Many life-saving health services could not operate after the breakout of the war in Ukraine.

But grass-root providers such as the Alliance for Public Health found ways to keep going. Despite roads being mined and many bridges blown up, the Mobile HIV Case-Finding project used its 16 vans to deliver food, HIV treatment and other essentials around the country. It also helped people find shelter.

Iryna, the Coordinator of the mobile clinic team in the Chernihiv region, said the war had complicated its work immensely. Chernihiv borders the Russian Federation and Belarus in northern Ukraine.

“Many people were on the move, going from one place to another,” she said. “It was very difficult to work.”

But since mid-March, the Alliance for Public Health has restored many of its services. The nongovernmental organization works mainly with people who inject drugs and their partners.

“The substantial number of new HIV cases in Ukraine are registered among injecting drug users because of unsafe injecting practices,” explains the UNAIDS Country Director for Ukraine, Raman Hailevich.

He knows that reaching drug users was a challenge before the war, and it’s an even greater challenge now. The credit, he said, goes to civil society groups.

“Community-based organizations working with this type of hard-to-reach population provide the most essential outreach to these groups. Without them, the delivery of prevention programmes among people who use drugs would not be possible,” he said.

Because of the insecurity, the Alliance for Public Health saw a drop in testing for HIV and hepatitis C. Iryna, however, is proud because, she said, the teams delivered treatment to more than 1400 people in March and April through the mail and/or personal home delivery.

The Mobile HIV Case-Finding project, founded in 2019, is implemented by the Alliance for Public Health and the Global Fund to Fight AIDS, Tuberculosis and Malaria and is funded by the CDC and PEPFAR.

A new report by UN Women and CARE International highlights the urgent need to provide health-care services to women in Ukraine and sets out why the international community needs to support a gendered response to Ukraine’s humanitarian crisis.

The report also emphasizes the need for an intersectional approach to the crisis that addresses the exacerbated risks for marginalized communities—lesbian, gay, bisexual, transgender and intersex (LGBTI) people, Roma people, people living with disabilities and people living with chronic diseases—who face immense hardship and have particular needs with regard to their health and safety.

“This powerful report illustrates why and how humanitarian responses need always to be gendered and need also to address the particular needs of marginalized communities,” said Winnie Byanyima, the Executive Director of UNAIDS. “The courage and commitment of women leaders who continue to serve their communities, even in the face of war, in Ukraine and across the world is an inspiration.”

The report’s analysis, which was based on surveys and interviews with people in Ukraine, was conducted in April and details some of the gender dynamics of the crisis and sets out practical and actionable recommendations for the international humanitarian response.

Women and girls interviewed for the report highlighted challenges in access to health-care services, especially for survivors of gender-based violence and pregnant women and new mothers, as well as rising fears of gender-based violence and lack of food, especially for those in conflict areas.

Many respondents referred to the health risks, including the spread of COVID-19, linked to unsanitary shelters.

The war has also impacted access to sexual and reproductive health, including family planning and maternal, newborn and child health. Many media reports have noted that conditions as a result of the war have increased the risk of premature birth.

Transgender people also require regular access to medicines, but many have had to stop hormone therapy due to supply shortages. Several LGBTI organizations are providing access to medicines to members of the transgender community, but their help does not cover all the needs.

“The Rapid Gender Analysis allows us to consult directly with affected populations in order to accurately identify what specific needs different groups of people have, and how to best meet them,” said Sofia Sprechmann Sineiro, the Secretary General of CARE International. “What we are hearing from the people of Ukraine is that certain groups—such as those with disabilities, Roma and other ethnic minorities, single mothers and unaccompanied children—are each in need of different forms of protection and assistance. To keep our response effective and relevant, such groups must be consulted and prioritized across the aid ecosystem as this truly devastating situation continues to evolve.”

The report calls for support for women-led and women’s rights organizations that provide financial resources and for their voices to be amplified at national and international platforms.

Gaps in services to respond to gender-based violence need to be filled, according to the report, while sexual and reproductive health, including the clinical care of survivors of sexual assault, and maternal, newborn and child health care, including access to contraception, should be made a priority.

“It’s critical that the humanitarian response in Ukraine takes into account and addresses the different needs of women and girls, men and boys, including those that are furthest left behind,” said Sima Bahous, the Executive Director of UN Women. “This timely analysis provides the evidence of those needs, and their urgency. Women have been playing vital roles in their communities’ humanitarian response. They must also be meaningfully involved in the planning and decision-making processes to make sure that their specific needs are met, especially those related to health, safety and access to livelihoods.”

The start of the Ukrainian war fifty days ago surprised many people including Berliner Aids-Hilfe’s migration consultant. Sergiu Grimalschi, along with his colleagues, has been thrust at the forefront of helping thousands of Ukrainian refugees coming to Germany, primarily those living with HIV.

Mr Grimalschi, a professional interpreter, came to Berlin from Romania in the early 1990s. For the past twenty-five years, he has been working on the HIV response primarily with migrants and is currently employed by Germany’s oldest HIV organization. From 2006 to 2012 he helped countries in Eastern Europe and Central Asia (EECA) develop HIV health services and worked in Ukraine, Belarus, Russia, and Poland.

UNAIDS spoke with Mr Grimalschi about the challenges Ukrainian refugees living with HIV face in Berlin.

Question: Sergiu, many refugees living with HIV in Germany are now coming to you directly. Were you able to prepare for this ahead of time?

