The plight of people living with HIV at risk in Ukraine

As the war in Ukraine escalates, the humanitarian crisis continues to grow. Since Russia invaded the country on February 24, the devastating effects on the population have become increasingly acute. Indiscriminate attacks on civilians and civilian infrastructure are on the rise, with little or no reconnaissance of humanitarian corridors, and the loss of life is increasing. To date, around 200 health facilities are located in conflict areas and several hospitals have been destroyed by military operations. The implications for people needing access to the country’s health systems are catastrophic.
The continued provision and secure access to HIV treatment and prevention services in Ukraine for people living with and affected by HIV is at serious risk. At the start of the war, concerns were expressed about the availability of HIV-related services during the conflict, UNAIDS stating that the supply of antiretrovirals for more than 150,000 people on HIV treatment was limited to a few weeks. Although the first aid deliveries have focused on essential drugs and emergency equipment, according to the WHO, the supply of antiretrovirals will be ensured thanks to funding and cooperation with international aid agencies, the Ukrainian Ministry of Health and local non-governmental organizations.
Before the invasion, Ukraine response to HIV had been mixed, hampered by poor socio-economic conditions, reduced external funding and unrest in breakaway eastern provinces. However, in recent years, the country has made substantial progress in tackling the epidemic, which is mainly concentrated among injecting drug users. The estimated population of people who inject drugs is over 350,000 with an HIV prevalence of 21%. In particular, there has been a great scaling up of harm reduction services, including needle exchange programs and the largest opioid agonist treatment program in Eastern Europe and Central Asia. The country has seen a 21% reduction in new infections since 2010. The besieged cities of Dnipro, Kyiv and Odessa had recently joined the Fast Track Cities initiative. The conflict threatens to reverse years of progress.
There are antiretrovirals in the country, but access to supplies is already limited in the areas most affected by the conflict, as an article in this issue points out. In-country storage, delivery and distribution of supplies may be disrupted as the intensity of the conflict spreads. Mitigation measures for interrupted and limited supplies of antiretrovirals should include trying to anticipate stock-outs, prescribing for several months, and identifying areas likely to have an influx of internally displaced people. of the country infected with HIV. Potential difficulties also exist for the supply and distribution of methadone for opioid agonist treatment. Shockingly, the Russian military has so far shown little respect for humanitarian corridors – the existence of such corridors is not only essential for the safe evacuation of civilians, but also to ensure that medical supplies reach those who need them most. Some organizations have already had to reduce or stop their HIV programs.
As covered by The Lancet HIV in 2018, the ongoing conflict and occupation by Russian forces in the breakaway eastern provinces of Luhansk and Donetsk has decimated HIV services in the region and serves as a wake-up call for health and well-being of people living with HIV if a Russian-backed regime were successful in Ukraine. Separatist authorities and the Russian administration of annexed Crimea have stopped opioid agonist therapy, mirroring the situation in the Russian Federation where the therapy is illegal.
The conflict could have serious implications for the HIV response by neighboring countries too. As of March 11, according to the UN migration agency, 2.5 million refugees had crossed the western border from Ukraine to neighboring friendly countries and estimates suggest that this figure will soon reach 4 million. Continuity of HIV services for refugees arriving in adjacent countries is a concern. It is imperative that the health systems of these countries are supported, especially Moldova, one of the poorest countries in Europe. The sanctions also risk straining already limited funding for HIV services in the Russian Federation, which has the largest HIV epidemic in Eastern Europe and Central Asia.

Building a functioning health system that ensures the health, safety and well-being of people, including those affected by HIV, is impossible if the conflict continues, despite the immense humanitarian efforts of governments, aid agencies and civil society. Ukraine’s HIV response and the HIV response in the region are in jeopardy unless the invasion ends now.

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