Ukraine

Two years of war in Ukraine have resulted in significant humanitarian consequences. Forty percent of the current population of Ukraine,14.6 million people, are in need of humanitarian assistance, 6.4 million refugees have fled the country, and more than 3 million people are internally displaced. People living with and affected by HIV continue to be vulnerable to the effects of the war, even as HIV services have been restored and are functional in most parts of the country.

Russian strikes have continued to wreak havoc on Ukrainian cities, causing death and destruction, impacting access to water, electricity, heating, and health services for millions of civilians.

In addition, there have been 1,570 attacks on health facilities and 630 health facilities damaged.

According to the latest data from The Ukrainian Public Health Center, prior to the war, Ukraine had made significant progress in reducing HIV incidence (-47%) and AIDS-related mortality (-81%) since 2010. Despite the initial disruption to the national AIDS response at the onset of the war, the national AIDS program has gradually resumed routine operations.

As of the end of 2023, the number of patients on antiretroviral therapy (ART) was only slightly below the pre-war figure, standing at 118,348 (130,724 as of February 2022). Additionally, approximately seven thousand patients are known to receive ART abroad. In the last two years, the number of patients on opioid agonist therapy (OAT) increased by 38%, reaching 27,511 people. Pre-exposure prophylaxis (PrEP) more than doubled, reaching 12,354 people.

However, in eastern and southern occupied territories data is incomplete or not available. This is true of Donetsk, Luhansk, Zaporizhzhia, Kherson regions, AR Crimea, and the city of Sevastopol. The same occurred in 2023.  Despite these challenges, the surveillance system in the government-controlled areas remains operational, ensuring the completeness and quality of data on HIV prevention, testing and treatment services.

In addition, 9.6 million people in Ukraine are estimated to be at risk of or living with a mental health condition, and 3.9 million people are estimated to suffer from moderate to severe symptoms. And there has been an increase in gender-based violence.

Ukraine remains committed to the HIV response through a strong coalition of government, civil society, international organizations, and donors, first and foremost The United States President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. This collaboration has secured vital supplies of antiretroviral therapy (ARV), tuberculosis medicines, and opioid agonist therapy (OAT), ensuring uninterrupted HIV treatment and services.

UNAIDS Secretariat, Co-sponsors and UN agencies have joined forces to provide a unified response, ensuring that vulnerable populations, including those on the frontline and in the most severely affected areas, receive comprehensive support. This collaborative effort aims to bridge gaps and address the unique challenges faced by women, people living with HIV and key populations, including the delivery of crucial humanitarian aid and HIV services.

The past two years have been very challenging. Even though the country has managed to maintain HIV services, the unpredictability of what lies ahead has many fearing the worst. Support is needed to ensure sustainability of the AIDS response and to protect key populations affected by the enduring hardships of war.

For more information and more in-depth analysis, read the Situation Report (February 2024)

Since the beginning of the war in Ukraine, communities of people living with and affected by HIV have been at the forefront of ensuring the continuity of life-saving HIV services, both for those who remained in Ukraine and for those arriving in Germany as refugees.

At a special World AIDS Day event in Berlin co-hosted by UNAIDS and 100% Life Ukraine, community representatives and civil society activists thanked the German government and UNAIDS for their support and spoke about the continued challenges they face.

“Our journey exemplifies how the strength of perceived minorities and real community leadership can drive life-saving programmes and innovations that can impact the lives of millions of people,” said Valeriia Rachinska, Director of Human Rights, Gender and Communities at 100% LIFE Ukraine. “None of this would be possible without the support of international partners and donors. Global solidarity and support from our partners are the chance for a fair and thriving tomorrow for all, especially those living with HIV.”

100% LIFE is the largest patient-led organization in Ukraine which has as its mission to fight for life. The Network works with patients and for patients, including the representation of the interests of people living with HIV in 25 regions of Ukraine.

Since the beginning of the war in Ukraine, Germany has donated €1,050,000 in emergency funding to UNAIDS, empowering the provision of critical support to people living with and affected by HIV in Ukraine, Poland and Moldova. This includes providing temporary accommodation, humanitarian assistance, social protection, primary health care and testing for HIV, hepatitis C, STIs and tuberculosis. The emergency fund also covered the enrollment of people in HIV prevention and treatment programmes, offering comprehensive care and support.

Among the speakers at the World AIDS Day event was Silke Klumb, CEO of the German AIDS Federation, who underlined the importance of the partnership between government and civil society in ensuring continued access to HIV prevention, treatment and care services for people affected by the war in Ukraine.