Answer: No. No one was prepared and, to be honest, the war was a complete surprise for us, and for me personally. Eastern Europe has been a priority for my organization since 2010. We all speak eastern European languages and have stayed informed about the situation in the region. So, when the war started, I did a simple thing that turned out to be decisive. I wrote one mass email to an EECA group saying that anyone living with HIV fleeing from the war to Germany could contact me or my colleague by phone. First, I got called by colleagues from Moldova, with whom I worked closely during the COVID-19 pandemic when we provided medicines to people stuck in Europe. Then various Ukrainian organizations started contacting me. They continued to share my email and within a week the Berliner Aids-Hilfe numbers were on all social networks and on all Telegram channels.

Question: Many refugees living with HIV fled to Europe, in particular Germany, because they believed that everyone here has access to HIV treatment and services. True or false?

Answer: Yes, everyone has access except migrants without health insurance. That has changed only recently.

In Berlin, for example, every person, including undocumented and uninsured migrants could access treatment but only since the end of 2018.

All this was due to the fact that people without health insurance in Germany cannot be treated, and the law does not take into account people without insurance. And, as you know, if you cannot be treated, you die. Since 2000, we focused on all possible ways to provide all people living with HIV without insurance with access to medicines and qualified medical treatment.

Addressing this issue was the most difficult and the most important task for us in many years, but we managed to solve it. And that is thanks to many years of advocacy work that we did.

Question: So tell us how you deal with influx of refugees in Germany?

Answer: It is still not so simple. Firstly, the situation is very different in different states (landers) of Germany.

Secondly, when the first refugees began to arrive, there were no really organized structures, so we had to improvise with colleagues across the country. One bad thing was for example that Ukrainian people fleeing their homes were advised to leave medicines for those who stayed in Ukraine. In the first days of the war, medicines were collected throughout Germany in order to send them to Ukraine or Poland. But after one week, a lot of people living with HIV from Ukraine were in Berlin. A few women came to me saying, ‘I have only 2 or 3 pills because I gave everything to my husband.’

We had to find an urgent solution.

We went to doctors in Berlin and found stockpiles of HIV treatment but then we ran out. Doctors wrote out prescriptions, but it was not clear how they would be covered or paid for. Only Dolutegravir, for example, which is a part of the treatment that a majority of Ukrainians living with HIV take, costs more than 700 euros here. But everyone made extra efforts– doctors, social workers, other people living with HIV – they said, 'There is a war going on.’ And eventually the German health authorities began gradually to cover treatment costs.

Many people who arrive from Ukraine still do not understand how one gets treatment in Germany. There are no big specialized centers that dispense medicine here. I explain to people: ‘we help you to get an HIV-specialized doctor in your region who gives you a prescription and then you can go to the pharmacy and get your medicine.’

In recent weeks, onlly some of the 16 German regions have been treating people without insurance, without registration, based only on the person’s passport. For the past two weeks in Berlin, doctors have been authorized to treat Ukrainian refugees just by providing photocopies of their passport and sending it to the social services to get reimbursed. A real show of human solidarity.

Question: How many people are currently receiving antiretroviral therapy in Berlin?

Answer: At the moment, about 600 Ukrainians living with HIV are in contact with me throughout Germany and 150 in Berlin. Overall, I would say about 2,000 people total but not everyone has asked for help yet because they have enough medicine.

Question: Sergiu, tell us how the war started for you?

Answer: When my mother called me from Romania on the morning of February 24 and said, ‘the war has begun,’ I asked her, ‘Mom, did you sleep badly? Stop!’ I thought she had a bad dream. I never thought that Russia would go ahead with the invasion of Ukraine.

Personally, I am very connected to Eastern Europe. My grandmother left Russia in 1918, my grandfather was from Chernivtsi, which means that theoretically, he could have been Ukrainian if he had not left in 1940. I have a lot of very good friends, relatives, and colleagues with whom I worked there so this is terribly painful for me.

Question: Sergiu, as I understand it, you not only help refugees with treatment but also help out with housing and other things?

Answer: Yes, of course, we help with the refugee registration and access to social aid services, health insurance, psychological support in their language and everything that they need. We also advise people against going to the countryside. It is better for people living with HIV or who need substitution therapy to stay in Berlin or other big cities, because there are better health facilities.

I and my colleagues and friends try to help people with accommodation and clothing. I have a friend, a Romanian doctor, whose house was empty. I asked her if she wanted to help. Now six Ukrainian families live in her house. Another German friend gave 2,500 euros to women from Ukraine for urgent needs. Of course, I am accountable for all this money, but this is a personal, private initiative. One of my friends, a lawyer, bought iPads for many refugee children. He says children need to study so now they can go online.

Question: Amazing work Sergiu... What keeps you going?

Answer: I am impressed by all this human solidarity and I hope that all this horror will end shortly...This is a big test for all of us.

Andrii Chernyshev heads the advocacy work of the Ukrainian national lesbian, gay, bisexual, transgender and intersex (LGBTI) organization ALLIANCE.GLOBAL, which is one of the largest among about 30 LGBTI community organizations across the country. After the start of the war in Ukraine, he moved from Kyiv to the central part of Ukraine, a safer place to continue his work. His Facebook page has been full of announcements about where LGBTI people fleeing hostilities can find shelter and help, both inside and outside the country.

