Here is an interesting interview I found on what I consider to be the best blog on Mongolia right now. It can be found at:
http://mongolia.neweurasia.net/The interview is provided below:
All quotations from this interview must be attributed as follows: “‘Mongolian Minister of Health L. Gundalai on HIV/AIDS in Mongolia,’ an Interview by Luke Distelhorst,
http://mongolia.neweurasia.net/”
May 8, 2006
Luke Distelhorst: From 1992 through March 2006, there were only 15 official cases of HIV/AIDS in Mongolia. Now since April 2006, there have been five new cases.
Lamjaviin Gundalai: Yes, last year before 2005 there were only 10 cases. In 2005 it went up to 15. When I took office, I saw the balance, and last year we had many more AIDS cases. I took action; it was very obvious that AIDS is spreading in Mongolia. I am a Mongolian and a medical physician, I studied medicine in Germany. I have the duty to make the public aware of the issue of HIV/AIDS. You know Mongolians are so sexually liberal. They sleep with each other like animals. There are no rules or customs in Mongolia. Mongolia is one of the most liberal countries in the world. We are an Asian country, but we are not like other Asian countries in terms of sexual liberties. Therefore this one indication that AIDS can spread quickly in Mongolia. Second is the poverty; 60-70% of Mongolians are poor. They cannot afford condoms; they have a lack of money. When they have some money they will use it for food, or vodka or cigarettes. Now they hear they have to use this money for condoms instead of vodka or some other nonsense. Therefore, my duty as Minister of Health was to inform the people about HIV/AIDS. I started a campaign, “Mongolians must learn to use condoms like they ride horses!” Also during the socialist times there was a slogan from Lenin, “Learning, learning and learning.” Now I have changed it to, “Condom, condom and condom.” All Mongolians know these slogans. Now I have said, “Tsövüün tsag,” [devastating times], it is not bad now, but will soon be much worse. I have sent these three messages myself. It is the first time that all Mongolians are aware of the danger. All of the people in the countryside say, “Oh, aids it can be here with us.” All people are now aware. For 14 days we had commercials on seven different channels, all day. I asked stations to give us good air time and reasonable prices. They gave us very cheap prices, normally they would charge us USD$60,000/year, but they made us pay only $6,000. It was only 1/10th of the price. I told them I would give them only $900 and they had to play 10 different commercials for two weeks at the most popular times that people watch TV, all against HIV/AIDS. This is very cheap and effective. Now people know about this danger, and we have reached one of our goals.
LD: Some Mongolian journalists wrote, and some people thought, that the only people who could get HIV/AIDS were sex workers and drug addicts. How is the Ministry of Health (MOH) combating these falsehoods, especially in countryside areas where educational materials are hard to come by?
LG: The Mongolian people are crazy for TV; they always watch TV, from 9 in the morning until 1 at night. There isn’t a whole lot of entertainment in Mongolia, especially in the countryside. A lot of herders have satellite dishes, and if a neighboring family doesn’t have a dish they all go to the family that has a TV. Also there is a lot of, “mouth to mouth advertising,” or conversation. Now it has reached every family in Mongolia. We made these commercials deliberately like this. In Mongolia we have a saying that if you say something one time, it will be repeated ten more times. Also in Mongolia we have a lot of sexually transmitted infections (STI). So if we can educate people to use condoms we can also stop the transmission of STI.
LD: Yeah, a 2003 UNDP report said that 58% of sex workers in Mongolia had at least one STI.
LG: Yes I know. It is a very high number.
LD: The World Health Organization (WHO) advises against coercing any group for testing, not only high risk groups, but testing people from all walks of life. In 2002 the MOH admitted to secretly testing people they felt were high risk. Is this something that they are still doing?
LG: My first goal is not to test the people. My task is to prevent. Healthy, responsible people will not get infected. When someone has AIDS, then it is their problem. When we let the people know about these dangers and they use condoms, are abstinent or are faithful to their partners then we can stop the spread. My problem is not for those who have contracted HIV/AIDS. They have been infected and we can’t do anything. So my goal is to first inform the people about these dangers and make them use condoms. In this way, we think that we can stop the spread in Mongolia. Generally now people are afraid of getting AIDS! So then the problem is solved. Now everyone knows that AIDS is dangerous and that there are a lot of cases in Mongolia. All of the people, not only the people in Ulaanbaatar, but the countryside as well; young, old, rich, poor, now they all know, but we will not stop.
