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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.

At the start of the invasion of Ukraine, the government of the neighbouring Republic of Moldova estimated that there might be around 300 000 people fleeing to the country from Ukraine. That estimate has now increased to 1 million refugees—a huge amount for a country that has a population of only 2.6 million and is one of the poorest countries in Europe.

Soon after the start of the war, a number of humanitarian organizations, United Nations agencies and civil society partners, coordinated by the government, formed response coordination groups and started to address the most acute needs of the people fleeing the war, including shelter, food, health, social protection, the prevention of gender-based violence and mental health support.

“First, we must focus on the basic needs. A lot is yet to be done around coordination with the many humanitarian organizations joining the response. Because this is also the first time ever for Moldovans to face a crisis of this size, we are learning by doing and learning from experience,” said Iurie Climasevschi, the National AIDS Coordinator at the Hospital of Dermatology and Communicable Diseases in the Republic of Moldova.

Svetlana Plamadeala, the UNAIDS Country Manager for the Republic of Moldova, visited several displacement centres near the border of Ukraine and the Republic of Moldova. “People are well-received there, the government is ensuring accommodation and food and trying to ensure that children attend school and kindergarten, as about 75% of the refugees are women and children—there are about 40 000 children under 18 years old in the centres,” she said.

According to Ms Plamadeala, almost half of the refugees are being accommodated by families in their homes. “We see the extraordinary mobilization of ordinary people, who are providing remarkable support to people who are fleeing from the war,” she said.  

The government’s policy is that Ukrainian refugees will receive the same services as Moldovans, including HIV-related services. “If any of the refugees ask for antiretroviral therapy, we provide it to anyone. We will not refuse anyone if we can help them,” said Mr Climasevschi.

“UNAIDS was part of the planning process right from the very beginning of the crisis to ensure that refugees have access to all HIV-related services that Moldovan people have, including antiretroviral therapy, opioid substitution therapy and HIV and tuberculosis testing,” said Ms Plamadeala. “Stigma and discrimination towards people living with HIV is still high. Perhaps not all people living with HIV have been able to access the services, so we are engaging with our civil society partners to proactively provide information to people so they know where to go for support.”

Ruslan Poverga, from the Initiativa Pozitiva nongovernmental organization, said that the organization is already identifying refugees in need of antiretroviral therapy and is referring them to support. “We’ve started proactively informing people, and, if required, providing an integrated package of HIV prevention services, including HIV, tuberculosis and hepatitis testing and screening, and the provision of harm reduction and condoms. We will understand the need for such services more clearly in the near future.”

The UNAIDS Country Office for the Republic of Moldova has reallocated funds for urgent humanitarian response needs. This will increase the capacity of the National AIDS Programme to provide antiretroviral therapy to a much larger number of refugees living with HIV. Viral load testing is available to check viral loads if a change of treatment regime is necessary.

“The situation is evolving. We monitor the situation very carefully to understand when and how to look for more support. The Global Fund to Fight AIDS, Tuberculosis and Malaria is ready to make reallocations if they are needed, and the Republic of Moldova is able to access resources from the Global Fund’s emergency fund. In the event that the National AIDS Programme would be not able to cover the needs, we will look for more support from the Global Fund, UNAIDS, the United Nations Children’s Fund and the World Health Organization,” added Ms Plamadeala.

Yana Panfilova is Ukrainian and was born with HIV. When she was 16 years old, she created Teenergizer, a civil society organization to support adolescents and young people living with HIV in Ukraine. Since 2016, Teenergizer has been working internationally, promoting the rights of teenagers and young people in Ukraine and in seven cities in five countries across eastern Europe and central Asia. In 2019, the organization began providing peer counseling and psychological support to adolescents, and has trained more than 120 online consultants–psychologists to support young people across the region. In June 2021, she spoke at the opening of the United Nations General Assembly High-Level Meeting on AIDS. When the war in Ukraine started, she left Kyiv, Ukraine, with her family and made her way to Berlin, Germany, from where she is continuing her work to support young people living with HIV in Ukraine.

Why and how did you leave Kyiv?

