As the war dragged on, organizations responding to the crisis realized they needed to be flexible and think beyond fixed, physical healthcare infrastructure. They had to get ART in humans — interrupted treatment can contribute to drug resistance — and they had to continue harm reduction programs and scale them up.
Andriy Klepikov, executive director of the Alliance for Public Health, a nonprofit that focuses on HIV and tuberculosis, says his teams have deployed 37 mobile clinics from Lviv in the west to Kharkiv in the northeast, where they have completed more than 109,000 consultations. and more than 90,000 people for communicable diseases, delivering nearly 2,000 tons of humanitarian aid and medical equipment to 200 healthcare facilities, and connecting small villages that would otherwise have been left to fend for themselves.
Equipped with body armor, helmets and metal detecting equipment, Alliance staffs moved into recently liberated towns and villages, some just a few miles from the front lines. “We work where no one else works, where there are no hospitals, no pharmacists, no doctors,” says Klepikov.
When it became difficult to get fuel last summer, they traded their vans for bicycles. In his office in Kiev, Klepikov proudly showed me a photo of one of the Alliance’s doctors hand-delivering care in a shelled city while riding one of the bicycles provided by his organization.
Preliminary data shows that disaster has – at least for now – been averted. At the end of 2021, just two months before the war started, about 132,000 Ukrainians living with HIV were using ART. Since then, the latest available figures show that this number has fallen only slightly to 120,000. Since the start of the large-scale invasion, the Ukrainian public health sector has connected 12,000 new people to ART. The latest available data from February 2023 also shows that more people will have started using PrEP (pre-exposure prophylaxis) in 2022 than in the previous four years.
These successes have come at a high personal cost. Rachinska, who herself has been living with HIV for more than 15 years, continued to work in Kiev as air raid sirens blared throughout the capital. Her mother took Rachinska’s youngest son and fled to Italy. She has only visited him a few times since then, but she hopes to return to Naples in October for his 11th birthday.
Rachinska could have joined them, but says her work — “her people,” as she calls them — takes precedence. Her son doesn’t blame her, she says. “I’m like, honey, mom is doing something good for people. So just forgive me,” she says in tears. Her son often replies, “Okay, do your job.”
In Kryvy Rih, Lee, 47, says he created his makeshift haven after realizing early in the war that at-risk populations, such as drug users, HIV-positive people, sex workers, LGBTQ+ people and those recently incarcerated, were more likely to be rejected. other spaces that provide refuge. He secured funding from UNAIDS and logistical support from the Public Health Charity Foundation and set out on his own to rescue people.