Before the war, the primary focus of ALLIANCE.GLOBAL was public health, HIV prevention, monitoring of violations of human rights and national LGBTI advocacy. But the war has brought about new urgent tasks.  

“The main challenge for all people during the war, including LGBTI people, is just to survive. Many have lost their homes and relatives. Just recently, we welcomed several people from Mariupol, which is now completely destroyed. Although they managed to leave the city, they are in a very bad psychological state,” said Mr Chernyshev.

According to the Office of the United Nations High Commissioner for Refugees, there are now 7.7 million internally displaced people in Ukraine. This number includes members of key populations, including LGBTI people, and others who are especially vulnerable.

Sviatoslav Sheremet, the coordinator of policy and legislation work of the National MSM Consortium, said that there are several factors that make LGBTI people especially vulnerable. “Many LGBTI people are fleeing the areas occupied by Russian forces. People are afraid, and this fear has pushed them to actively move out to safer zones in Ukraine and outside the country.”

He noted that LGBTI people often cannot reveal their sexual orientation or gender identity, fearing violence, rejection and discrimination if they do. He underlined that all cases of homophobia are still being recorded and submitted to state bodies. “The proceedings on such cases are postponed until there is peace,” he added.

Both ALLIANCE.GLOBAL and the National MSM Consortium have significantly changed their work. Several additional shelters for LGBTI people have opened in Dnipro and Chernivtsi. Men and women, including transgender people, can stay there one night and move on, or stay longer, and can bring their relatives and friends. People also receive financial support to leave the war zones and reach shelter.

“The shelter in Chernivtsi, for example, was in a non-residential building,” said Mr Chernyshev. With a small grant from the UNAIDS Emergency Fund and other donors, we installed a shower and bought heaters. People have food, the Internet, a first aid kit, access to HIV counselling and antiretroviral therapy.”

LGBTI organizations outside the country have also provided support to people in need.

Stas Mishchenko, an LGBTI activist from Ukraine, now lives in Munich, Germany. At the beginning of the war, he joined the Contact Group of Munich Kyiv Queer, which is part of the Alliance for Assistance to Queer People of Ukraine, a group of more than 50 LGBTI organizations in Germany whose members volunteer to help people who have fled to Germany and those who remain in Ukraine.

“Sometimes there is homophobia and transphobia in refugee camps. And even if these are not systemic, there is always the human factor, combined with stress, fear and violence. That is why we accompany people on their way to us, provide psychological assistance, try to resettle them in private homes, help with humanitarian aid,” said Mr Mishchenko.

“The war exacerbated both good and bad in our society,” said Marina Novachuk, UNAIDS Community Adviser at the UNAIDS Country Office for Ukraine. It is essential for the state and all stakeholders engaged in protecting forcibly displaced people to recognize and respond to the unique needs of LGBTI and gender-diverse people.”

Over the past 20 years, Ukraine has made a real breakthrough in ensuring the rights of LGBTI people and in protecting their security. LGBTI rights are an integral part of the National Human Rights Strategy. Leaders of the LGBTI community sit on the National Council of HIV and TB, as well as on regional councils. The number of participants of the annual equality marches has risen from just a dozen to thousands of people. Ukraine plans to develop legislation on the registration of civil partnerships.

“Achieving civil equality has been the goal of my work for many years—I have seen huge improvements. The attitude towards LGBTI communities is a litmus test of civilization,” Mr Sheremet said.

In April 2022, Ukraine received a questionnaire from the European Commission on its readiness for candidate status for membership of the European Union. On 18 April, Ukraine completed and submitted the first part of the questionnaire, which includes several questions on the situation with regard to LGBTI people and legislation, specifically about the legislative and policy instruments in place to prevent and respond to discrimination and how hate crimes are addressed in the criminal code. ALLIANCE.GLOBAL and the National MSM Consortium team will follow the process closely.

“We have been working on changes in the legislation on LGBTI rights for many years now and we hope that now it will take not years but months to change. But first the war should end,” added Mr Chernyshev.

Odesa is a major Black Sea port, with a substantial drug use. In the 1990s, Odesa saw the outbreak of HIV infection in Ukraine. But more recently it has successfully developed one of the world’s most effective systems of harm reduction services for people who use drugs. The system is funded by the state and local budgets and implemented jointly with non-governmental and community organizations. Odesa was one of the first cities in Eastern Europe and Central Asia that signed the Paris Declaration. Last year, it reported a reduction of new HIV cases among people who use drugs.

Natalia Kitsenko is head of the public health department of the Road to Home Foundation, one of Odesa’s oldest organizations providing services to people who use drugs. UNAIDS spoke with her about how her organization has been managing to continue to help people in need, even during this war. 

Question: Did many people flee Odesa?

Answer: Yes, many left, mostly women and children. The people in our organisation are an exception. Of 60 employees, 4 people left because they have small children. The rest stayed and we are actively continuing our usual work and also providing emergency assistance to women with children and elderly people fleeing from other cities—Mykolaiv, Kherson, Mariupol and Kharkiv. We mostly provide transportation to the Moldova border and connect them with volunteers who then help them in the country or in another destination depending on their needs.

We also prepare food such as pies and dumplings for people in need. This whole situation has united us; I have seen a lot of mutual support around.

Question: How many people from your harm reduction program have left the city?

