In Ukraine, Voices From The Front Lines, Fighting Inequality To End AIDS

By The Global Fund

November 29^th, 2021

Over the last two decades, the world has made tremendous progress in the fight against HIV. In countries where the Global Fund invests, AIDS-related deaths have dropped by 65% since the Global Fund was founded 20 years ago. But progress has not been even and inequalities continue to fuel the HIV epidemic.

This is particularly true for key populations – people who are most likely to be exposed to HIV and whose participation in fighting the disease is vital in ending the epidemic. This includes sex workers, people who inject drugs, prisoners, transgender people, and men who have sex with men.

Globally, key populations and their partners make up 62% of new HIV infections – in Eastern Europe and Central Asia they account for 99%. And in much of the world, COVID-19 has exacerbated these inequalities. Without urgent action the world risks missing the global target to end AIDS by 2030.

Ukraine is home to the second largest HIV epidemic in Eastern Europe and Central Asia. Here are the voices of some of the people delivering services and fighting inequality to end AIDS in the country.

In Ukraine, Voices From The Front Lines, Fighting Inequality To End AIDS

“I treat clients like any other people. I understand (sex work) is a job.” – Natalia Sholokh

Natalia Sholokh is a microbiologist during the day and a social worker providing HIV testing and prevention services to sex workers at night.

“I am a biologist with 22 years [of experience] in medicine. Twelve years ago, I needed another job,” she says. “I work in the clinical laboratory at the governmental hospital in Kyiv. And in recent years I work at medical social services for my night shifts, I drive along the streets where our clients are located. I treat clients like any other people. I understand (sex work) is a job.”

Natalia speaks with a sex worker on the mobile clinic where she works.

Natalia and a colleague give out leaflets, HIV tests and condoms to sex workers in front of the mobile clinic.

“I used to use drugs myself for 22 years and now I want to help other people.” – Vladyslav Sydorenko

Social worker Vladyslav Sydorenko contracted HIV when he was using illegal drugs. After 22 years he stopped, and then started working as a social worker with the Ukraine Public Health Center, a job he has now been doing for six years.

“I want to help other people,” he says. “Every day I drive to different towns and villages in the Kyiv area. I call my clients and they come to visit me. I visit the bedridden ones myself. I give them syringes, test them for HIV, hepatitis. I also provide consultations in different matters, help them get registered and receive medication.”

It is estimated that about 1% of the adult population has HIV in Ukraine but 21% of people who inject drugs are living with the virus. Sharing injecting equipment can transmit HIV and hepatitis C, so ensuring people who inject drugs can do so safely with clean needles and syringes helps to protect people – and their sexual partners – from both diseases.

Vladyslav speaks to client Sergiy at a drug addiction medical center.

Vladyslav provides one of his clients with disposable syringes during a home visit.

The Global Fund invests in a range of HIV prevention and human rights programs for people who inject drugs. This includes providing clean needles and syringes, funding mobile HIV testing and prevention services, providing peer-to-peer support through social workers like Vladyslav, supporting the community of people who use drugs and addressing human rights barriers to health services including by advocating for the removal of discriminatory laws and policies. Vladyslav says he sees about 250 clients every month.

“It is hard to be lonely among people, fight against the whole world. Now I feel that there are people who can protect me, support me.” – Anna Doronina

Anna Doronina, a 31-year-old transgender woman, is from a small town close to Crimea. She now lives in Ukraine’s capital city Kyiv. Anna says she has had many challenges in her life.

“I started everything for myself very late, when I was 25 years old. It was back in 2015, and we didn’t have much information at the time. It was very difficult,” she says.

Anna now receives support through community-based services funded by the Global Fund. These include HIV testing and prevention, testing for COVID-19, legal and social support as well as mental health care.

Anna tests herself for COVID-19 at a community center for transgender people.

Anna and other transgender women speak with social workers at a community center.

Globally it is estimated that transgender women are 34 times more likely to acquire HIV than other adults.

