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.

A new publication by UNAIDS and the World Health Organization (WHO) emphasizes the importance of integrating HIV and mental health services and other interventions, including linkages to social protection services, for people living with HIV and other vulnerable populations.

Mental health conditions increase the risk of HIV infection, and people living with HIV have an increased risk of mental health conditions, which are associated with lower retention in HIV care, increased risk behaviours and lower engagement with HIV prevention.

Furthermore, despite an increasing body of evidence showing that effective methods of prevention, screening and diagnosis of, and treatments for, common mental health conditions, including depression and anxiety, exist and can be implemented in low- and middle-income countries, services for mental health, neurological and substance use conditions are often not integrated into packages of essential services and care, including for HIV.

“We know that integration of screening, diagnosis, treatment and care for mental health conditions and psychosocial support with HIV services does not need to be expensive,” said Eamonn Murphy, UNAIDS Deputy Executive Director, a.i., Programme. “The integrated approaches that are people-centred and local context-specific ensure better HIV and overall health outcomes, well-being and quality of life.”

The publication is primarily intended for national and local policy-makers, global, regional, country and local programme implementers, organizations working in and providers of health, HIV, mental health and other relevant services, civil society and community-based and community-led organizations and advocates.

Although focus is on the integration of mental health with HIV services and other interventions, the considerations in the publication may be relevant to other services, including for HIV comorbidities such as tuberculosis, viral hepatitis and sexually transmitted infections.

“Our publication successfully brings together tools, best practices, case studies and guidelines that can help countries and facilitate the integration of interventions and services to address the interlinked public health challenges of mental health and HIV, all while improving access to care for persons who are the most vulnerable, such as adolescents and key populations,” said Meg Doherty, Director, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO.

“With this joint UNAIDS/WHO publication, we hope we can collectively support countries, service providers and other practitioners, policy-makers, programme implementers and communities in their efforts to address HIV, mental health, neurological and substance use conditions for affected individuals in an integrated and impactful way,”  said Devora Kestel, Director, Mental Health and Substance Use, WHO.

Integration of mental health and psychosocial support with HIV services and interventions, including those led by communities, is one of the key priority actions included in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. Both documents call for addressing the interlinked issues of HIV and mental health through integrated services by investing in robust, resilient, equitable and publicly funded systems for health and social protection, by reversing health and social inequalities and by ending stigma and discrimination.

The new publication stresses that the AIDS epidemic cannot end without addressing the mental health of people living with, at risk of or affected by HIV, ensuring equitable access to HIV services for people with mental health issues and conditions and achieving universal health coverage.

The economic impact of the COVID-19 pandemic on lesbian, gay, bisexual, transgender and intersex (LGBTI) people has been huge. A 2020 survey of more than 20 000 LGBTI people from 138 countries showed that many had lost their jobs because of the pandemic. In addition, members of the community experienced increased discrimination, hate crimes and arrests. Criminalization combined with stigma and discrimination of LGBTI people in some countries has hindered their ability to seek essential economic and health-care support.

Several of the 23 UNAIDS Solidarity Fund grantees across Brazil, Ghana, India, Madagascar and Uganda are supporting LGBTI organizations in building economic capacities and driving social impact for their respective communities through diverse social entrepreneurship projects.

Uganda is home to more than 1.5 million refugees. Same-sex sexual relations are illegal in the country, and being a refugee brings a host of other challenges, including social exclusion. Adding to this, the COVID-19 pandemic has destroyed the livelihoods of many of Uganda’s refugees who are members of key populations. Through a Solidarity Fund grant, the Simma Africa Creative Arts Foundation set up the Rainbow Drip Craft Shop Project, which markets creative and cultural goods, including fine beaded and brass jewellery, handmade leather-craft shoes and Ankara fusion clothing made by LGBTI people and adolescent girls and young women from refugee camps and host communities. “The shop has become a safe space and a creative outlet for the community to channel their skills and talents towards building self-sustaining livelihoods,” said Natasha Simma from Simma Africa.