Within days of the start of the Russian invasion I understood that we needed to make a life-changing decision—people with machine guns were patrolling the streets. I had to convince my mother that we needed to leave, because she was reluctant to go. We packed up our lives in less than an hour, drove to Kyiv railway station, left our car there and boarded the first train that we could find. There were so many people, mothers, children, and fathers and brothers seeing off their families, and many people were panicking. We had to stand on the train for 12 hours, with our suitcases and our cat. When our grandmother caught up with us at our first stop, we travelled together from Ukraine, along with her dog, crossed the border to Poland and went on to Berlin. The entire trip took seven days. It was the longest and most challenging trip of my life—I didn’t want to leave my beautiful Kyiv not knowing where we would end up. Now we are here in Berlin, refugees, safe and secure, but still in disbelief about what we have been through and distraught about what is happening to the people of Ukraine. But at least we are safe and together—my mother, my grandmother and her dog, and me and my cat. I was lucky that I brought enough antiretroviral therapy to last about two months.

Are you settled in Berlin?

I’m still in limbo, like millions of other Ukrainian women and children who have made this journey. But everyone we have met at every step of this journey has been so kind and welcoming. We are now clarifying the legal aspects of how to stay here in Berlin for the next few weeks and how we can access local medical and social services. Even how we can rent an apartment is still not yet clear. We made an appointment online with the municipality of Berlin to clarify the details with them. They are working to provide me with medical insurance so I can get access to medical care and uninterrupted access to HIV treatment.

I am also in contact with Berliner Aids-Hilfe, one of the oldest nongovernmental HIV organizations in Europe; after the war in the former Yugoslavia, they have a lot of experience in working with migrants living with HIV. They have been amazing, ready to help with access to antiretroviral therapy as well as the other needs that Ukrainians living with HIV will have here in Berlin.

So, you're more or less safe now. How are the other young people from Teenergizer doing?

Most of our teenagers living with HIV have already left Ukraine and now they are in Estonia, Germany, Lithuania, Poland and other countries. We are in contact with most of them every day. Some of our activists chose to stay with their parents in Kyiv and other cities that are under attack. We are now clarifying the latest information and trying to monitor where everyone is, and if they are safe. But this is not a quick or easy process. Everyone is now trying just to survive and stay in contact. Our staff, peer educators and clients are now scattered across different countries, each with different laws, treatment regimens and access to the Internet. Those still in Kyiv are connected with our partners, who are still providing access to antiretroviral therapy and emergency humanitarian assistance. Most of our consultants–psychologists are still providing online assistance to those in most in need.

What are the issues you are dealing with to stay in Berlin?

The people here in Berlin and all the Germans we have met since we arrived have been incredibly kind and welcoming. We are very grateful. I know all cities across Europe are struggling to support millions of Ukrainians, but I don’t think we could have found a safer and more tolerant place to stay than Berlin.

Of course, our most urgent questions are of a legal nature related to temporary status here and, second, questions about access to medical care and antiretroviral therapy. Third is housing. I never thought housing would be so important or so nerve-wracking. Local volunteers are helping around the clock, and millions of Europeans have opened up their homes. But for the hundreds of thousands of Ukrainians still living in warehouses, shelters and other temporary accommodation, the lack of a place you can call a temporary home can crush your spirit.

What do you think is most important to keep doing now?

No matter what happens with the war, we have to continue supporting each other in the Teenergizer family. In Ukraine, we spent years fighting so that young people living with HIV could have our health and rights protected. And now it feels like so many of our hard-won gains have disappeared overnight. In the middle of this crisis, we have to keep standing up for our rights and focus on the urgent needs facing the most vulnerable members of our Teenergizer network. I am so lucky to be alive and here in the safety of Germany. But many of our friends are still in Kyiv and in other cities across Ukraine, fighting for their lives and our country. Some of them have no way out and others don’t want to leave their homes and their families. Now, more than ever, they need our support and reassurance that we will continue to do everything we can to support them when they need it most.

First, we need to help them to navigate this new crisis and continue life-saving services—HIV treatment for those who urgently need it, and prevention and testing services. Second, during this crisis, we must continue to provide young people with mental health services, especially peer counselling. In our region, HIV is more of a social problem than a health problem. Today, young Ukrainians living with HIV are facing the triple crises of their health, their safety and acute stress and depression caused by the war. Psychologists call it PTSD. This trauma is continuing for an entire generation of Ukrainians. Young people who need professional psychological support will start using drugs and some of them will contract HIV, but they will be too scared or ashamed to ask for help in the current crisis. The same applies to adolescent girls and women who cannot exercise their reproductive and sexual rights, or young people who do not use a condom during sex, or millions of Ukrainian women who are at risk of exploitation when they are alone in Europe, away from their families and friends. Today, thousands of adolescents still in Ukraine who are living with HIV are afraid to reveal their status. Many still do not know how to protect themselves from HIV and from the violence of war. Millions of Ukrainian youth are left alone to cope with their anxieties and fears, and an entire generation will be dealing with post-traumatic disorders—this needs urgent attention. I am convinced that if we provide even basic counselling and support now, young people facing multiple crises will be better able to cope with their problems for years to come.