LD: Right, but for international people coming to Mongolia, are they tested? AIDS groups working in China, just to the south, have speculated that there are as many as 700,000 infected with HIV/AIDS. Now when people come here to live, what is the system? I know that international students need to be tested, but there are thousands of impoverished laborers here as well.
LG: Yes, these people do not have the requirement of being tested. At the same time I am working with the Ministry of Labor to try and write a resolution together so that every worker who comes here for a long time has to give an HIV test. We have agreed on this and we don’t need a law for it. We can do this within the ministries and put this into use. Also I am planning to pass a law in Parliament that every bottle of vodka and every pack of cigarettes must have a condom with it. This will help us reach everywhere. Just like TV, there are cigarettes and vodka every where in Mongolia. We want to put condoms in all of these places as well.
LD: There are a couple of NGOs that have worked with homosexuality and HIV/AIDS in Mongolia. Is the MOH also working with these groups to not only look at heterosexual transmission, but homosexual as well?
LG: Homosexual transmission is very rare in Mongolia. It is just a few people. Maybe a couple thousand people and it is their problem. We do not go to them and test them. Again, we are working for education.
LD: In 2004 there was a law that was passed to protect the identities and rights of those people who were found to be infected. Not too long ago there was the incident where a woman’s boss claimed she had AIDS, it was printed in the Mongolian papers and her husband beat her to death. She, in fact, did not have AIDS. How can we protect people from situations like this one?
LG: This was a bitter lesson for Mongolia. Now newspapers or TV will not broadcast about someone who may or may not have HIV/AIDS. Mongolia is small, everyone knows each other. It was a bad lesson, but at least now people have learned what they shouldn’t do. I don’t think we will see those things in the newspaper or media again.
LD: Two weeks ago on The Forum Show, the first TV interview with a Mongolian who has AIDS was broadcast. How important was that for Mongolians to see another Mongolian who has AIDS, and hear that person talk about it in a more personal way?
LG: I think such kinds of TV are very important in Mongolia. People understood quite well, about how that young man is living. Now people are afraid of getting AIDS.
LD: As you mentioned before many people cannot afford condoms. Many places, such as schools, universities and clinics, in developed countries have condoms available for free. In Mongolia the companies that sell condoms keep the prices low, and only make enough money to cover the import costs. Is the MOH working to make condoms widely available for free for the impoverished citizens of Mongolia? In surveys, Mongolian youths reported that they are having sex for the first time at the ages of 16-17.
LG: [big sigh] ah, this is a problem. I have never seen free condoms in Mongolia. The Global Fund distributes some free condoms to the countryside and some groups of people, but in reality the shops or kiosks resell these condoms. I have never heard of or seen free condoms in Mongolia.
LD: In 2003, before you became the Minister of Health, the MOH stated that as many as 200 people had already died of AIDS, and up to 1,000 are currently infected. How much have those numbers changed in the last three years?
LG: I think this figure is low. I think there are even more, which is a quite significant figure.
LD: Some Mongolians are very poorly informed and think that they can only get HIV/AIDS from foreigners.
LG: Yes, this is also a problem. The last case, number 20, he contracted it from Mongolian sex workers. We said this on TV that he got it within Mongolia. We need to say to the people that it can be everywhere. This is our message, if you don’t use condoms it can hurt you.
LD: Also a couple weeks ago there as a student march which involved many young people, and the commercials you have put on TV primarily use young, popular figures. Singers, athletes, etc.
LG: We sent out 12 different messages with pop and hip hop singers, MP S. Oyun, big wrestlers and even myself. This kind of message is quite interesting because the youth listen to these people. Now the youth are saying, “AIDS is in Mongolia, you must use condoms.” Under each message we say, “use condoms.” We don’t have too many drug users, and we still don’t have a confirmed case of AIDS that has come from blood transfusion. All of our cases have been sexually transmitted.
LD: Back on the Mongolian media, some papers will only report the short facts and stats of new AIDS cases, and don’t go into the disease in a personal way that more people will be able to relate to. How can the MOH get involved to help the others relate to those who have been infected and show that there aren’t any differences?