"Community-led responses have been and continue to be critical in the HIV response, both in Germany and globally. Thanks to public funding Deutsche Aidshilfe has been able to engage in community-led prevention, counselling, testing, care, and support for 40 years now. Upon this foundation and through the broad network in Ukraine, Eastern Europe and Central Asia, Germany’s community-led organizations under the umbrella of Deutsche Aidshilfe were able to act immediately to Russia’s full-scale invasion of Ukraine,” said Ms Klumb. ”Over the last 18 months, we provided support, information, translations to people fleeing the war and linked them to care. Platforms such as self-help conferences and other meetings helped to strengthen the communities of people living with and affected by HIV. Deutsche Aidshilfe is committed to continue putting the communities at the centre of our work.” 

During the event, UNAIDS Deputy Executive Director of Policy, Advocacy and Knowledge, Christine Stegling, presented the new UNAIDS World AIDS Day report Let Communities Lead. The report shows how communities have been the driving force for progress in the global fight against HIV.  It shows that investing in community-led HIV programmes can have transformational benefits.

“Since the earliest days of the AIDS pandemic, community leadership has driven life-saving access to HIV treatment and prevention. Continued progress against HIV/AIDS in Ukraine - despite the war and its resulting refugee crisis - is the direct result of Ukrainian and German community leadership. A community-led response is well-positioned to maintain continuity of HIV prevention and treatment services, especially in times of crisis,” said Ms Stegling. “Continuity of HIV care is essential for achieving our ultimate goal of ending AIDS as a public health threat by 2030. UNAIDS thanks all community leaders who stepped up in these challenging times and we thank nations like Germany who understand the value of investing in a community-led response to HIV/AIDS - especially in times of war and other crises.”

The event was moderated by Peter Wiessner of Action against AIDS Germany.

Oleg Kucherenko (not his real name) traveled from the eastern part of Ukraine to Lviv, in the western part of the country when his city, Kherson, was occupied by Russian forces.  He, like many other representatives of the LGBTQ+ community was desperately looking for a safe place to stay.

His friend recommended the Facebook group of the Alliance Global - the largest LGBTQ+ organisation in Ukraine, who helped him find a spot in a shelter.

Once there, he got food, a place to sleep, and was able to contact friends and colleagues courtesy of electric generators and internet service. Up to ten people can stay in this particular shelter. The shelter administrator, Vadim Pryzenko, sees this as a lifeline.

“Our clients can get not only a place to live but also food and social and psychological support,” he said. “For those who are not living here, we provide humanitarian aid, food, hygienic products, and also individual financial support,” Mr Pryzenko said.

Since the war began a year ago, more than 7.9 million Ukrainians have fled abroad and another 6.5 million moved within the country. 

Due to growing demand to find accommodation for internally displaced people that Alliance Global experienced, several organizations, including the Fondation de France, International Office of Migration (IOM) and UNAIDS’ Emergency Ukraine Fund, helped them set up the shelter. The shelter also provides health care and HIV services.

Mr Kucherenko got tested for HIV, hepatitis, and other diseases. His HIV test came back positive. He quickly met with a social worker, Andriy Kharatin, who accompanied him to the Lviv AIDS center where he got confirmation of his diagnosis, and additional tests.

"Several days later, with our help connecting him with to the health care system, Oleg started anti-retroviral therapy,” Mr Kharatin said.

Ukraine has the second - after the Russian Federation- biggest HIV epidemic in Eastern Europe and Central Asia (240 000 people are living with HIV according to 2022 estimates).

The country was making good progress in the AIDS response before the war – increasing the number of people living with HIV on antiretroviral treatment to nearly 60%.

However due to their destruction or occupation, more than 30 medical institutions providing HIV services have had to stop their operations, and logistics and supply chains have been broken. Despite this, Ukraine continues to help people living with HIV. Civil society has played a crucial role in adapting their response, engaging and reaching people in need.

“As a doctor, I am very pleased with the cooperation with Alliance Global,” said Dr. Olena Pavlishina from the Lviv Clinical Hospital. “Thanks to this cooperation we have the opportunity to be in touch with both internally displaced people and people who do not trust doctors much.”

In the past, she explains, a lot of the work was handled by health professionals.

“This part of the work that was previously done by health workers is now being done by social workers and civil society organisations,” she said.

And Mr Pryzenko doesn’t imagine that changing in the near future. He fears that if the war drags on, more people will come to the shelter and need services.

Meanwhile, Mr Kucherenko lives and works in Lutsk, not far from Lviv. He picks up his HIV medicine supply for three months and will get his next batch by mail when needed. He also stays in touch with his social worker for psychological support online.