And also no matter what, we have to push politicians to listen to young people and allow them to influence the decision-making process about their own health and future. The voices of young people, especially young women, should be heard to stop the war and rebuild Ukraine.

How do you see the future of Teenergizer now?

Today, me, my family and my country are facing the greatest crisis of our lives. So if I am not sure about tomorrow, it is difficult to see what the future holds. Over the years, we built a real family, teams of young Teenergizer leaders in different cities in eastern Europe and central Asia—in Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, even in Russia. But now we are divided. After the Second World War, Winston Churchill said that there would be a wall. And I think that a new wall is appearing now.

What would you say today if you were again on the podium of the United Nations General Assembly?

This is a war between the old world and the new world.

We are young people who want to live in a new world, where there are no wars, where pandemics such as HIV, tuberculosis and COVID-19 are ended, where poverty and climate change are solved. In this new world, all people, no matter who they are or who they love, whatever language they speak or what passport they hold, can enjoy freedom and live their life with dignity, and travel and move across open borders, between peaceful countries. We learned how important and precious this was in recent years when Ukrainians could travel. We could see how peace-loving people lived in other parts of the world, and it made us appreciate the beauty and freedom we have in Ukraine. Today, more than ever, we only understand what we want to rebuild in our own country when we compare it to the values we find in other countries.

And it is this old world that is financing and sustaining this war. This is a road to nowhere.

With the billions spent on this senseless war, the world could find a cure for HIV, end poverty and solve other humanitarian crises.

The new world is about development, not destruction. It is about being able to improve yourself, improve the quality of your life and really support others to do the same.

Everything has an end. And the war will eventually end. What will you do on the first day after the end of the war?

I'll start to read Leo Tolstoy’s book War and peace.

On 24 February, Olena Sherstyuck, UNAIDS Global Outreach Officer in Ukraine, had no choice but to flee Kyiv. We spoke to her from her new location in western Ukraine.

On 24 February, what were your first thoughts?

Well, my day started very early that day. My son messaged me at 5 a.m. saying, “It looks like the war has begun.” When I went out on my balcony, I heard loud sounds that sounded like bombs.

Is that when you decided to leave Kyiv?

At first, I sat in my car with my cats and then, after checking in with the country director and the rest of the staff, I decided to go to my country house with a garden outside of the city, where I met up with my son and his wife.

Was that safe enough?

When I arrived, I realized this was worse than the city. My house is in fact near the Gostomel Airport, so is a target of missiles. We hardly slept at all. The sky was red and what I love about the place is that there are panoramic windows, but this was not pleasant at all. The windows kept rattling.

So, what did you do next?

On 25 February, at midnight, we decided to leave for western Ukraine. I had worked in the region for five years while working at the United Nations Children’s Fund and had been back since then, so the mountainous region seemed like a good option to me.

It meant driving solidly for 28 hours because we zig-zagged from place to place to avoid fighting and to find alternatives to closed roads or blown-up bridges. We had to change our route constantly. That was quite challenging.

I asked friends in the region to help me find a place to stay, so we are now settled in a wooden house with five rooms and a common kitchen. 

Were you liaising with your team and your supervisor?

We are a small UNAIDS office in Ukraine and because of COVID-19 we had all sorts of ways of staying in touch, via WhatsApp, Viber, etc. Every morning we have our regular morning check-ins. That has helped a lot to stay connected. Colleagues from the region and the global hub have also reached out, which keeps me feeling like things are normal.

Normal, really?

I cannot sleep and I cannot eat but the work and meetings and coordinating efforts help keep me grounded—it keeps me going.

I am, however, addicted to the news. It’s impossible to stop watching and reading what is going on. I keep thinking about my apartment in the city and about my garden and when we can all go back to Kyiv.

I have no regrets about leaving. I am not a fighter nor am I in the army, so why get in the way of the people fighting. That first week I was in shock and I thought that it would end quickly, but we are now three weeks in.

I assume you took your passport and phone but what about food and clothing?

I took my key documents and passport and my work computer but only had gardening clothes from my house, so I have been wearing an all-purpose man’s jacket ever since. Let’s just say I am looking a bit disheveled, but I am not the only one! (Laughter.)

