The Invasion of Ukraine is a Looming HIV Crisis

By Marsha Martin, GAPP Member, Coordinating Director Global Network of Black People working in HIV

As the humanitarian crisis in Ukraine escalates with each passing day, there is one piece of the story that our community must lift up: the unique vulnerabilities of those living with or most at risk for HIV.

In 2018, I served as an NGO delegate to the UNAIDS’ Program Coordinating Board. As I took the lead in developing a report to the Board focused on the link between HIV and mobile populations, my Ukrainian colleagues shared insights from people living with HIV in their country, many of whom had been displaced due to conflict with Russia.

Our research clearly showed that mobile populations are over-represented among people living with HIV who are undiagnosed and not virally suppressed—and Ukraine was no exception.

Migrants not only lose access to their local healthcare providers and antiretroviral treatment, but those with HIV are often discriminated against in the countries to which they flee. In some cases, those known to have HIV are even treated as criminals, detained, or deported.

Today, well over a million people are fleeing Ukraine, which is home to the second largest HIV epidemic in Europe, behind only Russia. It is estimated that 250,000 people living with HIV reside in Ukraine, 156,000 of whom are on antiretroviral therapy. As these individuals leave the country to seek safety, they will face heightened risks, vulnerability, and uncertainty.

Those who remain in Ukraine are also at greater risk of acquiring HIV or going without treatment. Because the country’s epidemic is largely driven by injection drug use, harm reduction programs are crucial to preventing the spread of HIV. For those already living with HIV, access to medications and treatment is an ongoing necessity to remain healthy and prevent transmission. All of these services are being interrupted due to the Russian invasion, with new reports of attacks on hospitals, health centers, and medical workers in the media almost daily. We know, too, that those who stay behind will face greater risk of violence and human trafficking as they navigate life in a conflict setting.

As we watch this tragedy unfold from afar here in the U.S., we have an obligation to educate others on the impact these events will have on the trajectory of the disease. Advocates can ensure global health decision makers understand the health crisis underlying the humanitarian crisis in Ukraine. And, as the single largest donor to the HIV response, the U.S. can encourage other countries to direct resources to address it.

Our international response requires us to go beyond the basic needs of food, clothing, and shelter. Medical assessments and support for those affected by HIV will be crucial to effective relief efforts. Networks that support key populations—men who have sex with men, sex workers, and injecting drug users—should be mobilized to provide services in a way that address migrants’ unique sensitivities and circumstances.

The Presidents Emergency Plan for AIDS Relief (PEPFAR) has already had an enormous impact on the lives of people living with HIV in Ukraine, committing $150 million in funds annually. As a global health platform with the ability to work with both governments and communities on the ground, PEPFAR will be central to addressing this crisis. Already, PEFPAR has created mobile units and rapid needs assessment in Ukraine. We must build on its existing framework to connect displaced people to the treatment and services they need, regardless of their location.

President Biden’s nominee for Global AIDS Coordinator, Dr. John Nkengasong, is uniquely qualified to steer PEPFAR in its response to the Ukraine crisis. As the Africa CDC director, he has dealt with a continent ravaged by HIV and AIDS. He is a strong leader with equally strong technical experience. It is imperative that lawmakers move quickly to confirm his appointment.

To have any chance at ending AIDS as a global health threat by 2030, we must address the link between HIV and individuals on the move. As growing numbers of Ukrainians flee their country, tens of thousands of people will be traveling around the world without access to HIV testing and treatment. We must act now to curb this health crisis and maintain the progress we’ve made against HIV.