Interview
We Were Taught to Be Silent: Debt2Health as a turning point for youth-led organizations in Mongolia
This text is based on an interview between Tilman Rüppel from medmissio and Action against AIDS Germany and Anuka Anar, director of Youth LEAD Mongolia, that took place in Berlin on October 13, 2025, right after a plenary on the Debt2Health (D2H) initiative. The initiative, developed by Germany and the Global Fund in 2007, was jointly organized by Action against AIDS and the Global Fund Advocates Network (GFAN). The Global Fund’s D2H mechanism allows countries to convert part of their debt obligations into investments for combating HIV/AIDS, tuberculosis, and malaria, as well as for strengthening health systems. Germany has played a pioneering role and has concluded agreements worth several hundred million euros with multiple countries implementing Global Fund grants. With this first in a series of interviews, we explore the impact of the initiative on civil society and key populations in various countries
We were taught to be silent
“In our culture, young people are taught to be silent, even if our rights are violated or when we are not protected by our government,” says Anar Anudari, known as Anuka, Executive Director of Youth LEAD Mongolia. “We are taught to be silent and obedient to those in power. The nature of our organization is to fix that silence.”
Anuka is the Executive Director of Youth LEAD Mongolia, a grassroots organization that empowers young people to speak up for their health, rights, and dignity. In a country still navigating its post-socialist transformation, her work challenges deep-seated cultural taboos around sexuality, gender, and HIV.
“Because we have been silent for so long, many young people don’t know what is wrong or why it is wrong,” Anuka explains. “The first step is to show them that they can speak. Then they need to learn how to speak, and finally, we must make sure someone listens.”
From silence to voice
Despite low HIV prevalence, social stigma remains high in Mongolia. Fear of discrimination keeps many from seeking healthcare, particularly young people living with or vulnerable to HIV. “The healthcare system often leaves people out,” Anuka says. “Those without power to demand their rights are the ones most often left behind.”
Anuka’s work unfolds at a time of economic and political transition. Mongolia, like many lower-middle-income countries, carries a heavy debt burden. “Our government has a lot of debt,” she says. “Money that should go to healthcare often goes to repaying debts from previous generations.”
Debt2Health as a turning point
In recent years, Mongolia has become one of the countries implementing a Debt2Health agreement, a mechanism developed by Germany and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through the agreement, part of Mongolia’s bilateral debt to Germany was converted into new investments in health, specifically HIV prevention and control.
“Debt2Health created space for our government to listen, not only to the Global Fund, but also to the community,” says Anuka. “That was a turning point. For the first time, we could step in and be part of the conversation.”
Through the agreement, Mongolia redirected funds into HIV prevention and testing, areas often underfinanced by domestic budgets that focus primarily on treatment. “Debt2Health filled the gap,” Anuka explains. “It supported prevention and outreach to rural and migrant workers, people who are usually invisible in national programs.”
Strengthening participation
For Anuka, the initiative’s impact goes beyond financing. It also strengthens community participation in national decision-making through the Country Coordinating Mechanism (CCM), a multi-stakeholder body that oversees Global Fund programs.
“Having space in the CCM means having a voice in decisions,” she says. “It’s where we can influence priorities and ensure that programs reflect real community needs.”
Continuing challenges
Yet, structural barriers persist. In Mongolia, people under 18 cannot take an HIV test without parental consent. “That means a 16-year-old has to tell their parents, ‘I’ve had sex, maybe with someone of the same gender,’” Anuka explains. “So they simply don’t get tested.”
New HIV cases among young people aged 15 to 24 have emerged in recent years, highlighting the urgency of reform. “We are advocating for the government to change this law,” she says. “Human rights and health go hand in hand. Young people should not have to choose between their privacy and their life.”