Answer: Our coverage in Odesa and surrounding region includes about 20,000 people per year. As far as we know only 7 clients have fled abroad. Some clients have gone into the local territorial defense groups. Others have taken part in building protective structures, which involves collecting bags of sand and transporting them to protect streets and monuments. Others reside with us for the services they need. We had an influx of people who use drugs from other regions of Ukraine where conditions are far worse.

Question: What services does your organization offer to people who use drugs?

Answer: First of all the basic harm reduction package which we provide under the state budget includes consultations, HIV prevention (syringes, condoms, wipes, lubricants, etc.); HIV testing, and TB screening. Among clients who have used these services for a long time, the detection rate of HIV infection is 0.02%. Among new clients who have just joined the programme, it reaches up to 7%. We set up a client recruitment model with the Alliance for Public Health coordination using the Global Fund Grant and ECDC support. We encourage people who use drugs to bring their close friends to our community centres for testing. This is an important aspect because new clients, especially young people, those who recently started using drugs, can be a very difficult group to reach. Many hide their use and try to stay invisible. This recruitment system allows us to attract them to our harm reduction services, and first of all to testing. Management of new cases, support for diagnosis and receiving antiretroviral therapy, screening, and follow-up for tuberculosis is also provided through donor funding, in particular the PEPFAR project.

Question: Have you gotten additional funds?

Answer: Yes. We just received additional funding from the UNAIDS Emergency Fund to purchase medicines, dressings and hygiene products for our clients. This is a very timely and essential help because many medical products like Fluconazole (antibiotic) are not affordable to our clients and they are not widely available anymore.

Question: Natalia, you have been working in the HIV field for more than 20 years, have public attitudes changed regarding people living with HIV and drug users?

Answer: We have seen a welcome dramatic reduction in the level of stigma and discrimination and the overall attitude towards our clients in medical settings. However, we still experience problems with prejudices. Many people say that they do not want to have our syringe exchange points and community centers near their homes, and that they don't want to see people who use drugs near them as they fear that they might threaten their comfort, well-being and safety. We understand these fears, and we try to explain to concerned people why we are here, how these syringe exchange points and community centers work. We organise outings and sessions to explain to people the reality that people who use drugs face. We work to continually demonstrate our contribution and show how we help keep the epidemics of HIV, TB and hepatitis under control.

Since the war started we have also provided shelter to people who live by our centres. As our syringe exchange points are usually in basements, when the sirens sound the neighbors come to us; and that means for some their first time being in close contact with people living with HIV or people who use drugs.

Question: What are the most pressing issues for you now?

Answer: At the moment we are experiencing difficulties in providing our customers with Naloxone, which can prevent drug overdoses. Although we are constantly working on counseling and informing people about signs of overdosing, with the war going on, overdoses have increased. And because Naloxone is manufactured in the heavily bombed city of Kharkiv we have no more. We need it in any form, preferably ready-made, intranasal or injectable, as this would save many lives. And we need to sustain HIV services for people who use drugs together with providing them with urgent humanitarian aid.

On 10 April, Tetyana Pryadko (not her real name) was phoned by her doctor, who told her that her antiretroviral therapy to treat HIV had arrived. For Tetyana, who has been on treatment for 10 years, it was an important call. Her treatment hadn’t been interrupted once in 10 years, but now she had only a five-day supply left. She lives in Chernihiv, which was on the war’s front line, cut off from the old supply chains that kept her supply of HIV treatment uninterrupted.

Before the outbreak of the war, antiretroviral therapy was widely available in Ukraine. Larisa Getman, the Head of the HIV Management and Response Department of the Public Health Centre, Ministry of Health of Ukraine, explained that, “The majority of antiretroviral therapy was procured by the state through the National Procurement Agency.” 100% LIFE is the largest organization of people living with HIV in Ukraine, that implements the procurement of medical goods under the Global Fund projects and operates humanitarian aid under PEPFAR programs, including emergency supplies of antiretroviral drugs.

Valeria Rachinskaya, the Director of Human Rights, Gender and Community Development at 100% LIFE, who herself has been on antiretroviral therapy for many years, explained that the COVID-19 pandemic had actually improved treatment adherence, since it has become the norm to have a multiple-month supply of medicine at home, which was mailed to those who couldn’t access a clinic. Remote counselling and the widespread use of mobile applications have also become routine.

“People weren’t without medicines at the start of the war. The worst was for people in the cities that were the most heavily bombed, where not only medical facilities were destroyed but also logistic chains were interrupted,” she said.

“Before the war, the whole procurement and delivery process in Ukraine was quite easy,” said Evgenia Rudenka, Head of 100% Life’s Procurement Department. “Cargo was delivered to the airport, we cleared it at our warehouse and transported it. But the war happened, and it was urgently needed to figure out how to deliver those medicines to the country, and, most importantly, how to deliver them to patients. And we worked out these mechanisms from the very first days of the war with our partners.”

At the request of the Ukrainian Public Health Centre, under support of USAID and CDC, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) agreed to help with the urgent supply of antiretroviral therapy. Chemonics, a purchasing agency of PEPFAR, searched around the world for spare stock and secured vital supplies.

Through the support of the European Union who immediately developed the special humanitarian aid transit procedures for Ukraine, deliveries have begun to take place through neighbouring countries, primarily Poland and Romania. “Through the support of the Railway Service, we have organized the pickup of the cargo at a separate station away from the main delivery point of most Humanitarian Aid that comes to Ukraine. It was done with the purpose to manage the immediate distribution to regions. (As a huge number of humanitarian supplies from different countries goes through the State Agency for Strategic Reserves of Poland, it is quite hard to take the goods immediately from there.) So we have brought in a logistics company that can deliver goods to Ukraine under the humanitarian transit procedure, to a warehouse in Lviv, from where we are able to make the immediate distribution” said Ms Rudenka.

