Emergency HIV Prevention for People Displaced in Ukraine

By The Global Fund

November 23^rd, 2022

It was on the seventh day of the Russian invasion of Ukraine that 500-kilogram bombs were exploding near Vadym’s house in the city of Kharkiv.

“My house was shaking. It was dark and airplanes were flying very low. I decided that if I survived that night I would leave in the morning," he says.

Vadym is a biotechnologist by training. Prior to being forced to flee his home, for 15 years he was the chief technologist at a company producing packing materials.

“I had a great career, friends and family, and a private house. It was only the war that forced me to leave,” he says.

Vadym is one of an estimated 14 million people who have had to flee their homes in search of safety due to the war in Ukraine. Now in the city of Lviv in the west of the country, safety and stability are still out of reach.

“It's very difficult to plan things because one missile strike can change all the plans, reshape our lives in a second," he says.

Smoke rises over Lviv after a missile strike by Russian forces. Lviv was one of multiple cities across Ukraine targeted on November 15, a day now known for some of the heaviest waves of simultaneous missile strikes since the war began.

HIV services severely disrupted

In addition to the many risks and fears of fleeing home and being caught in conflict, Vadym was also concerned about staying HIV-free. Four days before the Russian invasion he had started taking PrEP.

Pre-exposure prophylaxis, known as PrEP, is a medicine that people can take to prevent themselves from getting HIV. PrEP is highly effective and safe and can reduce a person’s likelihood of getting HIV by 99%.

Prior to the war, Ukraine was home to the second largest HIV epidemic in Eastern Europe and Central Asia. But infections had been steadily reducing largely because of strong Ukrainian leadership, including among civil society. There is now a concern that the displacement, service disruptions and trauma caused by the war will lead to spikes in new infections.

"I did not know how or where I would get more PrEP,” says Vadym. “I was worried if it was even ok to raise such an issue and contact social workers with my questions."

But by the time Vadym needed more PrEP, about six weeks after the war began, a new clinic providing HIV prevention, testing and treatment services targeting men who have sex with men had opened in Lviv. Vadym was one of its very first clients.

Emergency HIV Prevention for People Displaced in Ukraine

New PrEP clinic established in Lviv

For the last three years, Andrii Bogoslavets has been the PrEP project manager at Alliance Global, the largest organization serving men who have sex with men in Ukraine. The organization works closely with civil society organization Alliance for Public Health with support from the Global Fund to provide HIV prevention, testing and treatment services while advocating to end stigma and discrimination that prevent people from accessing health services.

Andrii says that he knew the war would impact the organization’s work.

“My first thought was: That's the end. We lost everything we were working on,” he says.

By mid-March, five of the six PrEP clinics Alliance Global ran in Ukraine were no longer operational. Andrii and colleagues became increasingly aware of the growing need for PrEP in the west of the country, where many people were fleeing for safety.

“A lot of people were displaced here (in Lviv). So, we decided to open an office to start providing services,” says Andrii. “Western parts of Ukraine are more religious. At the time, there were no organizations focusing on men who have sex with men in Lviv."

PrEP services reach more people than ever before

Centrally located, the office has a modest sign on the door that says "Testing." Behind the door, social worker Vitaliy and medical consultant Liudmyla see clients seven days a week.

Vitaliy says that the first couple of months of the war were chaotic. People who ended up in Lviv did not know where to go to get services.

“The fact that Lviv was able to provide timely antiretroviral therapy and PrEP helped prevent an HIV outbreak here in the summer,” he says.

By April the Lviv office was fully functioning.

"It is revolutionary for men who have sex with men to get tested and receive PrEP, information, support, condoms and lubricants – and all for free and in one place in Lviv," says Vitaliy.

Vadym is thankful he was able to access these vital services.

Today he is managing a shelter that Alliance Global runs for people from the LGBTQI+ community that have nowhere to live.

“Alliance Global has brought positive change into my life: from the first visit to the office for testing and receiving PrEP to what I'm doing right now. My life has changed a lot over the past year,” he says.

The Global Fund in partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) support PrEP across Ukraine.

This year alone, more than 7,400 people have started PrEP in Ukraine, of which more than half enrolled between July and September, despite the ongoing conflict. Approximately 80% of people who initiated PrEP this year did so with the support from Alliance for Public Health. Ukraine’s national PrEP strategy aims to reach over 11,000 people with PrEP by the end of 2023.