One year on, the war in Ukraine continues to inflict massive suffering and destruction. Since the start of the war on 24 February 2022, more than 13.5 million people have been internally displaced or forced to flee to neighboring countries as refugees, including people living with HIV and key populations.

Ukraine, the country with the second-largest AIDS epidemic in the Eastern Europe and Central Asia region, has been hit hard by the war.

The country was making strong progress in the AIDS response by: 1) increasing the number of people living with HIV on life-saving medicine (more than 150 000 people are on treatment out of 240 000 living with HIV); 2) working hand in hand with community-based organisations and 3) reaching full state financing of innovative HIV prevention services among key populations.

The shock of the war pushed all stakeholders to protect those precious gains.  

The government of Ukraine and civil society partners have received enough anti-retroviral therapy (ARV), tuberculosis medicine, and opioid substitution therapy (OST) to provide uninterrupted treatment for everyone with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, and other partners.

Civil society has been the engine of the national HIV response along with the Ukrainian Public Health Centre before the war and throughout the year. They have delivered services, medicines, and humanitarian aid to those in need without fail despite bombings, attacks, lack of electricity and reduced access to the east and south of the country.

This effort needs our ongoing support and funding. We cannot let Ukraine’s HIV response fall back.

UN agencies and partners on the ground have been working closely with local authorities to reach and help people in need. More recently they have delivered humanitarian assistance to  hard hit territories in the country that have only now become accessible.

“Delivering essential aid and assistance relies on collaboration,” said Winnie Byanyima, UNAIDS Executive Director. “A coalition of government, civil society and international organisations has been and continues to be a cornerstone of the effective HIV response in Ukraine during the war. UNAIDS stands in solidarity with all the people and our partners working so hard on the frontlines.”    

A UNAIDS Emergency Fund has enabled partners across the country to sustain HIV care and support services, as well as providing direct humanitarian assistance and targeted support to the most vulnerable. This has meant, for example, creating dozens of shelters for internally displaced persons, including people who use drugs, LGBTIQ+ people, and other key populations linking HIV service providers with available humanitarian assistance programmes. The Fund has received support from the Red Cross Monaco, the United States of America and Germany.

With further funding from Germany, civil society organizations in Moldova, Poland, and other neighboring countries united their efforts to improve access to services for Ukrainian refugees living with HIV.

UNAIDS has issued an urgent call to the international community for additional funding for civil society organisations to keep providing essential HIV support services in Ukraine and in countries receiving refugees in need of HIV services.

UNAIDS will continue to support HIV prevention, testing, treatment, care and support for people across Ukraine affected by the war and people displaced by the conflict.

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.

On 17 May, people around the world came together to celebrate the International Day against Homophobia, Transphobia and Biphobia (IDAHOBIT) to champion inclusion and build a better world for the lesbian, gay, bisexual, transgender and intersex (LGBTI) community. In many countries, lack of adequate legal protection against discrimination on grounds of sexual orientation and gender identity exposes many LGBTI people to violations of their human rights. This is even more the case within the context of war and humanitarian crisis, as currently experienced in Ukraine.

UNAIDS and ILGA-Europe co-hosted an event, moderated by Cianán B. Russell, Senior Policy Officer, ILGA-Europe, to mark IDAHOBIT. The event brought together LGBTI representatives and a wide range of thought leaders, policymakers and practitioners.

The panellists highlighted the multiple vulnerabilities and challenges facing LGBTI people in and fleeing from Ukraine during the war. These vulnerabilities and challenges were clearly articulated by two LGBTI representatives.

“Levels of discrimination, violation of rights and hate crimes have risen in Ukraine since the start of the war. Meanwhile, no regulations or specific measures have been put in place in shelters to protect key populations. LGBTI people have no safety net since the war started,” said Olena Shevchenko, from Insight. “Go to local organizations and ask them what they need if you are intent on helping Ukraine. Ensure the accountability of humanitarian missions to fulfil the needs of the local community,” she added.

Tymur Lysenko, a Ukraine crisis consultant working for Transgender Europe, spoke about the essence of leaving no one behind, saying ““Leave no one behind” should work, not just be empty words. Trans people in Ukraine should be provided with humanitarian support, safe evacuation and access to medical care, and functioning gender recognition regulation procedures. Foster direct connections that are strong and sustainable between local organizations and international humanitarian missions. Stick to organizations that have a track record in providing direct support to LGBTI people.”

Reflecting on their own work and experiences, the panellists also reviewed the actions taken to date to protect the human rights of LGBTI people in and fleeing from Ukraine and the existing gaps within the humanitarian response and concluded with recommendations and commitment to better protect the human rights of LGBTI people staying in Ukraine or who have left.

