HIV and sexually transmitted infection-related risks among female sex workers in Mongolia: second-generation surveillance survey, 2011-2012.
BACKGROUND
Surveillance studies among female sex workers (FSWs) in Mongolia have found no HIV but high rates of syphilis, ranging from 10.7% in 2002 to 20.8% in 2007.


OBJECTIVE
To determine the current prevalence of HIV and syphilis among FSWs, and to identify syphilis risk factors.


METHODS
761 FSWs were recruited by time-location sampling between 2 January and 29 March 2012 in Ulaanbaatar city, Darkhan-Uul, Orkhon, Khuvsgul and Dornod provinces in Mongolia. Participants were administered an anonymous structured survey. Blood samples were tested for HIV and syphilis. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with syphilis.


RESULTS
The mean age of participants was 31 (median 30, interquartile range 24-38). HIV knowledge was modest: 41.3% correctly answered all questions. Consistent condom use with clients was reported by 49.1% of participants and exposure to HIV prevention programmes by 50.1%. Although no cases of HIV were found, syphilis prevalence was -27.8% (95% CI 24.3% to 31.7%). In multivariate analyses, variables associated with syphilis were younger age (age >30 years, OR=0.96, 95% CI 0.92 to 0.99) and occurrence of genital ulcer (OR=2.24, 95% CI 1.17 to 4.28).


CONCLUSIONS
A syphilis epidemic continues to grow among FSWs in Mongolia. These women are at high risk of HIV transmission if introduced into their sexual networks. With the increase in migration of mining workers in Mongolia, introduction of HIV may be imminent. Efforts to intensify treatment and prevention programmes among FSWs are needed.
Global Fund Supported Projects on HIV/AIDS and TB, Ministry of Health, Ulaanbaatar, Mongolia.
Sergelen
S
Munkhbaatar
HIV/AIDS and STI Surveillance and Research Department, National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
Bulbul
B
Aumakhan
Mongolian Field Epidemiology Training Program, Ministry of Health, Ulaanbaatar, Mongolia.
Baigalmaa
B
Jantsansengee
Global Fund Supported Projects on HIV/AIDS and TB, Ministry of Health, Ulaanbaatar, Mongolia.
Iliza
I
Azyei
HIV/AIDS and STI Surveillance and Research Department, National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
Zolzaya
Z
Sanjaajamts
HIV/AIDS and STI Surveillance and Research Department, National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
Jugderjav
J
Badrakh
Monitoring, Evaluation and Internal Auditing Department, Ministry of Health, Ulaanbaatar, Mongolia.
Tugsdelger
T
Sovd
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Susanne
S
Stromdahl
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Stefan
S
Baral
Global Fund Supported Projects on HIV/AIDS and TB, Ministry of Health, Ulaanbaatar, Mongolia.
Oyunbileg
O
Amindavaa
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008986:Mongolia / Q000453:epidemiology; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology*; D014456:Ulcer / Q000453:epidemiology; D055815:Young Adult
BEHAVIOURAL SCIENCE; COMMERCIAL SEX; DEVELOPING WORLD; EPIDEMIOLOGY (GENERAL); GENITOURINARY MEDICINE