Also working with the Ugandan LGBTI and sex worker communities, Vijana Na Children’s Foundation (VINACEF Uganda) has set up a community-run salon offering diverse beauty treatment services. About 80 community members have been connected to social services and trained in social enterprise and financial management. “The social entrepreneurship project has enhanced community involvement and strengthened the capacity of LGBTI and sex worker communities while allowing them to gain and practice new skills to earn a sustainable income,” said Benard Ssembatya, the Executive Director of VINACEF Uganda. Inspired by this initiative, VINACEF Uganda is forming a network of salons to improve access to information on HIV, sexual and reproductive rights, tuberculosis, cancer and noncommunicable diseases for community members.

Similarly in Brazil, tapping into the talents of members from the LGBTI and sex worker communities in beauty treatment, Associação Social Anglicana de Solidariedade do Cerrado (Casa A+) implemented the Empodera Mais Project. “We motivated members from vulnerable backgrounds to participate in the social entrepreneurship project through the provision of the Empodera Mais Kit, with basic equipment and supplies for entering the hairdressing and beauty treatment profession,” said Anglican Bishop Maurício Andrade, the founder of Casa A+. The technical skills provided and encouraged members to start businesses in beauty treatment and survive the hardships of the COVID-19 pandemic. Technical partnerships with professionals, a beauty studio and institutions such as Palmas’ Municipal Department of Human Development provided the participants with on-site experience before launching their own businesses and generated a professional network to exchange experiences and get new business.

In Ghana, the Hope Alliance Foundation and the OHF Initiative launched the Community Economic Empowerment Program to set up social enterprises led by people living with HIV and LGBTI people to support them economically to confront complex political and COVID-19-related challenges. The initiative provided vocational skills training for the production of food and hygiene products to 30 young people, supported the creation of social enterprises in fashion design and supported the refurbishment and revamping of 10 selected small-scale businesses adversely impacted by COVID-19.

In India, Nachbaja.com’s online artist platform was set up to overcome the challenges of discrimination, unfair remuneration and the safety of artists from the LGBTI community. Meanwhile, Gaurav Trust opened its doors for members to be a part of a community-led salon, La Beauté and Style, and mobilized additional funding for sustainability and scalability.

Stories of growth continue with Let’s Walk Uganda, whose Jump Start project was established to host small-scale enterprises in fashion, design and the production of liquid soap led by gay men and other men who have sex with men. Community members have proven their ingenuity to grow, scale up and diversify their enterprises by successfully reinvesting the revenue from the first batch of products in new entrepreneurial ventures. This led to the development and launch of the UNAIDS-supported Stall App, an online social marketing app that could help to boost the sale of products developed by several key population-led enterprises, including other Solidarity Fund grantees.

“We must recognize that while the rest of the world recovers from the economic impact of the COVID-19 pandemic, its effects will last longer for marginalized communities. Hence, it is of the utmost importance to continue to support innovative community-led social enterprises designed to support livelihoods and overcome special challenges,” said Pradeep Kakkattil, the UNAIDS Director of Innovation.

Restoring the self-reliance and dignity of LGBTI communities must be grounded in initiatives led by themselves, with a focus on addressing inequalities. A common thread that connects these diverse enterprises is the ingenuity of LGBTI people in the face of hardship. The grantees demonstrated the potential of empowerment through art, creativity and professional skills supported by the Solidarity Fund seed funding.  Acknowledging and embracing diversity in sexual orientation and gender identity in all areas is crucial to making the community visible, protecting them from stigma, discrimination and violence, and engaging them in the response to pandemics.

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.

Men and boys are less likely to test for HIV, to initiate antiretroviral therapy and to remain engaged in care, and are therefore dying of AIDS-related illnesses and many other diseases at disproportionately higher rates than their female counterparts. This has become increasingly clear over the past decade.

Globally, antiretroviral therapy coverage of men lags that of women. In many countries in eastern and southern Africa, the region with the highest HIV burden, more than half of men aged 24–35 years living with HIV are unaware of their status and therefore not on treatment. This imperils their own health and increases the risk of HIV transmission. The diagnosis of undiagnosed men is essential for promoting men’s health and breaking the cycle of HIV transmission.