The most difficult and the most important part of the process is delivery throughout Ukraine, including the front-line zones.

According to Evgenia, many logistics companies have stopped operations during the war, and those that remain have increased the cost of their services by two- or threefold.

Commercial organizations are not willing to go to cities such as to Kharkiv, Kherson or Mykolaiv, but volunteer drivers, working in coordination with local authorities, drive there, evacuating people and delivering medicines and other goods.

“Where there is fighting, the volunteer drivers will unload at, for example, the regional administration headquarters, and then we communicate with the medical institutions that are the final recipients, we tell them where to pick up the goods,” she said.

Even so, several volunteers have come under attack, and four have been killed.

“The situation for people living with HIV in Ukraine is desperate. We are trying to deliver medicines, food, and other emergency assistance to people in need, but the work is dangerous and volunteer drivers are putting their lives at risk. If we don’t get more help, I am not sure how much longer we can continue, especially reaching people in the front-line zones,” said Dmytro Sherembey, the Head of the 100% LIFE Coordination Council.

Urgent call issued for a dramatic upscaling of international support for the heroic efforts of civil society-led networks to reach people with life-saving HIV treatment 

GENEVA, 13 April 2022—The war in Ukraine has resulted in the destruction and disruption of health services and logistical supply chains that hundreds of thousands of people living with and affected by HIV depend on for survival. More than a quarter of a million Ukrainians are living with HIV, and lack of access to antiretroviral therapy and prevention services would mean a wave of deaths and risks a resurgence of Ukraine’s AIDS pandemic. The community-led networks which are vital to maintaining life-saving services need an urgent upscaling of international support.  

More than 40 health facilities that offered HIV treatment, prevention and care services before the war are now closed and there are various levels of service disruption at other sites. By 11 April, the World Health Organization (WHO) had verified more than 100 attacks on health facilities in Ukraine, while supply routes within the country have been thrown into disarray. The United Nations Children’s Fund reports that attacks on water system infrastructure and power outages have left an estimated 1.4 million people without access to water, while another 4.6 million have only limited access. Meanwhile, the World Bank has said it expects Ukraine’s economy to shrink by 45% this year, posing a dire threat to the maintenance of vital health and social programmes. 

An initial delivery of more than 18 million doses of life-saving antiretroviral medicine procured by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) that arrived in Lviv last week is now being distributed in partnership with the Public Health Center of the Ministry of Health of Ukraine and 100% Life, the largest organization of people living with HIV in Ukraine. If they can be delivered to those in need, the medicines are sufficient to cover a six-month supply for all people living with HIV on first-line treatment. This first tranche is part of PEPFAR’s commitment to fund 12-month HIV treatment needs in Ukraine. UNAIDS estimates that 260 000 people were living with HIV in Ukraine before the war broke out, 152 000 of whom were taking daily medication for HIV.  

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is also providing emergency funding to ensure the continuity of life-saving HIV and tuberculosis services. 

Attention is now on ensuring that the life-saving HIV medicines reach all people in need in time. Civil society organizations are mounting a heroic effort to deliver vital medical supplies and HIV services to people living with and affected by HIV, including to vulnerable populations. They are reaching people in extraordinary challenging locations, despite the huge obstacles. But the civil society organizations on which this delivery and care system depends need further international support to be able to continue their work.  

“The situation for people living with HIV in Ukraine is desperate. We are trying to deliver medicines, food and other emergency assistance to people in need, but the work is dangerous and volunteers are putting their lives at risk,” said Dmytro Sherembey, Head of the 100% Life Coordination Council. “If we don’t get more help, I am not sure how much longer we can continue, especially reaching people in the front-line zones.” 

UNAIDS, which has released an initial US$ 200 000 in emergency funds to address urgent humanitarian and programme demands in seven cities that have large HIV epidemics (Chernihiv, Dnipro, Kharkiv, Kryvy Rih, Kyiv, Odesa and Poltava), has issued an urgent call to the international community for an additional US$ 2.42 million for civil society organizations providing HIV services in Ukraine and for those receiving refugees affected by HIV in other countries, as part of the wider upscaling needed.  

“Civil society organizations and communities of people living with and affected by HIV are the bedrock of the HIV response in Ukraine,” said Winnie Byanyima, Executive Director of UNAIDS. “They urgently require additional financial and logistical support to ensure the continuity of HIV treatment, care and prevention programmes. We urge all donors to be part of enabling this vital service to save lives and prevent a resurgence of the AIDS pandemic in Ukraine.”  

It is only because Ukraine’s pioneering response to HIV has been a partnership between public and community-led provision that it has been able to continue to provide for people even through the horrors of war. But the civil society networks, on whose creativity and courage the HIV services depend, require a boost in international support to ensure continued operations at the level required.  

Getting medical supplies and services to vulnerable groups of people remains extremely challenging and UNAIDS is working with humanitarian partners in Ukraine and internationally to advance urgent solutions to provide medical and humanitarian support to hundreds of thousands of Ukrainians.  

