Evolving Understanding of the Epidemiology of HIV and Prevention Needs among Men Who Have Sex with Men in Ulaanbaatar, Mongolia

Azyei, Iliza; Aumakhan, Bulbul; Jantsansengee, Baigalmaa; Munkhbaatar, Sergelen; Gombo, Erdenetuya; Puntsag, Unenchimeg; Jagdagsuren, Davaalkham; Ketende, Sosthenes; Strömdahl, Susanne; Baral, Stefan; Sovd, Tugsdelger; Amindavaa, Oyunbileg

doi:10.1007/s10461-014-0780-5

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Mongolia has experienced a gradual rise in STIs including syphilis since the Soviet Union collapsed in the 1990s (Ebright, Altantsetseg, & Oyungerel, 2003; Garland, Tabrizi, Chen, Byambaa, & Davaajav, 2001; Purevdawa et al., 1997; Schwebke, Aira, Jordan, Jolly, & Vermund, 1998) and STIs account for over one-third of all reportable diseases (Baigalmaa et al., 2012). Reported adult syphilis and congenital syphilis cases rose over 2004–2015 (Azyei et al., 2014; Baigalmaa et al., 2012; Erdenetungalag et al., 2017), and an outbreak was reported in 2012 (Munkhzul, Batdorj, & Baigalmaa, 2012). STI control is a health sector priority in Mongolia, but the STI program lacks human and financial resources, and coverage of ANC, syphilis screening and treatment in ANC are incomplete.…”

Section: Introductionmentioning

confidence: 99%

Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Enkhbat

Korenromp²,

Badrakh

et al. 2018

Infectious Disease Modelling

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IntroductionMongolia's health ministry prioritizes control of Sexually Transmitted Infections, including syphilis screening and treatment in antenatal care (ANC).MethodsAdult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool, using data from ANC surveys and routine screening over 1997–2016. Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis (CS) and CS-attributable adverse birth outcomes (ABO), which we compared with CS case reports.ResultsSyphilis prevalence in pregnant women was estimated at 1.7% in 2000 and 3.0% in 2016. We estimated 652 CS cases, of which 410 ABO, in 2016. Far larger, annually increasing numbers of CS cases and ABO were estimated to have been prevented: 1654 cases, of which 789 ABO in 2016 − thanks to increasing coverages of ANC (99% in 2016), ANC-based screening (97% in 2016) and treatment of women diagnosed (81% in 2016). The 42 CS cases reported nationally over 2016 (liveborn infants only) represented 27% of liveborn infants with clinical CS, but only 7% of estimated CS cases among women found syphilis-infected in ANC, and 6% of all estimated CS cases including those born to women with undiagnosed syphilis.Discussion/ConclusionMongolia's ANC-based syphilis screening program is reducing CS, but maternal prevalence remains high. To eliminate CS (target: <50 cases per 100,000 live births), Mongolia should strengthen ANC services, limiting losses during referral for treatment, and under-diagnosis of CS including still-births and neonatal deaths, and expand syphilis screening and prevention programs.

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Section: Introductionmentioning

confidence: 99%

Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Enkhbat

Korenromp²,

Badrakh

et al. 2018

Infectious Disease Modelling

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“…Men who have sex with men (MSM) and transgender women in low- and middle-income countries have more than 19 times higher odds of living with HIV compared to other reproductive age adults [ 3 ], while transgender women globally when studied alone had nearly 50 times higher odds of HIV infection [ 5 ]. In Mongolia, a lower-middle income country where homosexuality is legal but stigmatized and not protected by anti-discrimination legislation [ 6 ], 61% of all cumulative HIV cases observed until 2014 have been among MSM and transgender women, and HIV prevalence appears to be growing in this population [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Sexual Violence against Men Who Have Sex with Men and Transgender Women in Mongolia: A Mixed-Methods Study of Scope and Consequences