Primary health-care services in eastern and southern Africa place a great deal of focus on women of reproductive age, and reproductive, maternal and child health services offer ideal entry points for HIV services—similar entry points for men are not commonplace.

The architecture of health service delivery needs to be reviewed. Are health institutions organized in ways that promote access to services for men and boys?  Do HIV-related health systems, policies and strategies include men, especially men at higher risk of HIV? However, health-system barriers go beyond the service delivery level, and a broader supportive enabling environment needs to be created, including laws, policies and health strategies.

UNAIDS has recognized the gaps and the importance of male engagement in the HIV response—therefore, in collaboration with Sonke Gender Justice, the World Health Organization, UN Women and other partners, Male engagement in HIV testing, treatment and prevention in eastern and southern Africa: a framework for action was developed. The framework provides a foundation for country-led action to achieve the globally agreed HIV goals in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and work towards achieving gender equality. It categorizes existing research and best practice and elaborates strategies on how to increase HIV prevention services coverage, and HIV testing and treatment among men and boys, within a broader gender equality agenda.

In line with the Global AIDS Strategy 2021–2026 and an emphasis on societal enablers, the framework provides direction and strategies on addressing structural barriers. The focus is on transforming social, economic, legal and policy structures, addressing supply- and demand-side factors and transforming gender norms.

“On our part, I confirm the United Nations family’s continued commitment and support to governments and civil society in eastern and southern Africa to engage men, for fewer new HIV infections, better treatment and fewer AIDS-related deaths. The road ahead is clear. The urgent and hard work of implementation with the close engagement of men needs to begin now,” said Anne Githuku-Shongwe, the Director of the UNAIDS Regional Support Team for Eastern and Southern Africa.

The 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030 reaffirmed the importance of leadership by young people in the HIV response.

The Global Network of Young People Living with HIV (Y+ Global) and The PACT are two innovative networks led by young people that have consistently proved the innovation and resourcefulness of young people in the HIV response. With support from UNAIDS, they are currently rolling out the #UPROOT Scorecard 2.0, a monitoring tool led by young people, in seven countries: Burundi, Ghana, Kyrgyzstan, the Philippines, Uganda, Viet Nam and Zimbabwe.

This is the second phase of monitoring work led by young people, which started in 2017 with the #UPROOT Agenda. The scorecard process engages young people, bringing them together to assess how their country’s HIV response is working for them and if they are meeting the commitments on young people that are required to reach the 2025 HIV targets and achieve Sustainable Development Goal 3.

Tinashe Grateful Rufurwadzo, the Director of Programmes, Management and Governance at Y+ Global, has been working closely with UNAIDS on the roll-out. “Equity, inclusion and solidarity are core principles in ensuring that we end the AIDS epidemic by 2030. The #Uproot Scorecards 2.0 will continue to strengthen youth-led monitoring at the country level, further harvesting evidence for advocacy and holding our governments accountable. There is a continued need to improve the quality of care that young people living with and affected by HIV in our diversity receive and to ensure that we are all leading happy, healthy and fulfilling lives. #UPROOT Scorecard 2.0 is a platform to raise our voices and secure our future!” he said.

Ekanem Itoro, Chair of The PACT, reiterated the need for data on young people. “It is extremely crucial in the global HIV response to strengthen adolescent and youth engagement using real-time data systems and interpersonal platforms in order to positively influence knowledge, attitudes and social and behaviour change, as well as to enhance social accountability of service providers and decision-makers towards improving the quality of life of young people living with HIV and other sexual minorities.”

Young people make up 16% of the world’s population but accounted for 27% of new HIV infections in 2020. Despite the disproportionate HIV burden on young people, they continue to face age-based discrimination and exclusion from sexual and reproductive health and rights, harm reduction and HIV services. Through the completion of the scorecards, The PACT and Y+ Global aim to generate accurate qualitative data for national and grass-roots organizations led by young people to hold their governments and service providers accountable for commitments made on the health and well-being of young people. This will help catalyse advocacy on identified national priorities to achieve the targets set out in the Political Declaration on AIDS and the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS.