The Alliance for Public Health is working to provide the emergency support needed during the conflict, using minibuses to meet pressing humanitarian needs, including the evacuation of vulnerable populations and the delivery of food and medicines. Communities on the front line of the response are making exceptional efforts to reach people. For example, mobile clinics have been deployed by the Alliance for Public Health to take opioid substitution therapy to people who use drugs in areas where facilities have been forced to close. UNAIDS is also working with the Global Fund and with a UNAIDS Cosponsor, the United Nations Office on Drugs and Crime, to obtain additional supplies of opioid substitution therapy. 

The conflict has forced millions of Ukrainians to leave the country and thousands of Ukrainian women and children living with HIV are in need of support in host countries. Civil society networks supported by UNAIDS Cosponsors and partners are helping refugees access antiretroviral therapy in the Republic of Moldova and across the European Union.  

WHO has helped to broker a deal with the pharmaceutical company ViiV Healthcare to provide donations of HIV medicines to Czechia, Poland and other European Union countries receiving large numbers of Ukrainian refugees.  

UNAIDS is also urging the international community to help refugee accommodation centres strengthen their support for people facing the highest risks, by expanding psychosocial services, HIV treatment and prevention services, and services related to gender-based violence. A UNAIDS Cosponsor, UN Women, has said that reports of sexual abuse and human trafficking in Ukraine indicate a protection crisis. UNAIDS has warned of increased risks for lesbian, gay, bisexual, transgender and intersex people. 

Ms Byanyima reaffirmed the United Nation’s call for an end to the war. “The biggest need is for peace”, said Ms Byanyima. “The war in Ukraine must stop—now. Recovery requires an end to this war. And even when it ends there will be so much help needed. Ukrainians living with HIV have been put in grave danger by this war. The civil society-led responder networks for HIV services who risk their lives to save lives need every possible support.” 

HIV hotline number in Ukraine: 0800 500 451. 

More support for Ukrainian refugees living with HIV can be found on the ART Initiative for Ukrainians Abroad website, which was established in coordination with Ukraine’s Public Health Center. More precise data on the whereabouts and needs of people living with HIV in Ukraine and those forced to flee the country are being collected. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Many of the Ukrainian refugees seeking sanctuary in the Republic of Moldova are from Odesa or the surrounding region, which is one of the regions of Ukraine most affected by HIV. 

Iryna Kvitko (not her real name) fled with her entire family, including her daughter-in-law and young grandson, to the Republic of Moldova. She said that an air-raid siren would sound several times a day, terrifying her grandson. “We thought about whether we should go or not, but it was scary to sit all night in our home—me, my husband, son, daughter-in-law and grandson—and try to explain to the child what the explosions and sounds of shooting were. Plus, to be honest, I was very afraid of the situation regarding my antiretroviral therapy—I was running out of it and it was not clear what would happen next.”

Ms Kvitko has been living with HIV for more than 15 years but keeps her diagnosis a secret. “I work, we live decently. I have a family, children, relatives, friends, colleagues. God forbid that someone would find out—it would all go to dust,” she said.

She described her difficult journey to the Republic of Moldova—there was widespread panic and at the border checkpoints the queues of traffic reached up to 80 kilometres. “Many people just got out of their cars and walked. Our main goal was to take our children and grandson out of Ukraine,” she said.

“My doctor in Odesa gave me information on where people can go to get help with antiretroviral therapy. I called them and after they took my contact number they immediately called me back and explained where to go and what to do and said that they would help me and give me the medicines I need.”

On the very first day of the war, Ihor Plamos (not his real name), together with his wife and child, drove to the Republic of Moldova from Odesa. There were a lot of people at the border, he recalled. “As soon as we got to our destination, I started to drive back to the border, to give a lift to people who had travelled on their own, who had walked seven or eight kilometres.” He took them to an aid distribution centre, from where they travelled on to Georgia or Germany.

“When we arrived, we didn’t know what to do. So, I called my doctor in Ukraine, and she told me where to go,” he said.

The clinic that his doctor referred him to tested his viral load free of charge, and the doctor prescribed antiretroviral therapy for him. He does not want anyone to know that he is living with HIV, noting that the level of stigma around the virus remains very high. “Therefore, I was worried at the beginning about what would happen to my treatment,” he said.

Hanna Brovko (not her real name) travelled to the Republic of Moldova from Odesa with her 11-year-old son, leaving behind her sewing business, clients and friends. She has been living with HIV for more than 12 years, but she does not tell people about her diagnosis. “I don’t need pity, and I don’t want things to be said about me behind my back.”

She received all the necessary medicines upon her arrival in the country but decided to move on to Germany. Berliner Aids-Hilfe helped her to arrange her flight from Chisinau to Berlin, set up her in a family’s house and arranged medical insurance, which is necessary for her to obtain her HIV treatment.

Elena Golovko, an infectious diseases doctor at the Hospital of Dermatology and Infectious Diseases in Chisinau, emphasized that people who come from Ukraine receive all HIV services in the same way that Moldovan people living with HIV do. “Today, we have a person living with HIV hospitalized, there are several HIV-positive women, there are those who have already given birth here and who received syrup to prevent mother-to-child transmission of HIV. There is also a person receiving pre-exposure prophylaxis. We issue a 30-day supply of antiretroviral therapy to refugees. If people stay longer in the country, they can come and receive a refill. We don’t have any problems with ensuring the same level of HIV services,” she said.