“Humanitarian agencies must ensure that civil society organizations with expertise are included in the planning and implementation of all humanitarian assistance and in recovery efforts,” said Victor Madrigal-Borloz, a United Nations Independent Expert on Sexual Orientation and Gender Identity.

This was echoed by Kate Thomson, Head of the Community, Rights and Gender Department at the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), who referred to the need for all partners to work collectively to build back resilient health and community systems. “All partners to work together to support access to HIV services in Ukraine, including those led by LGBTI communities, inside Ukraine and abroad. Let’s work collectively to help Ukraine build back better its health and community systems,” she said.

Matthew Kavanagh, UNAIDS Deputy Executive Director, a.i., spoke about the importance of maintaining and increasing the funding for the AIDS response. “We stand with the Ukrainians who are fighting so hard to make sure that their responses—the AIDS response, the community response, the rights response, the LGBTI response—are not destroyed by the moment that we are in now. There is an urgent need to move funding towards that, and an urgent need to fund the Global Fund at the same time. We cannot choose between these two things or we will end up in a less safe world—we have to do both,” he said.

Joanna Darmanin, Head of the Humanitarian Aid Thematic Policies Unit, European Union Directorate-General for European Civil Protection and Humanitarian Aid Operations, reiterated the European Union’s commitment for an inclusive humanitarian response. “Supporting Ukraine and neighbouring countries remains the priority for the European Union, and we remain committed to providing humanitarian support in an inclusive manner, taking into account the specific needs and vulnerabilities faced by the LGBTI community,” she said.

This commitment was re-echoed by Katalin Cseh, Member of the European Parliament Committee on Foreign Affairs, who pledged to fight for inclusiveness of the LGBTI community. “I pledge to fight with all my means to ensure better consultation with the LGBTI communities on the ground in Ukraine and also within the European reception area.”

Maria Arena, Chair of the European Parliament Subcommittee on Human Rights, highlighted the need to position the humanitarian response to the needs of LGBTI people, saying, “The conflict zones are putting at risk people with these vulnerabilities, so we have to be really aware of the situation and to adapt our answers for the needs of these people, including with traceability of these funds.”

Marc Angel, Co-President of the European Parliament LGBTI Intergroup, emphasized the importance of ensuring that promises made correspond with funding. “Action and money must follow words and promises,” he said.

Valeriia Rachynska, from the Global Partnership against All Forms of HIV-Related Stigma and Discrimination, spoke about the Global Partnership’s commitment to fight for and save all lives, saying, “Our main target is to save and fight for life; we will do everything in our power to save the lives of LGBTI people in Ukraine.”

Indeed, to champion and build a better world for the LGBTI community, and to end inequalities for an effective AIDS response, especially in a humanitarian crisis context, institutional actors with differing responsibilities must ensure that no one is left behind. This among others, includes directed action to: combat discrimination targeting LGBTI people and people living with HIV, rebuild or reinforce the HIV response system, meaningfully engage LGBTI civil society both in crisis planning and in crisis response systems, ensure that LGBTI-led humanitarian efforts are adequately resourced and ensure that human rights violations faced by LGBTI people are documented, investigated and result in access to justice. 

On 25 November 2021, the city of Kryvyi Rih, the fourth largest city in Ukraine, signed the Paris Declaration to end the AIDS epidemic in cities. The city is an important economic and industrial centre, a major transport hub and the birthplace of the Ukrainian President, Volodymyr Zelensky.

A group created by the city administration to develop and implement the Paris Declaration determined the main areas of work, which included the expansion of HIV prevention services for key populations through community organizations and the scale-up of HIV testing through family doctors, among others.

Physicians across the city were trained in HIV, while Gennady Kruglenko, the chief doctor at the Kryvyi Rih municipal AIDS centre, visited Odesa and Dnipro to learn about their experience with implementing the Paris Declaration.

“We were seriously preparing to start this work,” said Mr Kruglenko. “But the war slowed down our plans. Our region borders the areas of active military operations, but our centre continues providing full-scale HIV services, and we are not going to stop. And we have not abandoned the main goal of the Paris Declaration: ending the AIDS epidemic.”

The Kryvyi Rih AIDS centre has been operating since 1994, and today there are about 10 000 people living with HIV accessing HIV treatment from it. People can get HIV treatment from five different sites, which makes it much easier for people living in different parts of Kryvyi Rih. Kryvyi Rih is the longest city in Europe, the length of which exceeds 120 km.

The AIDS centre continues to work as a reference laboratory for several regional centres. Its modern equipment allows the performance of all necessary tests, including diagnosis confirmation, CD4 counts, viral load and others, to be performed. People living with HIV with complex cases, for example opportunistic infections, that require the attention of experienced doctors are referred to the centre.

