Opinion: 3 key ways to fight the HIV crisis in Ukraine

Despite Ukraine’s severe displacement crisis after almost seven months of war and significant damage and losses caused by the hostilities, collaboration between Ukrainian and international partners, along with support from NGOs, donors, and volunteers is a cornerstone of the country's approach to providing HIV services. It has helped to ensure patients’ ongoing access to medicines and secured funding for medical services.

Evidently the challenges are high. Hostilities in Ukraine are happening in the regions with the highest HIV prevalence and disrupting the medicine supply chain. Simultaneously, the country’s western regions are experiencing an influx of internally displaced people but have limited infrastructure and capacity to provide services to them, especially when it comes to HIV. Within the already vulnerable population of IDPs, people living with HIV face added social stigma and discrimination.

Some of our qualified HIV-service providers have left the country, creating further gaps in coverage. There have been more than 500 verified attacks on health, which includes attacks on health care facilities, warehouses, supplies, personnel, and medical transport.  

Yet there are key areas in the fight against HIV that we know work well in this conflict situation and that we need to keep doing more of. Below are three of them.

Support packages  

An integral part of HIV prevention response should include constant support of emerging and war-related humanitarian needs and lifesaving initiatives for both people living with HIV and populations at risk. With NGO partners, HIV and humanitarian services can be tailored based on clients’ needs, NGO capacity, and local context.  

This includes food packages, hygiene kits, shelter, legal support, and more. In some cases, we must provide relocation assistance and facilitate transport to medical facilities. Mental health and psychosocial support is especially critical.  

We are facing increasing demands for humanitarian assistance among displaced key populations, including for water supply and food. As we approach the winter, firewood for heating will be essential.

Information campaigns 

Timely response to the situation on the ground linked to the consequences of conflict is essential. This includes providing emergency information on service availability. In the conditions of hybrid war, with both military and nonmilitary dimensions, it is extremely important to receive information from verified sources.  

My team at Pact Ukraine created a platform called #ARTnearby on the Center for Public Health website for finding the nearest antiretroviral therapy, or ART, sites. To get the word out, we conducted an information campaign using Telegram, QR codes displayed on digital and paper posters and screens in railway stations and intercity trains, and a special project with the media outlet Ukrainian Pravda.  

We know that 26,000 individuals have used the #ARTnearby platform and chatbot to find ART services in their new locations. We must keep working toward digitalizing services, developing telemedicine and online counseling, and creating a national register of clients, services, and service providers.

In addition, awareness-raising campaigns will need to be conducted among authorities, security agencies, businesses, and health care facilities to reduce stigma and discrimination against key populations at risk of HIV/AIDS.

Recovery planning 

At the request of the Ministry of Health and the Center for Public Health, we have facilitated the development of a recovery plan for HIV, tuberculosis, methadone assisted therapy, and HC(B)V — infection caused by the hepatitis C or B virus — services in the public sector. This plan is critical to the country’s recovery process addressing the needs caused by displacement, war-damaged health infrastructure, provision of medicines, and more.

We also aligned with the priorities in the MOH’s health sector recovery plan for 2022-2032. Even while we are responding to the immediate needs, we need to be thinking about how Ukraine will recover from the war. We know there will be a long-term effort to rebuild health systems destroyed by the war.

Ukraine is a very legislative country where everything must be codified in the law. HIV testing by providers without a medical background, called “lay testing,” has not been possible because it must be done in health facilities by doctors and nurses. It's a huge constraint to increase HIV testing. The health sector recovery plan is an opportunity for Ukraine to accelerate improvements in how HIV services are delivered. And it could also be an opportunity to strengthen partnerships between the MOH and civil society organizations to mobilize coverage of HIV services.

Looking ahead

Before the war, more than 130,000 people living with HIV in Ukraine were receiving ART from HIV treatment sites on a monthly or quarterly basis. According to Centre for Public Health data, 14,000 of them — 10% of the population on ART — didn't visit a health institution and have likely interrupted their treatment. It is critical that we find them and do more research on this, as there’s an increased risk for them of HIV drug resistance.  

Also, as people move west, we need to determine if HIV is spreading more. With HIV, we know that if we take the eye of the ball, it will proliferate.

NGO staffers are dispersed within and outside of Ukraine, which makes project and service delivery difficult. For those in Ukraine, we need to ensure safety and security through individual protective equipment — helmets and bulletproof vests — and of course, the safety of the clients we serve.

In the face of these challenges and more, we will continue to work tirelessly to ensure that the gains we’ve made in achieving epidemic control of HIV will not be reversed. As we respond to the current situation, we must continue to look forward to the time when the war will be over.