“I meet more and more people like me. This is very cool because people open up, communicate, provide psychological support to each other. I like where Ukraine is going. I finally see a bright future because five years ago it was very difficult for me. It is hard to be lonely among people, fight against the whole world. Now I feel that there are people who can protect me, support me and it is cool,” she says.

“I understand their problems right away as I myself am like them.” – Andrey Yarovoy

Andrey Yarovoy’s first degree is in naval engineering and he worked as a sailor before he began using drugs. In 2009, Andrey stopped using illegal drugs with opioid substitution therapy (OST) and obtained a second university degree in psychology. He now works at Ukraine’s National Hotline on Drug Dependence and OST administered by the nongovernmental organization Trust and Hope providing support and counselling to other drug users to help protect their rights.

“I like the concept of consulting on a peer-to-peer basis, I think this is the most acceptable and effective type of service… I understand their problems right away as I myself am like them. A person who uses drugs would be uncomfortable to admit that he is a user to a stranger. Clients are more open with me, they listen to what I have to say,” says Andrey.

Andrey takes about 10 to 15 calls per day at the hotline. Many of the callers are people looking for information and support to access OST. OST helps reduce people’s dependence on opioid drugs and decreases injecting, which in turns decreases a person’s risk of contracting HIV and other blood-borne diseases. OST can also increase retention in HIV treatment programs for people living with HIV and improves the overall well-being of people who inject drugs.

"I knew about the hotline before, but I never knew how much people actually needed it."

Andrey speaks with clients while working at Ukraine’s National Hotline on Drug Dependence and OST.

Ukraine’s first complete OST program began in 2005 with support from the Global Fund through the Alliance for Public Health. As of June 2021, there were approximately 18,000 people on OST across the country, making it the largest OST program in Eastern Europe and Central Asia.

“Our hotline has been working for a long time, everybody knows it and treats it seriously. I knew about the hotline before, but I never knew how much people actually needed it. When I started working here, I understood how much it can do for people like us,” says Andrey.

Globally, female sex workers are at 26 times greater risk of acquiring HIV than other adult women. Sex workers also face increased risks of violence and abuse which in turn increases their vulnerability to HIV.

In Ukraine, the Global Fund supports HIV prevention and testing services to sex workers through mobile clinics and in health centers as well as a range of human rights programs including providing “know your rights” information, peer support, access to community paralegal support and a hotline, as well as training for health workers and police officers on protecting sex workers’ human rights. In 2020, Global Fund investments through the Alliance for Public Health reached more than 42,000 sex workers with these vital services.

“I had no idea that PrEP even existed.” – David

David stands outside the ALLIANCE.GLOBAL office in Kyiv, Ukraine, a Global Fund partner organization that provides HIV prevention services to men who have sex with men in addition to community-led advocacy, documentation of human rights violations and referrals to legal support. These services include providing people with pre-exposure prophylaxis (PrEP) – a medicine that people who are at high risk of HIV can take to protect themselves from contracting the disease.

“I had no idea that PrEP even existed,” says David. “I saw the ad on an app, it said I could be tested for free and receive PrEP. I was tested for HIV in the presence of a doctor. After that I got the PrEP. Everything was at the highest level, no complications, I got it fast. In addition to all of this they drove me to the clinic where I received the medication.”

David speaks with a doctor at a clinic where is tested for HIV and receives PrEP or pre-exposure prophylaxis - a medicine that helps protect people from HIV.

David performs an HIV self-test at the Alliance Global office in Kyiv.

The first Global Fund-supported PrEP project, implemented by the Alliance for Public Health, started in Ukraine in 2017. By December 2020, 2,500 people across the country had access. Plans are underway to further expand access to PrEP to protect more people who are most at risk of HIV.

The Global Fund supports countries in tackling human rights barriers to health care in order to end AIDS, TB and malaria. This work includes Breaking Down Barriers – a bold initiative aimed at vastly scaling up programming and commitments to reduce human rights- barriers to HIV, TB and malaria services.

Over the last six years, the Global Fund has provided US$86 million in additional funding to the 20 countries that are part of the initiative. Ukraine is one of these countries and has also joined the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination.