March 22 (Thomson Reuters Foundation) – In basement shelters and makeshift clinics, Ukrainian doctors are striving to keep treatment for HIV-positive people on track as Russia’s invasion raises fears that years of progress to combat the virus could be undone.
Russian bombing and fighting has shuttered HIV clinics in two Ukrainian cities and forced others to limit their services, a leading nonprofit said, while the supply and distribution of vital antiretroviral drugs is also at risk.
“(The war is) making people with HIV more vulnerable to everything,” Valeriia Rachynska, the head of human rights at the All-Ukrainian Network of People Living With HIV group, told the Thomson Reuters Foundation in a WhatsApp call.
Infectious disease experts say the war could unleash a public health crisis both in Ukraine and neighboring countries in HIV, tuberculosis (TB), hepatitis C, and opioid addiction.
Research shows interrupting antiretroviral treatment can give rise to drug-resistant strains of HIV, potentially narrowing future treatment options, and also undoes the protection the therapy provides against transmitting the virus.
“It’s just heartbreaking, and it’s so disturbing,” said Chris Beyrer, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, referring to the war’s impact on Ukraine’s HIV prevention, care and treatment infrastructure.
Roughly 260,000 people were living with HIV in the nation of 43 million people in 2021, according to UNAIDS, with about 152,000 people of them receiving treatment.
“Whatever the outcome from a military and political perspective, this crisis will shake health and will generate a major health crisis across the region,” said Michel Kazatchkine, former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
AD HOC CLINICS
According to the AIDS Healthcare Foundation (AHF), military assaults and bombings have forced the complete closure of its clinics in the eastern city of Kharkiv and the seaport of Mariupol in the south.
The NGO, which provided treatment to about one in three people receiving antiretrovirals in Ukraine when the war broke out, said Russian military incursions have also limited the work of clinics in cities including Kherson, Mykolaiv, Severodonetsk, Slavyansk and Odessa.
Still, Martin C. Donoghoe, senior advisor for TB, HIV and hepatitis at the WHO’s Ukraine office, said many of the nation’s infectious disease physicians remain in the country, managing to care for their patients from basements and ad hoc clinics.
“There is an incorrect narrative that nothing is working,” Donoghoe said from Copenhagen, where he is in regular contact with colleagues in Ukraine, adding that many people are still receiving their HIV medications.
But as international NGOs mobilise to send new supplies to the country, distributing them could also prove difficult.
“The challenge will then be not only to bring them inside the country, but to dispatch these medicines in various areas of Ukraine,” said Kazatchkine.
Rachynska, who left the capital for the relative safety of western Ukraine after Russian troops invaded the country on Feb. 24, said she feared President Vladimir Putin would seek to enforce the same punitive policies in Ukraine as he has at home.
“Am I afraid of Russia? Yes. But not to fight with them or to have a war with them, but to live with them,” Rachynska said, adding that LGBTQ+ Ukrainians could be at particular risk.
In Russia, gay men and people who inject drugs are often persecuted by the police, with the names of HIV-positive people kept on a central registry.
HIV awareness programmes are often stymied by the effect of the country’s 2013 “gay propaganda” law that outlaws discussion of LGBTQ+ matters with minors, Beyrer added.
Beyrer said he was concerned that prominent people working in HIV services in Ukraine could be targeted under Russian rule.
Ruslan, a 42-year-old bisexual man living with HIV who declined to give his surname or reveal his exact location, said he feared losing access to antiretroviral medication if drafted into the army.
“I am worried that I and people with HIV won’t receive timely therapy, Ruslan said. “I try not to lose heart and live in the hope that all will be well.”
Global NGOs are trying to help avert an infectious-disease crisis in Ukraine and across Europe, where some 3.6 million refugees have fled so far.
The Global Fund has committed an extra $15 million to prop up prevention, testing and treatment of TB and HIV, as well as support opioid addiction treatment programmes in Ukraine.
The U.S. global HIV aid programme, PEPFAR, has contributed an additional $6 million towards providing antiretroviral treatment in Ukraine and to Ukrainian refugees.
A delivery of 209,000 90-day supplies of antiretrovirals is expected to arrive in Poland this week bound for Ukraine, which has made more progress against HIV than most of its neighbors in Eastern Europe and Central Asia in recent years.
According to UNAIDS, this is the only global region to have seen a substantial rise – of 43% – in the estimated annual HIV transmission rate between 2010 and 2020.
In Russia, new HIV diagnoses have trended upward over the past decade, with nearly 1 million people testing positive, according to the European Centre for Disease Control and Prevention.
By contrast, Ukraine reversed annual HIV transmissions and deaths during the decade – achievements that are now threatened, Rachynska said.
If the Russians occupy Ukraine, “it will be a disaster for the gay population, for people living with HIV”, she said.
“We will have the same disaster in HIV and AIDS that (Russia has) right now.”