“Leadership by young people has been recognized as key to achieving the global targets that have been set, and the generation of that data will be central to scaling up the already pivotal work of networks of young people around the world,” said Suki Beavers, Director of the UNAIDS Department for Gender Equality, Human Rights and Community Engagement.

UNAIDS will continue to partner with organizations led by young people to promote youth leadership in the HIV response.

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.

In the city of Recife, capital of the state of Pernambuco, in the Northeast Region of Brazil, a specially adapted bicycle carries products made by people living with HIV to be sold directly to consumers. It is called the Diversibike, one of the strategies for income generation implemented in the context of the Solidarity Kitchen, a project developed by the Posithive Prevention Working Group (GTP+) nongovernmental organization, one of the three Brazilian organizations that have benefited from resources from the UNAIDS Solidarity Fund, whose objective is to support entrepreneurial activities led by people living with HIV and key populations. 

GTP+ was created in 2000 and was the first nongovernmental organization in the Northeast Region of Brazil to be led exclusively by people living with HIV. Among the projects developed by the organization, in addition to the Solidarity Kitchen, are the Espaço Posithivo, which welcomes people living with HIV who seek support, and Mercadores de Ilusões, which works to support sex workers to strengthen their self-esteem and claim their rights to citizenship. 

The Solidarity Kitchen emerged in 2005, initially to produce meals for people living with HIV who sought support from GTP+. In 2019, a new element, the Confectionery School, was added to provide sex workers, ex-prisoners and other vulnerable people living with HIV with a way to generate income through cooking. With the resources received from the Solidarity Fund, GTP+ was able to boost initiatives to commercialize the products developed in the Solidarity Kitchen and train the participants in different aspects of entrepreneurship. 

“The project has contributed to transforming the lives of people living with HIV in vulnerable situations. Through the project, they found an opportunity to generate income through entrepreneurial activities and developed their skills in gastronomy, learning recipes and techniques to improve their products,” said Wladimir Reis, the General Coordinator of GTP+. 

Sérgio Pereira, one of the founders of GTP+ and the Coordinator of the Solidarity Kitchen, agreed, adding, “When the job market knows that we live with HIV, it doesn’t accept us. The Solidarity Kitchen brings to the participants the possibility of sustainability and opens doors for them to be able to enter the job market.”

Karen Silva, one of the beneficiaries of the Confectionery School of the Solidarity Kitchen, said, “I was welcomed at GTP+ with a lot of attention and care. First, I participated in the Posithive Space, then little by little I started helping in the kitchen and here I am. Participating in the Solidarity Kitchen changed my life and my self-esteem as well.” In total, 20 people have directly benefited from the Solidarity Kitchen, with the support of the Solidarity Fund.

As the objective of the project was on finding and promoting the best conditions for marketing products made in the Solidarity Kitchen, the team responsible for the project held weekly planning, organization and production meetings. They also conducted market research to identify the tastes and interests of potential customers, which was especially important in identifying Diversibike’s potential. 

According to Mr Reis, an important part of the process of capacity- and knowledge-building of the group of project participants were the virtual trainings in gastronomy and administration offered through a partnership with the Federal Rural University of Pernambuco. Two scholarship-holders from the university supported the group in the meetings and by producing support materials.

One point to which Mr Reis draws attention is the fact that the project was born in a time of extreme social inequality. “For this reason, it is essential that we implement more initiatives like this, with support from the Solidarity Fund, so that other people in vulnerable situations can have the same development opportunities. With the project, we were able to observe the impact of generating financial resources for the participants, in addition to strengthening their knowledge to implement their projects and ensure their sustainability during the COVID-19 pandemic.” 

“The Solidarity Fund’s support for GTP+ highlights the importance of guaranteeing income generation by organizations led by vulnerable key populations. It is a strategic action, which generates social protection for those people, allowing them access to basic resources to take care of their health and to access HIV prevention and treatment services,” said Claudia Velasquez, the UNAIDS Country Director for Brazil.