As for food, there are small markets and so far we have had no shortages. We are trying to make ourselves busy by joining local women making bread and there are other communal activities organized in the village.

(Interruption) Do you hear that, Charlotte? You heard the sound of the air raid alert? It’s stopped now.

Not having lived through something like this, what advice do you have for us?

First of all, having personal relationships with people really comes in handy in such times. Not only was I able to connect with my current colleagues, I also did so with my former work friends too.

And from the first day, I was able to reach out to the numerous networks of people living with HIV and other nongovernmental organizations I work with to see how they are doing. This meant lots of calls back and forth, but these are professional and personal relationships I have made over the years—I wanted to know if everyone was safe.

I must say we at UNAIDS were really good at sharing and passing on key information regarding what services are available, where and with whom, services such as antiretroviral therapy refills or opioid substitution therapy, and then updating the information. Before the war, I was a member of the national oversight committee and programmatic committee that oversees Global Fund to Fight AIDS, Tuberculosis and Malaria grants, so my colleagues and I are trying to follow up on programming aspects. It is not easy, and as for monitoring, many people are still hiding in basements, so that complicates things.

Secondly, it is really hard to plan strategically. In the beginning, everyone is making ad hoc decisions. Our partners, other international organizations, basically everyone was scrambling to help and unfortunately there was a lot of duplication. One day I would be asked to find mattresses, another day someone needed gas, now things feel more organized.

I learned that it takes time to understand how to act and react and it’s important to find one’s niche. Don’t try and spread out too much.

Good advice—basically, assign roles and/or tap into each organization’s strengths to work better as a whole?

Exactly. Another thing that has been helpful is to have the global hub’s input. I mainly work with local counterparts—for me, that is 90% of my time and because of all the running around and the forever-changing situation, it has been useful to have HQ give us the bigger picture.

How so?

It’s reassuring to know that countries, such as Poland and the Republic of Moldova, and people have committed to help Ukraine. I now know what our colleagues in the region are doing regarding antiretroviral therapy stocks and using international assistance. In Ukraine, we adopted more European standards, so, for example, our regulations on medicines and intellectual property are close to European standards and have little in common with former Soviet satellite countries. Our legislations contain chapters on key populations and prohibit discrimination and the Ukrainian Government financed basic HIV prevention services for hundreds of thousands of people from key populations. We also really pushed harm reduction services, since HIV in Ukraine affects mostly people who inject drugs, with thousands of people on opioid substitution therapy and pre-exposure prophylaxis. The rights of lesbian, gay, bisexual, transgender and intersex people have also been an integral component of the country’s human rights strategy.  I can hardly imagine such developments in many eastern European countries.

Any last thoughts?

It’s really important to feel like I have human contact, so do reach out. And I must say I have been impressed by people uniting, Ukraine feels more united to me. That is my one optimistic note in all of this—there has been fantastic support among people. Glory to Ukraine!

By Michel Kazatchkine — This article appeared first on The Telegraph

It is no surprise that the World Health Organization (WHO) is calling for oxygen and critical medical supplies to safely reach those who need them in Ukraine and moving to establish safe transit for shipments through Poland. But nor is the call new. We`ve been here before.

Russian annexation of Crimea and the conflict in the Donetsk and Luhansk oblasts of Eastern Ukraine in 2014 threatened the supply of HIV and tuberculosis medicines. Fragile trans-internal border efforts and financing by the Global Fund to Fight Aids, Tuberculosis and Malaria allowed the continued supply of the medicines in the separatist territories despite the conflict during the last eight years. 

One has to assume that should Russia occupy new Ukraine territories, the challenges to guarantee people living with tuberculosis and HIV access to those drugs will be just as great, high risk, if not already lost.

The separatist authorities in the Donbass and the Russian administration in Crimea also abruptly stopped opioid agonist therapy (OAT) for people who inject drugs, which resulted in much suffering and deaths from overdose and suicide.

NGOs working with affected communities in Donbass were basically closed down. Decades of fighting HIV and tuberculosis have taught us just how critical civil society, community leadership and human rights are to ending those diseases.

The Russian Federation refuses to countenance OAT as a harm reduction measure to reduce the risk of HIV transmission through shared needles.

Ukraine on the other hand, is a notable champion of harm reduction, including OAT and needle exchange programs. This matters greatly in eastern Europe and central Asia which continues to be home to the fastest growing HIV epidemic in the world.

Some 1.6 million people are living with HIV in the region (with Russia accounting for 70 per cent) and around 146,000 are newly infected each year. Drug use accounts for around 50 per cent of new infections but unprotected sex is set to become the main driver in the coming years.

Ukraine, however, has been one on of the most successful countries in the region in terms of guaranteeing access to antiretroviral drugs – 146,500 people in the past year.

These gains were at risk before the war with Covid-19 restrictions seeing a drop in people testing by a quarter in 2020. The coming weeks and months of war will cause this effort to collapse entirely. 

Eastern Europe also remains the global epicentre of multi-drug resistant tuberculosis globally. Despite progress in the last ten years, TB prevalence, mortality levels and particularly, incidence of multi-drug resistant tuberculosis remain high in Ukraine which has the second highest number of cases in the region. 

Drug resistant tuberculosis represents around 27.9 per cent of new tuberculosis patients and 43.6 per cent of previously treated patients and treatment success of multi-drug resistant tuberculosis is around 50 per cent.

If Covid-19 halved case detection in 2020, it is not hard to imagine it being totally wiped out by the ongoing war.

As health systems collapse and treatment and prevention services are interrupted, mortality from HIV, tuberculosis, multi-drug resistant tuberculosis and Covid-19 will readily increase in Ukraine. Hundreds of thousands of people are internally displaced and cities such as Lviv are running short of medicines and medical supplies.

Scarily, the fallout of the invasion will also go beyond Ukraine: over a million refugees have already fled for their lives. The impact of this will be felt across border towns and areas in central Europe whose response to tuberculosis, HIV and more recently Covid-19, has been fragile. 

Border locations and neighboring countries will have to anticipate and address an avalanche of new health needs. We are at an impasse: international cooperation and solidarity towards the Eastern European region has not been a strong feature of the last two years of the global pandemic response.

The arrival of WHO health supplies and the formation of a safe corridor for refugees are fragments of good news in this unfolding tragedy, but we need so much more.

Health systems and facilities must be protected, be functional, safe and accessible to all who need essential medical services, and health workers must be protected.

Michel Kazatchkine is Course director at the Graduate Institute for International Affairs and Development in Geneva, Switzerland, and the former UN Secretary General and UNAIDS special Envoy on HIV/AIDS in Eastern Europe and central Asia. Previous to that he was the Executive Director of the Global Fund to fight AIDS, TB and malaria.

Ten days after the start of the Russian invasion of Ukraine, UNAIDS spoke to Oleksii Kvytkovskyi, the head of the Volna Donbas Resource Center of the All-Ukrainian Association of People with Drug Addiction, a nongovernmental organization working with people who inject drugs in Ukraine.

How are you feeling Oleksii?

I am tired of fear and fleeing. I have decided I will carry on doing what I have been doing for the past 14 years—defending the rights of key communities, notably people who inject drugs and people in need.

This is not your first encounter with war?

Eight years ago, I was there when the Russian Federation attacked the eastern part of Ukraine—as you know, they are now self-proclaimed republics. I have three children and two were born during that conflict, one in 2014 and the other in 2019.

I still work in four cities in the Luhansk oblast (region), which are controlled by the Ukrainian Government, located almost on the front line: Severodonetsk, Lysychansk, Rubizhne and Kreminna.

What are you currently doing in your job?

We at the nongovernmental organization receive and then deliver opioid substitution therapy (OST) and food and water to those who need it. We only have enough OST until the month’s end. That’s about 28 days, and then I don’t know what we will do.

Access to antiretroviral therapy is also problematic in some cities. Basically, we look at who lacks what and if there are risks of interruption.

Have a lot of people left your area?

Very few people can leave because they don’t have enough funds to do so. Until now they have been evacuating women, small children and the elderly as a priority.

Our nongovernmental organization turned to international organizations and we received assistance from the Eurasian Harm Reduction Network, the Eurasian Network of People who Use Drugs and Volna, and that has really helped to provide urgent assistance.

What about you?

I begged my wife to take the children and leave for Lviv. I even found a place for them to live but she said that she wouldn't leave me, and so she stayed.

But I am afraid. I am anxious about my children and my beloved wife.

What keeps you going?

I go to work every day. People ask me if I fear for my life. My answer to this is, “When you solve someone’s problems, you unknowingly forget about fear and war. Then solving the problem of a person from the community becomes the key objective for you, so you set out to help in any way.”