However, she added that some people did not know their latest test results or could not remember the name of the medicines they take. “It was important for us to establish communication with colleagues in Ukraine, especially fast communication when a person is directly in the clinic.”

Alina Cojocari, the coordinator of assistance for people living with HIV at the Positive Initiative nongovernmental organization highlighted that it is fully involved in service delivery for refugees in need of HIV services. “We are referring people to health services, supporting them with accommodation in the country and offering them psychosocial and legal support,” she said. “For those travelling from the Republic of Moldova to other countries, we ensure they are linked to HIV services in the next country,” she added.

“This level of HIV services for refugees living with HIV in the Republic of Moldova became possible as these services in the country have long been built around people’s needs,” said Svetlana Plamadeala, the UNAIDS Country Manager for the Republic of Moldova. “This approach is now also being used for refugees. During humanitarian crises, such as the war in Ukraine, everyone is vulnerable and people fear for their loved ones. For people living with HIV, there is also the fear of not receiving timely, life-saving HIV treatment, and in many cases the fear of the disclosure of their status. That is why it is so important to create sustainable, agile, equitable health and social protection systems with people at the centre, which can protect people during a crisis.

Anastasiia Yeva Domani is the Director of Cohort, an expert on the Working Group of Trans People on HIV and Health in Eastern Europe and Central Asia and a representative of the transgender community on the Ukrainian National Council on HIV/AIDS and Tuberculosis.

UNAIDS spoke to her to see how she and the wider transgender community are coping after the Russian attack on Ukraine.

Tell us a bit about yourself and the transgender community in Ukraine

I am the Director of Cohort, an organization for transgender people. Cohort has existed for about two years, although I have been an activist for more than six years. According to the Public Health Center of the Ministry of Health of Ukraine, before the war there were about 10 000 transgender people in the country, although that number is likely to be an underestimate since many transgender people are not open about their gender identity. Many only seek help during a crisis—this was the case during the COVID-19 pandemic, and is happening now, during the war. Today, we are receiving requests for help from people we have never heard from before, people who are in dire need of humanitarian, financial and medical assistance.

Ukraine created the most favourable environment for transgender people in the post-Soviet countries with regard to changing documentation and the legal and medical aspects of gender transition. It is far from perfect, but we and other organizations have done our best to improve it. Since 2019, transgender people have been represented on the Ukrainian National Council on HIV/AIDS and Tuberculosis.

What was the situation like for transgender people at the beginning of the war?

In 2016, a new clinical protocol for medical care for gender dysphoria was adopted in Ukraine, which greatly facilitated the medical part of gender transition. Thanks to it, the next year people were able to receive certificates of gender change.

However, many transgender people have yet to change all their documentation. Some people didn’t change any, some only changed a few documents and only a few changed absolutely all of them, including driver’s licences, documents on education and those that relate to military registration and enlistment. We warned about this, and now there is a war. Many transgender people didn’t realize that they needed to be deregistered at the military registration and enlistment office.

Due to martial law, men aged 18–60 years cannot leave the territory of Ukraine if they do not have permission from the military registration and enlistment office. We have a lot of non-binary people with male documentation who cannot leave.

With the outbreak of the war, many transgender people moved to western Ukraine. But, if according to your documents you are a man, you cannot leave Ukraine.

What is the situation now and what is the focus of your work?

Because of the war, in some cities there is no one left at all. Kharkiv had the largest number of transgender activists after Kyiv, including many who moved there from the occupied Luhansk and Donetsk regions in 2014. And now they must move again. We have no information about the death of any transgender people, but I think that this is only because there is no connection with some cities, such as Mariupol. Many simply did not have time to leave the city, and then it became impossible. I’m afraid that the statistics will be terrible, it just will take time to understand what happened there.

There is a lot of work going on in Odesa now—we have two Yulias there, transgender women from whom the community receives tremendous support. They took on many issues of support and funding. In Odesa, the situation is better with hormones, with medicines. We also still have a coordinator in Dnipro—she also does a lot.

Our work is now focused on financial, medical and legal assistance to transgender people who are in Ukraine, no matter where, in western Ukraine in shelters or apartments, or staying in their cities where the bombings are. Everyone has fears, but you still need to have some kind of inner core and try to fight. I don’t think everyone should leave. I understand that many people have a grudge against society, the state. For many years, decades, they lived as a victim. There is nothing to keep many of them here—there is neither work nor housing.

Who is supporting you financially?

We had projects planned for 2022, and literally on the first or second day of the war representatives of our donors said that the money could be used not only for planned projects but also for humanitarian aid. This included RFSL, Sweden, which approached this issue in the most flexible way and allowed us not only to use the project money but also to send money directly to our coordinators, so that they themselves could pay for people’s housing, travel, etc.

Then GATE (Global Action for Trans Equality) also immediately said that their funds could be used for humanitarian aid, and promised additional funds. The Public Health Alliance, through the Global Fund to Fight AIDS, Tuberculosis and Malaria, allowed changes to be made to the budget and the nature of the planned activities.

Now we will do what we can do in the context of the war, and the mobilization of the community will continue in Dnipro, Odesa, Lviv and Chernivtsi. New partners appeared that immediately responded to our needs.

I use OutRight Action funds every day for the humanitarian needs of transgender people, and also funds from LGBT Europe. There are also private donations, not large, of course, but they are also there.

What does your average day look like?

My day is filled with communication with journalists from leading publications. I also go to supermarkets for groceries and distribute them to those who need them—I have Google forms where I can see requests for help.

