Despite war, Pact and its partners in Ukraine deliver critical HIV services

When Russia invaded Ukraine in February 2022, Olha Belkova and her colleagues were busy doing what they’d been doing for years – providing HIV services to people who needed them most in Mariupol and Donetsk.

"Then a nightmare began, in which the main task was simply to survive,” recalls Belkova, who heads the Ukrainian organization Istok. “We sat helplessly in basements. People were starving. We took water from puddles. There was no communication with my employees. There was no way we could work in those conditions.”

For two months, Belkova was trapped before she finally made her way out of Mariupol to safety. One of the first things she did was charge her phone to try to make contact with Istok’s staff, some of whom had survived and some of whom had not.

Today, despite enormous challenges, Belkova and Istok are back at work, providing HIV testing and treatment services amid war. They are doing it with support from the Pact-led Community Action for HIV Control project, or CAHC, which is accelerating Ukraine’s efforts to achieve HIV epidemic control by 2030 with improved prevention, testing and linkages to care among key populations.

Funded by USAID and PEPFAR, CAHC was launched just a few months before Russia’s full-scale invasion. Pact and its local partners in the project have of course had to make major adjustments in both their priorities and operations, but with determination and courage, efforts to provide vital HIV services have persisted.

“Amid constant danger, active hostilities and missile strikes, social workers are continuing to provide services for clients in 14 regions of Ukraine and Kyiv city under our project,” says Pact’s Olha Petrash, CAHC’s deputy chief of party. “The war has affected every aspect of life. Yet HIV/AIDS organizations have maintained the progress of previous years, preserved the system of HIV services for key populations, and expanded services in response to survival needs. The number of clients reached has not decrease significantly, which is quite incredible considering the circumstances.”

Between January and March of this year, the 17 local HIV organizations that Pact supports through CAHC provided HIV testing for more than 18,000 Ukrainians, and provided nearly 20,000 people with support to cope with the difficulties of war, including pyschosocial support, food and hygiene kits. Of those who tested positive for HIV, all were offered treatment services, and the vast majority are now taking antiretroviral medication. 

“Through our brave partners, internally displaced people (IDPs) have received critical services, and assistance has been organized for clients who went abroad by creating databases of service information and new communication channels,” Petrash says. “Our partners have gone well beyond the call of duty to support their communities.”

For Istok, there was no way the organization could work in Donetsk region, so it restarted across the country in Zakarpattia region, where several employees had fled. They started with a flash drive on which they’d managed to save the organization's data amid shelling. With a grant from CAHC, they bought chairs and laptops and opened an office. They started from scratch building cooperation with local authorities, medical institutions and other NGOs, and gaining the trust of communities in need of HIV services. Istok now serves the region’s key populations including the Roma community and has provided HIV testing to hundreds of people since the fall.

In Zaporizhzhia, which has seen heavy fighting, rocket attacks and destruction, CAHC partner Network 100% Life has carried on. They have adapted their HIV services to new realities and also provide humanitarian assistance.

"We are like guardians of the city of Zaporizhzhia,” says the organization’s Oleksiy Protsenko. “Many people have left, while new ones are constantly arriving from the areas of active hostilities. We feel more comfortable staying at home and helping people.”

The organization is providing HIV services through outreach routes to be closer to clients; staff travel the city offering HIV testing services to key and priority populations in designated locations. With some of the organization’s employees now in the military, the remaining staff have become multifunctional and acquired new skills. Protsenko managed a humanitarian aid point for several months, while the organization’s public relations manager collected requests for medicine.

With support from CAHC, Network 100% Life is developing digital communications to engage key populations to HIV services and promote health in wartime. The organization has launched a channel through the Telegram app on HIV prevention and treatment, for example.

CAHC has worked to overcome many challenges, Petrash notes. For example, a wave of migration to western Ukraine lead to increased demand for HIV services there, so the project’s footprint was expanded. And key populations began avoiding contact with unknown service providers because they feared receiving summons to join the military, making it harder for CAHC and its partners to reach new clients in some cases.

"We work on the principle of ‘Be here and now’ with each IDP,” explains Olha Ruban, who heads an HIV organization in Kryvyi Rih that CAHC supports. “Depending on individual needs, we provide IDPs with HIV counseling and testing services, refer them to health centers and provide humanitarian aid. We give out clothes, food and information about social and medical services in the city.”

After the start of massive rocket attacks, the organization created a “point of invincibility” in its bomb shelter, where, in addition to providing shelter to people during alarms and long blackouts, HIV services were also provided.

"I finally felt protected there,” says a man who sought shelter there. “I was also offered an HIV test. I understood that I was in the risk group, so I agreed. I was sad to hear the positive result. However, this level of service and support gave me confidence in my future. I am currently receiving treatment and know that I will be fine.” 

In Kramatorsk, Pact partner Club Svitanok has received HIV rapid tests through CAHC, and has managed to increase HIV detection rates despite incredibly difficult circumstances.

“The level of marginalization is terrible,” says Nataliia Bezeleva, the organization’s head. “People use a lot of drugs. So we started going to the villages, found the leaders of these communities and started cooperating with them.”

Thanks to this approach, the organization has identified many clients over age 40 who had never been tested for HIV, raising detection rates.  

"The Russians began to reach Kostyantynivka, Kramatorsk. It is very loud here now,” Bezeleva says.

“But we continue to work. People need our help, and that is why we don’t stop working.”