et al. 2015

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The role of sexual violence in health and human rights-related outcomes, including HIV, is receiving increasing attention globally, yet the prevalence, patterns, and correlates of sexual violence have been little-studied among men who have sex with men (MSM) and transgender women in low and middle income countries. A mixed-methods study with quantitative and qualitative phases was conducted among MSM and transgender women in Ulaanbaatar, Mongolia. Methods included respondent-driven sampling (RDS) with structured socio-behavioral surveys (N = 313) as well as qualitative methods including 30 in-depth interviews and 2 focus group discussions. Forced sex in the last three years was reported by 14.7% of respondents (RDS-weighted estimate, 95%CI: 9.4–20.1; crude estimate 16.1%, 49/307) in the quantitative phase. A descriptive typology of common scenarios was constructed based on the specific incidents of sexual violence shared by respondents in the qualitative phase (37 incidents across 28 interviews and 2 focus groups). Eight major types of sexual violence were identified, most frequent of which were bias-motivated street violence and alcohol-involved party-related violence. Many vulnerabilities to and consequences of sexual violence described during the qualitative phase were also independently associated with forced sex, including alcohol use at least once per week (AOR = 3.39, 95% CI:1.69–6.81), and having received payment for sex (AOR = 2.77, 95% CI:1.14–6.75). Building on the promising strategies used in other settings to prevent and respond to sexual violence, similar strengthening of legal and social sector responses may provide much needed support to survivors and prevent future sexual violence.

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“…(9.8%) but low incidence (0.10/100 PY) of HIV-1 infection in this cohort. The nationwide SGS surveillance conducted every two years reported the prevalence of HIV-1 infection in MSM of 0.85%, 1.8%, 10.7%, and 13.7% for 2007, 2009, 2011, and 2014, respectively (5)(6)(7)9). These data indicate that HIV-1 infection in MSM increased steeply before 2011.…”

Section: Table 2 Prevalence and Incidence Of Syphilis In Our Men Whomentioning

confidence: 99%

Prevalence and incidence of HIV-1 infection in a community-based men who have sex with men (MSM) cohort in Ulaanbaatar, Mongolia

Takano

Jagdagsuren

Gombo

et al. 2020

GHM

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The number of HIV-1-infected men who have sex with men (MSM) Mongolian patients started to increase steeply just before 2011. We started collaborative work with community-based organizations that promote safer sex and HIV testing for MSM since mid-2010. Since early 2013, the Mongolian Government has implemented the treat-all strategy for MSM. To determine the efficacy of these countermeasures, we established an MSM cohort in the capital of Mongolia, Ulaanbaatar, in December 2013. HIV antibody was examined at every visit by rapid test. Syphilis was also examined to monitor their sexual behavior. Clients positive for either rapid test were referred to the National Center for Communicable Diseases, Ulaanbaatar, to confirm the results and treatment. Since safer sex promotion is one of the purposes of this cohort, HIV-positive clients were also eligible to participate. A total of 849 MSM were registered and 2,409 HIV/syphilis tests were conducted until December 2017. During this period, 499 (58.8%) clients visited the testing sites repeatedly. Among the 849 clients, HIV-1 infection was confirmed in 83 at registration (prevalence of HIV-1: 9.8%). One HIV-1 seroconverter was identified (from negative to positive), resulting in incidence of HIV-1 of 0.10/100 person-years (PY). Syphilis was positive in 144 cases at registration (syphilis prevalence: 17.0%), and 53 new syphilis infection cases were diagnosed during the same period, with an incidence of 5.66/100 PY. Despite the high prevalence of HIV-1, the incidence was very low. The results suggest that countermeasures for HIV-1 prevention seem effective in this cohort, however, we still need further strategies for syphilis control.

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Evolving Understanding of the Epidemiology of HIV and Prevention Needs among Men Who Have Sex with Men in Ulaanbaatar, Mongolia

Cited by 4 publications

References 8 publications

Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Sexual Violence against Men Who Have Sex with Men and Transgender Women in Mongolia: A Mixed-Methods Study of Scope and Consequences

Prevalence and incidence of HIV-1 infection in a community-based men who have sex with men (MSM) cohort in Ulaanbaatar, Mongolia

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