I administer requests for consultations with a psychologist and an endocrinologist, who continue to work in Ukraine. I receive many questions related to crossing the border and I provide information on how to communicate with the military registration and enlistment office and on which documents they need for deregistration.

There are a lot of calls, so I charge the phone five times a day. I have two Instagram accounts, two Facebooks accounts, three mail addresses, Signal, WhatsApp, etc. You need to be constantly in touch. I also need time to stand in two-hour queues at the post office—it’s such a waste of time, but people need the medicines I send. I also need to leave time to monitor the news, I need to know what is happening at the front, in the cities.

What is giving you strength?

Until my family and child left the city, I could not work in peace.

I am currently in Kyiv. In the first 10 days of the war I felt shock and fear—we literally lived from one hour to the next. Now we have got used to the danger and I’m not afraid anymore. I decided for myself, if it is destined, then so it will be. I no longer go down to the shelter: so much work, so many requests for help, calls, consultations every minute.

I was born here, in Kyiv, this is my home town. I realized that when things are bad for your country, you have to stay. I can’t run away, my conscience just won’t let me. I can’t because I know my city needs to be protected. You don’t have to be in the military to help—there is military defence, but there is also volunteer work, humanitarian aid is a lot of work.

What gives me strength? Because this is my country, I understand that everyone who can do anything, on any front, is there. We can do it everywhere, everyone can contribute, do something useful, and that gives me a sense of being needed, a sense that we can all do so much together.

As shipments of antiretroviral treatment arrive, challenges are mounting to ensure it reaches those in need

GENEVA, 5 April 2022—The war in Ukraine has resulted in a catastrophic humanitarian crisis with rapidly growing numbers of deaths and casualties, the destruction of entire cities and towns and unconscionable attacks on health facilities and other civilian targets. This is putting Ukrainians living with HIV in grave danger.

“It is becoming increasingly difficult for people to access the health care they need, including services for HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “UNAIDS estimates that 260 000 people were living with HIV in Ukraine before the war broke out, 152 000 of whom were taking daily medication for HIV. There is no cure for HIV. Without access to antiretroviral medicines people living with HIV will die.”

The World Health Organization estimates that there have been 82 separate attacks on hospitals, ambulances and doctors in Ukraine since the war began, killing 72 and injuring at least 43 people. Nearly 50% of Ukraine’s pharmacies are presumed to be closed and many health workers are either displaced or unable to work.

UNAIDS with its cosponsors WHO and UNICEF together with USAID, PEPFAR, and the Global Fund to Fight AIDS, TB and Malaria are working to ensure a 12-month supply of the medicines for people living with HIV in Ukraine. A delivery of 209 000, 90-day supplies of antiretroviral medicines has arrived in Lviv, Ukraine ready to be distributed to people in need. However, distribution within Ukraine is set to be a challenge, particularly in conflict areas. UNAIDS urges respect for and protection of humanitarian corridors to allow for the distribution of humanitarian aid and safe passage for civilians to safety.

The UN Secretary-General has called for “unimpeded access to all affected people and communities” to be guaranteed, and for an end to the war.

“Through remarkable efforts by civil society and government, most sites providing antiretroviral therapy are still at least partially functioning, but the war has disrupted supply chains and patients’ access to those sites,” said Ms Byanyima. “Partners on the ground are scrambling to get lifesaving medicines to people safely. The flexible ability of civil society to reach people is vital and funds are urgently needed to support and strengthen these critical life-lines.”  

UNAIDS has issued an appeal for funds to support people living with HIV and key populations with access to HIV services and basic humanitarian needs including the uninterrupted provision of HIV treatment and harm reduction services such as opioid substitution therapy (OST—an effective treatment for dependence on opioids). People living with HIV are urged to contact the Ukrainian HIV hotline number* for more information on the availability of HIV treatment.

A number of prisons are no longer controlled by the government of Ukraine. Prisoners in need must have access to antiretroviral therapy for HIV, or OST (in the case of dependence on opioids).

More than 4 million refugees have fled Ukraine since the war began. It is estimated that up to 1% of refugees could be living with HIV and in need HIV services. UNAIDS with its cosponsors WHO and UNHCR have held talks with the neighbouring countries of Romania, Slovakia, Moldova, Hungary and Poland to brief their respective capitals and health officials on the needs of refugees living with HIV as well as the importance of providing HIV prevention services.

As part of efforts to ensure continuity of HIV treatment, UNAIDS and cosponsor WHO have helped broker a deal with the pharmaceutical company ViiV Healthcare to provide donations of HIV medicines to Poland, the Czech Republic and other European Union countries receiving large numbers of Ukrainian refugees. More support for Ukrainian refugees living with HIV can be found on the ART Initiative for Ukrainians Abroad website which was established in coordination with Ukraine’s Public Health Centre.

The World Health Organization is working with Ukraine’s Public Health Centre on collecting data, while maintaining confidentiality, to understand the whereabouts and needs of people living with HIV affected by the war. There is currently no precise data on the movements of people living with HIV who have already left the country.

UNAIDS is monitoring the situation and closely and working with civil society organizations to support refugees and people living with HIV in Ukraine. UNAIDS is also working to ensure people from key populations including the LGBTI community both in Ukraine and those who have left the country have access to humanitarian services. 

*HIV hotline number in Ukraine: 0800 500 451

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.