Holding the line: Ukraine’s NGOs sustain critical HIV services amid punishing winter and war

When war reshapes everyday life, even the most routine tasks become extraordinary challenges. For the partner organizations of the Community Action for HIV Control (CAHC) project, the mission of providing HIV services across Ukraine has turned into a daily struggle against blackouts, air raids, and forced displacement. 

CAHC is accelerating the country’s efforts to achieve HIV epidemic control by 2030. Together with 18 Ukrainian partner organizations, the project ensures access to lifesaving services across 14 regions. These partners, namely their staff of social workers, continue to deliver vital services despite arduous conditions. Even in the midst of war and winter, the CAHC project is meeting its targets for HIV testing and treatment.

Here, we spotlight experiences from Kyiv, Zhytomyr, and Cherkasy — vivid examples of how Pact’s local partners adapt, innovate, and persevere. Because behind every service is a person who cannot be left to face HIV alone.

KYIV

At CO 100 Percent of Life. Kyiv Region, mornings no longer begin with coffee and a calm review of scheduled tasks. Instead, staff urgently check whether electricity is available, whether mobile service is functioning, and if the HIV service center can even open. With constant missile and drone threats, blackouts lasting up to 22 hours, and heating outages, the organization’s staff continue their work.

“Air raid sirens have become the backdrop of our work. Sometimes consultations are cut off mid‑sentence, testing sessions are postponed, and clients and staff descend together into shelters, waiting until it’s safe to continue,” a specialist explains.

The cold season has made outreach nearly impossible. Social workers often cancel meetings or seek temporary shelters where they can at least briefly connect with clients. Even indoors, conditions remain harsh. Heating and electricity outages leave offices freezing, dark, and unsuitable for working with documents, equipment, or people.

This winter has also brought constant power surges, causing equipment failures and disrupting routine processes. The heating boiler at the NGO’s administrative office broke down, leaving staff without warmth in the middle of the season. Some operations had to be urgently relocated to other sites.

Extended outages have also forced several employees to leave their homes. Staff members sought temporary shelter, all while continuing to provide HIV services.

Clients often face even harsher conditions. When many lack heat, water, or a safe place to sleep, HIV prevention becomes secondary. Specialists increasingly hear questions not about health, but about where to warm up, spend the night, or simply survive the next day. Maintaining contact and explaining the importance of HIV prevention or treatment has become a challenge in itself. Mobilization measures further complicate movements: some clients hesitate to leave home, while others cancel planned meetings.

Despite all of these difficulties, the work of CO 100 Percent of Life. Kyiv Region keeps going — steady and determined. Since the beginning of winter, specialists have tested more than 2,300 people, with 33 learning they were HIV‑positive.

The team adapts to wartime realities by adjusting routes and schedules, working in short sessions between air raids, rescheduling meetings, and reaching out to clients in the evenings or on weekends. They find alternative premises, heat offices with portable devices, and sometimes work from home or any place with a reliable network connection. Just as important, staff support one another, ensuring that no one is left to face exhaustion or fear alone.

“We keep in touch with clients even when it feels like we have no strength left. Because we know that if we disappear even briefly, we’ll lose contact with many people and bringing them back will be far harder. We hold on not because it’s easy, but because our services still save lives. Even in the toughest conditions, we do everything possible to show people they are not abandoned,” a team member says.

ZHYTOMYR

In Zhytomyr, CF Let Your Heart Beat has also seen its everyday work turn into an exercise in constant adaptation. What once seemed routine — arranging an HIV test and carrying it out — now requires far more time and effort. Staff note that clients often miss appointments because of air raid alerts or fail to reach testing sites after long hours spent in shelters. Conducting tests inside shelters is not an option, given the lack of privacy and suitable conditions. Added to this is the psychological toll of war: fear, exhaustion, and uncertainty about the future. Today, the role of a social worker extends well beyond testing — it includes long conversations, emotional support, and at times, spontaneous crisis counseling.

A typical day for the organization’s team now begins with handling online requests. Much of the initial communication with clients takes place through apps and social media, often supported by AI technology. These tools, adopted after the war began, have become essential for maintaining contact. 

One recent example involved a young man who reached out via a Telegram community after relocating to Zhytomyr Region from eastern Ukraine. Unsure where HIV services were available — or if they were available at all — he turned to the organization for guidance. At the same time, the city was experiencing prolonged blackouts, unstable mobile service, and frequent air raid alerts. A social worker spent considerable time engaging with him online, offering reassurance and answering questions about HIV and self‑testing. Only later were they able to meet in person at a local NGO about 10 km outside the city, where conditions were safer.

The team makes extraordinary efforts to ensure that every client receives the necessary service. They search for alternative locations, adjust routes, and reschedule meetings. At times, the organization cannot cover the costs of delivering self‑testing kits, so staff travel to clients in person. 

Reflecting on their work, staff at CF Let Your Heart Beat emphasize that in wartime, their greatest challenge is time itself. Tasks that once took minutes now stretch into hours, straining the patience and motivation of both clients and providers. Still, they persist. 

CHERKASY

In Cherkasy, the challenges of wartime service delivery take on a deeply personal dimension. Inna, a social worker at CO One Hundred Percent Life Cherkasy, provides HIV services in a small settlement of just over 5,500 residents. Here, the work has always been sensitive — in a community where “everyone knows everyone,” stigma around HIV remains strong.

War has only intensified these difficulties. Air raid alerts and unstable mobile connections make even the simplest tasks — arranging meetings, confirming services, or staying in touch with clients — a major job. For Inna, the role of a social worker now stretches far beyond testing: It requires persistence, empathy, and the willingness to meet people where they are.

Recently, men at high risk of HIV infection — and others as well — have increasingly refused to visit health facilities or share their phone numbers. Routine tasks that used to be handled quickly now demand long explanations and careful negotiations. To ensure people still access testing and prevention tools, Inna often travels to clients’ homes, working evenings and weekends to reach those who would otherwise remain isolated.

“It is better to work this way than to leave someone alone with risk. If people cannot check their HIV status or receive condoms today, tomorrow there will be new cases of HIV infection. My efforts are about preventing those scenarios, even in the hardest times,” she says.