LG: When we had the 18, 19 and 20th cases, each time we gave a press conference and said if the person was male or female, how old, how they contracted it, etc. But the media only writes what they like, they don’t write too much. We invited them and gave them all the information we could and convinced them to write. All of the MOH people were there, and they asked us many questions, but they didn’t write anything. We told them to report this issue well, and told them that if they did a good job we could give them Tg10 or 20,000. But they didn’t do it. This is one dilemma in Mongolia; all of the newspapers have their own bosses. Most of the bosses are politicians and are affiliated with certain parties. I am the chairman of a new party, I don’t have a TV station or paper, and other groups don’t want to broadcast about what we have done here. This is why we asked them to put these stories on the front page or maybe the second page and we could pay them a little more. We had fundraising and got money for advertisement about HIV/AIDS. Without this funding for advertising it will not go through and get into the mass media.
LD: What is the current main focus of the MOH on HIV/AIDS? Finding out how many cases actually exist, or education and prevention?
LG: Prevention and education is the easiest thing we can do. Mongolia is not a rich country, and right now we don’t have much money. We can’t treat all the people and most of the time we don’t have sufficient equipment. Now we are planning to have a forum on TV that will be only about health in Mongolia. We have talked with many TV stations, and they want USD$1,000/week. So for a year it is almost $60,000 and the MOH doesn’t have this kind of money. Even National TV which is now public, asked us for Tg1.6 million per week, which is USD$1,300. This is for a 50 minute program, only about health, once a week. Even they don’t support us at all. The old forum show covered all topics in Mongolia and is now done, but the new one that we want to start will only cover health. There are a lot of topics that need to be covered on health! Some of our future campaigns are going to cover traffic accidents and household accidents that can be easily prevented. In traffic, every five days, one child is killed by a car accident. Every second day, one adult dies in a car accident. It is like a small war in Mongolia. Also in Naadam so many small children get injured falling off of their horses. Also in winter they still race their horses and get frostbite and eye damage. More than 10,000 children get injured in horse races every year. We must stop this, this is so stupid, and we aren’t caring enough for our children. There are many simple things that Mongolians don’t know about how to protect our children. Every year, 70 children die from drinking poisonous items like acid that are kept in refrigerators. We will address problems like this that are so easy to fix, and say it on TV so many people will hide or destroy these poisons. Also we need to work on stopping the import of such items. Mongolians have a lack of knowledge about these problems.
LD: Is the MOH going to print out educational books and pamphlets for those who do not have access to TV, especially in the countryside?
LG: No, no. I spoke with all of the HIV/AIDS organizations here and told them, “Let’s all work together, we need to be united.” Then we can have joint programs and have better results. For instance the Global AIDS Fund spends a lot of money on brochures and books, but I said this is bullshit. The most important things in Mongolia are TV and radio. Nothing more. If you want to spend money against HIV/AIDS, give your money to TV and radio, and since then they have paid three times as much as we have for advertising and educational programs. I also said that I will go to these stations myself to meet with the directors, and I did. I went there with less than $1,000 and told them that they must do this, this is for the Mongolian people, and they agreed. Before I sent my workers, and the directors said they had to pay $60,000. I don’t have this money! The education is most important though. I also want to improve primary health care in Mongolia. We have too many specialists, and not enough general practitioners. In developed countries these general doctors and family practice doctors can treat up to 80% of the patients. In Mongolia, it is only 20%.
LD: Well thank you for your time.
LG: Thank you and I hope we can fight against HIV/AIDS in Mongolia. AIDS has already spread so much in Mongolia, and we can’t stop what has already happened, but we need to stop the spread and save our future generations. I want to make the people aware, and make sure they protect themselves, because we can’t protect them.
END
I would love to hear what you experts in HIV/AIDS think of this interview.
You can either post a comment here or send me your thoughts via e-mail.
Talk to you about Mongolia soon. We leave in two days!
Tomorrow the real work begins, I have to register with the polic, the embassy, the American Center for Mongolian Studies as well as meet the Mongolian physician who will be carrying out the interviews with me in Husvsgul as well as my friend Khurelee's father who used to work at the Ministry of Health. He will be a great source of information. You will certainly hear more from me about that later. I am off to bed, still having a little trouble with the time adjustment. However, it is to be expected, I am not as young as I used to be. All the best.
