The power of communities in advancing the quality of HIV care in Ukraine

Pact’s approach is careful to recognize that there are real people behind each data point that tracks progress toward ending AIDS in 2030. Each statistic represents individuals and communities affected by HIV, and their efforts to overcome HIV challenges are creating meaningful change. These community-led efforts change HIV care, especially for groups at higher risk for HIV.

Led by Pact in partnership with FHI 360 and AFEW, the USAID Community Action for HIV Control (CAHC) project in Ukraine empowers key populations – people who inject drugs (PWID), men who have sex with men (MSM), sex workers (SW) – many of whom are impacted by HIV, to take the lead in assessing the availability and quality of health care services. By taking on this role, these key population representatives share invaluable insights and identify issues that may not have been possible without them, including detailing what barriers stand in the way of assisting hard-to-reach populations in accessing HIV care in a challenging wartime environment.

Today, through CAHC support, key population representatives actively monitor the availability of 12 HIV services across the prevention, testing, care and treatment cascade as shared here. Together, they have conducted more than 400 monitor reviews in 26 cities, providing project staff and stakeholders a clearer picture into what is working well and what aspects of HIV service provision require further improvement.

In addition, between August 2023 and September 2024, the CAHC project trained interested community monitors in 12 Ukrainian regions on the “secret client” method, a technique used to assess quality of care standards from the client’s perspective. These trained key population representatives made 123 visits to public health care facilities and 26 visits to NGO-run facilities, seeking services such as HIV testing, pre-exposure prophylaxis and viral hepatitis testing and management. Through using the “secret client” approach, the project has gained more transparent insights into the actual experiences of individuals seeking HIV and related health care at these facilities. 

The CAHC project is dedicated to translating findings from the key population representatives and secret clients into action by reviewing and sharing them with the Ministry of Health’s Centre for Public Health. This enables the MoH to identify and implement responsive quality improvement measures. To evaluate the impact of these efforts, sites are re-assessed by different “secret clients” three to six months after the initial visit to support continuous service improvement and ensure accountability.

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While key population monitors have flagged areas for improvement in some health facilities, such as insufficient post-test counseling and lack of confidentiality during HIV testing, the project can proudly highlight that clients of trained NGO partner organizations consistently receive confidential services and substantial support. For instance, NGO-supported social workers in 15 regions maintain direct communications with clients, encouraging them to get tested for HIV and access treatment. These social workers have become a trusted and reliable source of support for representatives of key populations who may have nowhere else to turn.

The CAHC project is actively enhancing the capacity of social workers by providing more educational and training activities to ensure that the quality of HIV services received by community members through local NGOs meets the highest standards. The overall goal is to ensure that clients receive comprehensive support along with their test results as part of their right to accessible, high-quality person-centered HIV services. 

Social workers often come from key population communities themselves, so they are very familiar with the problems specific to their clients. One of the most prominent issues is the stigma and discrimination that PLHIV often face in health care facilities, at work or even at home. Let's hear it in their own words:

    "A lot of my work is with people who use injecting drugs, but encouraging them to get tested isn’t always easy. I make it clear that we’re equals — I set boundaries, but I also let them know I’m here for them, willing to grab a coffee, talk one-on-one and be in a safe space. Some clients don’t even know what HIV is. Little by little, conversations build trust, and that’s where real change begins."
- Natalia (name changed), social worker in Zaporizhzhia (whole story here)

    "In my job, we’re fighting many battles, and discrimination remains one of the biggest. I have encountered this kind of attitude many times in my own life, so I deeply understand how it feels for people experiencing it for the first time. I don’t have a label that says I’m different — I’m just an ordinary person, like everyone else. Sometimes I jokingly say that my immunity is weaker, but that’s all."
- Maria (name changed), social worker in Kryvyi Rih (whole story here)

    "Thanks to Mykyta’s professionalism and support, I was able to accept my status and take control of my health. At first, I was very stressed and didn’t understand what to do next, but conversations with the social worker and his guidance gave me confidence and strength, for which I am incredibly grateful."
- Andriy (name changed), client supported by a social worker of PO Alliance Global (whole story here)

Let’s continue to listen to local voices, empower communities and take actionable steps based on the insights they provide. By putting communities in the lead, as the UNAIDS World AIDS Day 2024 theme suggests, we can move closer to ending HIV once and for all.