implementing, safer sex practices.

HIV/AIDS, Youth.

Although the reported number of HIV/AIDS cases in Mongolia is still low, a growing number of other sexually transmitted infections (STIs) indicates a relaxed attitude toward safe sex. Health officials from Mongolia and around the world are working to increase public awareness toward, and implement prevention programmes about, this problem before it is too late.

Mongolia presents a unique set of challenges for organisations working to stop the spread of HIV. The sprawling steppes and vast expanses of the country's rugged Altai Mountains and Gobi Desert make travel and communication difficult. Only 2.7 million Mongolians live in an area three times the size of France. Many live in remote rural settlements or in nomadic groups tending their herds of horses, cattle, and sheep. The remainder of the population lives in several sprawling cities, with more than 800,000 people in the capital Ulaan Bataar. In addition, more than half of the population is under 30 years of age. These young people are more sexually active than were previous generations. Rising levels of STIs and the first reported cases of HIV/AIDS are the warning signs of health-care problems to come.

Following the disintegration of the Soviet Union, Mongolian officials, along with UN agencies, implemented small-scale HIV prevention initiatives, but there was no coordinated mass media campaign to educate the public. Although only two cases of HIV/AIDS have been officially reported in Mongolia to date, indications are that the stage is set for a significant epidemic. Registered cases of STIs such as syphilis and gonorrhoea are sharply increasing and many researchers feel the official figures underestimate the actual HIV/AIDS situation. Mongolian health authorities acknowledge the danger of an epidemic and the need to start prevention activities. In 1999, they contacted MSF, an international humanitarian organisation that had been implementing HIV prevention programmes in Russia for three years. That same year, an MSF team began a two-pronged approach - a pre- and post-HIV counselling programme and the "A Healthy and Wise Choice" campaign. In the past, Mongolia implemented involuntary HIV testing or testing without informed consent. MSF has worked to change this policy through the implementation of a voluntary counselling and testing programme with the results incorporated into a countrywide HIV prevention approach. This programme, which provides training for health professionals who administer HIV/STI tests, resulted in the creation of a national training team representing disciplines like psychology, venerology, and gynaecology. To date, more than 250 health-care providers from all 21 provinces of Mongolia have participated in these training courses, which provide teaching materials, round-table discussions, and evaluation visits to test sites. Training teams have also received additional instruction in basic psychology, social marketing, and fundraising. About a third of those who have participated in the training programme have gone on to conduct their own programmes, sharing facts, information, and strategies about continuing the spread of the programme throughout the country.

Although the campaign was originally designed only for Ulaan Bataar youth, interest in and demand by doctors and other health-care providers soon spread the message across the country. A survey following completion of the campaign showed overwhelming support for the campaign message, with nine out of ten Mongolian respondents saying that the education effort should continue. Nonetheless, MSF programme coordinators continued to find many youth reluctant to discuss safe sex issues with their partners. While most were aware of the campaign, less than one-third were regularly using condoms, mostly because they were too shy or reluctant to broach the issue.

A survey of the effectiveness of the second campaign is still underway, but initial indications are that more and more Mongolians are getting the message and heeding the warning. The campaigns appear to be relaxing many of the traditional cultural barriers and improving the knowledge, attitudes, and behaviour of Mongolian young people toward HIV/AIDS and safer sex issues. Mass media campaigns are scheduled to continue.