Marina Baidachenko, an infectious diseases doctor at the AIDS centre, says that the centre currently also provides services to people who have fled the war. “There are people who move within the country, who apply for services through a network of our social workers. The system in Ukraine is such that no matter where the patient is, he or she can receive treatment through the general system,” she said.

Each doctor providing specialized HIV care in Ukraine has access to the medical records of patients in a general electronic registry, with strict confidentiality measures in place. This ensures that the records of people living with HIV who move from one region to another can be accessed in the new region, thereby allowing the maximum number of displaced patients to remain on antiretroviral therapy, despite the war.

According to Ms Baidachenko, the war is felt every minute. “Air raids are very frequent, missiles are flying,” she said. The employees of the AIDS centre must go to the first floor or basement, which have been adapted as bomb shelters, every time the air raid siren sounds.

“To issue antiretroviral therapy to a person, you need to open his or her electronic card in the computer, create an electronic prescription through the registry and send it to the warehouse where the medicines are issued. When there are 200–300 patients in the centre, it’s hard to tell them to wait until the alarm is over,” said Ms Baidachenko.

With the help of a UNAIDS emergency grant, the centre equipped additional workplaces with laptop computers, office equipment and Wi-Fi. Now prescriptions take only minutes and doctors can move to a safe place when the siren sounds and take their computers and continue to serve people.

Close cooperation with community organizations, such as the Public Health Charity Foundation of Krivyi Rih, has become even more important during the war.

“Each of our doctors has about 2000 people on antiretroviral therapy. Now with the war, there are only two doctors left. They have to give a prescription, check the tests, explain the medical aspects—they simply don’t have time for other important issues, such as psychological support,” said Mr Kruglenko.

According to Alexander Lee, the Project Manager of the Public Health Charity Foundation, the war has changed the format and scope of the organization’s work. “Many of our clients were left alone with their problems and fears because family members left Ukraine. The response required increased mobility of the organization’s employees for consultations and assistance to clients in remote areas of the city,” he said.

Social workers are also helping to connect medical facilities with people who use drugs, gay men and other men who have sex with men and members of other communities, who have become even more vulnerable.

“Therefore, in the chain of services, everyone does a small, but very “big”, thing,” Mr Kruglenko added.

Raman Khailevich, the UNAIDS Country Director for Ukraine, emphasized that UNAIDS supports the city’s efforts to continue providing all HIV services in close cooperation with civil society organizations. “Such interaction in peacetime was one of the most important components of the successful AIDS response in Kryvyi Rih, and in wartime it is the only way not to lose what has been achieved but also to continue moving towards the goal of ending AIDS, saving every life,” he said.

More than 600 000 Ukrainian refugees arrived in Germany since the war broke out. Among them many people living with HIV – mostly women.

In the beginning many needed shelter and then there were lots of requests about obtaining HIV treatment. Many refugees had left their supply behind or took the bare minimum.

Vasilisa Sutushko, who was born with HIV, arrived in Berlin at the beginning of March and had only one month of HIV medicine with her. She also had no clue navigating the German health system. A local NGO, Berliner AIDS Hilfe, one of Germany’s oldest HIV organizations, was flooded with an influx of calls for help.

“I got these pills for €10 for three months,” Ms Sutushko said, pointing at a box of HIV treatment. “When I came to Berlin, I had to understand whether I received medicine for myself here for free or for a fee,” she said.

Unlike in her native country, she explained, in Germany you need a prescription for almost all medicines.

“In Ukraine, I can get any pills I need without any problems at the pharmacy,” Ms Sutushko said.

Berliner Aids-Hilfe’s migration consultant, Sergiu Grimalschi, said when the first refugees began to arrive there were few organized structures, so they had to improvise across the country. “We had to find an urgent solution,” he said.

They helped countless refugees with medicine, paperwork, housing, and other pressing health issues.

According to Berliner AIDS Hilfe, most of the refugees living with HIV won’t be able to go back until the bombed medical facilities are rebuilt.

Ms Sutushko, founder of Teens Ukraine – an NGO that helps young people who live with HIV- and others are now trying to set up a network to further help people living with HIV. Stigma and discrimination in Ukraine regarding one’s HIV status has made many refugees hesitant about seeking help or open about living with HIV in their adopted countries. "I'm happy to see people like me here who need help, I can also be helpful," she said.

UNAIDS estimates that 260 000 Ukrainians live with HIV. Up to 30 000 fled their country since the start of the war and need HIV treatment.

Interrupting treatment, even temporarily, can lead to drug resistance and increased risk of progression to AIDS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.