In the shadow of war: The life-saving work of social workers in Ukraine for people with HIV

Being a social worker is a challenging job. Dealing with fear, shame and the need to provide support and a sense of acceptance when people discover their positive HIV status is difficult enough. But fulfilling this role while your country is in a state of war adds another level of complexity.

In Ukraine, social workers in HIV service NGOs play a critical role in addressing the HIV, health and social support needs of key populations, particularly those who are hardest to reach or hesitant to seek care at a health clinic first. Through the Community Action for HIV Control Project (CAHC), funded by USAID, Pact supports social workers through our local NGO partners with trainings, supportive supervision, tools and more. These NGOs implement community outreach among key population groups and deliver services such as community-based HIV testing, distribution of HIV self-test kits, referrals for HIV treatment, individual follow-up of HIV-positive cases and provision of psychosocial support. 

This story will introduce you to three social workers supported by CAHC — three quiet heroes who help detect new HIV cases and persuade patients to begin antiretroviral therapy. These heroes work in Odesa, Kryvyi Rih and Zaporizhzhya — essentially front-line cities that are regularly shelled. Their work is about more than health care — it’s about staying strong, caring deeply and never giving up, no matter the challenges.

Maria, Kryvyi Rih
Finding out that you’re HIV-positive comes with a shock, and I was no exception. When it happened seven years ago, I wasn’t alone, but neither my partner nor I knew how to go on or what to do next. There was a fear of telling anyone about my HIV status, thinking they would judge and most certainly reject us. What’s more, we found out we were expecting a child, which raised even more questions, like, Do I need to consider termination because of HIV? Can I have a healthy baby? It was a baby we had dreamed of, just not under these circumstances.

I couldn’t have been more wrong; people didn’t judge, and they didn’t abandon me. Though it was frightening to tell my parents about my status, they supported me. I gave birth to a healthy baby, and slowly, life returned to normal. These experiences led me to the realization that I wanted to help others, to support people who hear what feels like a death sentence: You have HIV. From that moment, I decided I would live as an example, showing that you can lead a happy life, have healthy children, and that you deserve happiness too.

Six years later, after countless trainings and certifications, I still believe that helping people like me is my calling. Supporting dozens of people living with HIV is my daily work. When the full-scale invasion began, I was pregnant with my second child. It’s hard to imagine being close to giving birth as war starts. Again, I felt helpless and fearful, with no sense of clarity. A week later, I had my baby, and soon after, I returned to work. The people who depended on me were terrified — they feared they would suddenly run out of medicine. People called in panic, shouting, “The war has started; what should we do!?” Many were fleeing the city, but I couldn’t abandon my clients. They needed me. It’s dangerous, it’s frightening, and I am literally working between life and death — the city is constantly under fire.

In September 2023, while I was at the post office sending ART medicine to one of my clients, a rocket flew directly overhead. I saw it get shot down, and the debris fell in three directions — toward the hospital, where many of my clients are; toward my home, where my mother cares for my second child; and into the school district, where my older child had just started first grade. In that moment, I panicked, unsure where to run. All I knew was that I needed to confirm my children were safe.

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.

When I gave birth to my first child, I faced terrible discrimination in the maternity hospital. One night, when I was bleeding, the staff were afraid to even touch me.

It’s a horrible feeling, and it shouldn’t be this way. When I look at myself in the mirror, I realize that I am no different from anyone else. 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.

I believe that science will soon find a cure for HIV. Diseases like gonorrhea and syphilis were once considered incurable, but now they are treated as easily as the flu. I hope the same will happen for HIV someday.

Natalia, Zaporizhzhia
When ten years ago Russia occupied Donbas, I was living in Horlivka, working as a school psychologist and nurse. My son was injured in the shelling, and I had no choice but to leave our home. We packed up and moved to Zaporizhzhia, hoping to find safety and a fresh start.

Why this line of work, you ask? Well, part of it is my background — I’m a trained doctor and psychologist. But honestly, it’s also just my nature. I really love people and nothing beats that feeling when you see someone turn their life around; it’s the kind of thing that keeps me going.

A lot of my work is with people who use injecting drugs, but encouraging them to get tested isn’t always easy. Working with this group takes a special approach. 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.

When I suggest testing, I’ll sometimes hear, “But I’m healthy.” To that, I say, “Hey, I feel great too, but I still get tested!”

The full-scale invasion triggered the worst memories of my life. On February 24, I woke up to the sound of explosions and kept repeating one thing: “I’m not going anywhere; my whole life is here.” My biggest fear was that the nightmare my family went through ten years ago — when I left Horlivka with just one bag and two children — would happen again.

Then, I made myself a coffee, calmed down, and began calling everyone — reassuring colleagues and clients before heading to work. The level of tension among my clients was immense; everyone was worried that their supply of ART might run out.

One of the biggest challenges in my work is tackling discrimination against people who are HIV-positive or struggling with addiction. This issue runs deep. Once, in collaboration with medical institutions, we brought together healthcare workers and clients. The goal? To switch roles and imagine being in that person’s shoes, feeling the weight of intolerance. When the staff saw themselves through their clients’ eyes and could ask open questions, they left with a whole new perspective. It’s amazing how that simple shift can spark empathy and support.

Bohdan, Odesa
Becoming a social worker was never something I anticipated. In 2007, I was diagnosed with hepatitis C, and two years later, with HIV. Shock, denial — the typical reactions anyone might have. Eventually, I agreed to treatment, but I never started it because of the discriminatory attitude of a medical worker.

He asked me, “Do you want to be treated?” I said yes. The doctor replied, “Then wait until someone dies.”

Understandably, those words were demotivating, and it wasn’t until four years later, when my health seriously declined, that I decided to seek help. That’s when I met my social worker, Nadia (whose name means “hope”), who supported me and helped me see there was a way out of my situation. She became my hope. I realized then that I wanted to become that kind of person for someone else.

I’ve been working as a social worker for six years already, and in these six years it’s hundreds of people that I’ve helped. This is the greatest joy in my work — to see how a person’s life has changed for the better. This is what gives me faith, inspiration and strength to live on.

The toughest part of my work was, without a doubt, at the start of the full-scale invasion. Everyone was terrified, transportation had shut down, and there was absolute chaos. People were panicked, especially about running out of ART. It’s then I understood just how many lives depended on me. I found myself traveling to villages, going door to door to deliver medications to my clients so no one would miss their treatment. I know all too well the consequences of stopping therapy — I’ve seen it before, and it’s devastating.

Since the war began, the number of people with HIV in our region has risen, largely due to displaced people moving here from the east of the country. Just like anyone else first diagnosed with HIV, what they need most is support — they need to know there’s a way forward. Most believe that life is over and even ask when to order a funeral procession. But I calmly explain the reality: with therapy, they can live a normal, fulfilling life. I share examples of young people with HIV having children and tell them about my clients in their 80s who take their therapy and live happy lives.

The names of the social workers in this story have been changed to protect their security.