World AIDS Day has been commemorated each year since 1988 on the 1^st of December to show support for people living with HIV (PLHIV) and to remember those who have died from AIDS-related illnesses. Each World AIDS Day focuses on a specific theme, and in 2022 UNAIDS is urging each of us to address the inequalities which are holding back progress in ending AIDS.

The 2022 theme "Equalize" is a call to increase the availability and quality of HIV treatment, testing and prevention services, to review existing laws, policies, and practices to eliminate the stigma and discrimination faced by PLHIV and members of key communities and to ensure the availability of modern technologies and the latest scientific developments in the field of HIV. 

HIV continues to be a major global public health issue. According to the World Health Organization, in 2021, 650,000 people died from HIV-related causes and 1.5 million people acquired HIV. For Ukrainians living with HIV, the invasion has put at risk both the accessibility and quality of treatment. The following article addresses the challenges of confronting this disease in the midst of war and the risks of not.

Ukraine’s progress in providing HIV treatment before the war

Ukraine was making good progress in its National AIDS response before the war. The number of people living with HIV and receiving antiretroviral (ARV) treatment grew steadily, reaching 132,239 by the beginning of 2022. At the same time, the quality and effectiveness of the treatment steadily increased as a result of the introduction of new protocols, as exemplified by the proportion of patients whose viral load reached undetectable levels. Undetectable is the term used to indicate the viral load test cannot detect the viral particles in the blood. More importantly, undetectable means untransmittable. This is a proven scientific approach of stopping the spread of the disease and controlling the HIV epidemic.

Ukraine was the only country in the EECA region (Eastern European and Central Asian countries), where the Government financed a basic package of HIV prevention services in key populations from the state budget. Hundreds of thousands of people benefited from these services, which were provided by community-based organizations contracted by the government.

War challenges and Ukraine’s response 

The war has caused significant migration – more than 7.9 million Ukrainians have fled to other countries and another 6.5 million remain internally displaced within the country. More than 30 medical institutions providing HIV services stopped their operations, because of destruction or occupation. Logistic chains also were broken.

However, Ukraine has demonstrated unique resilience in its HIV response. Today, thanks to partners like the Global Fund and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Ukraine has received enough ARV medicines to ensure uninterrupted treatment for everyone, leaving no one with HIV/AIDS behind. Civil society, which always was the heart and engine of the national response to the epidemic, did the nearly impossible, delivering services, medicines, and humanitarian aid even where the fighting was taking place.

A UNAIDS Emergency Fund was established within the UN during the first weeks of the war, enabling supporting partners to continue their HIV services, and creating dozens of shelters for internally displaced persons (IDPs). With technical support from international agencies, the Ministry of Health and the Public Health Center of Ukraine demonstrated the ability to monitor the ever-changing situation clearly and to respond professionally to the challenges caused by the war. All this once again confirms that investments in capacity building and sustainability of national AIDS responses were the right and strategically calibrated solution from the beginning.

UNAIDS Ukraine Country Director Raman Hailevich said UN organizations have a Joint Programme of support on AIDS, a common framework of assistance to the Government of Ukraine in the area of HIV. “Today, on the occasion of the World Aids Day 2022, I can declare the war has not altered our goals and intentions to overcome AIDS one iota,” he said. “We continue to ensure equitable access to HIV services in Ukraine and remain focused and well-coordinated with our UN partners to deliver common results.”

UNDP’s input in combating AIDS

Interim UNDP Resident Representative Jaco Cilliers said he believes it is of paramount importance for all partner organizations to continue helping Ukraine to maintain its level of efficient response to HIV/AIDS despite the circumstances of war. “We will continue our support to the Ukrainian health system within UN joint efforts in these hardest times for Ukraine, to ensure that no one is left behind,” he said.

UNDP has been procuring HIV diagnostics for the Ministry of Health of Ukraine since the end of 2021. The supply provided through 9 subprogrammes has so far reached UAH 10 million ($275,000) and has included test systems for diagnosing HIV infection, supporting antiretroviral therapy (ART) and monitoring HIV infection for patients, identifying virus resistance, conducting reference studies.

UNDP also continues to support efforts to combat of HIV/AIDS through the implementation of  the global Fast Track Cities initiative in Ukraine. The Paris Declaration on Fast Track Cities is a global partnership between cities and municipalities around the world to fight HIV/AIDS and tuberculosis. The logic behind this initiative is that 70 percent of PLHIV and key populations are located in urban areas. And control over epidemic in big cities will significantly contribute to control over the epidemic at the national level. Tuberculosis remains the main cause of death among AIDS patients in Ukraine — it accounts for more than 50 percent of all AIDS-related deaths. The Declaration on Fast Track Cities aims to achieve the goal of 95/95/95 — 95 percent of people living with HIV know about their status, 95 percent of those diagnosed receive ARV, and 95 percent of those receiving therapy achieve sustainable suppression of the virus. Also, the purpose of the declaration is to achieve zero rates of discrimination and stigmatization of PLHIV.

Pursuing this vision should lead to the defeat of the HIV epidemic. The third of 17 Sustainable Development Goals seeks to ensure “healthy lives and promote well-being for all at all ages” by 2030. SDG target 3.3 calls for the end of AIDS by the same year. This vision was adopted by all  United Nations member states in 2015.

According to data from the Ministry of Health, Dnipropetrovsk region ranks first in terms of AIDS mortality in Ukraine and is among the top three regions with the highest prevalence of HIV infections. At the same time, this area has strong potential for combating HIV infection and tuberculosis, and has demonstrated the ability to control infectious diseases even in wartime. The city of Dnipro joined the global Fast Track Cities initiative on September 2020 and in November 2021 Kryvyi Rih also signed the Declaration and become the fourth city in Ukraine to join the initiative.

In August 2022, at the initiative of UNDP and with the participation of UNAIDS, a strategic session on the development of the Roadmap project for the implementation of Fast Track initiative was held in Kryvyi Rih. The road map is a tool for achieving the goals of Fast Track within the framework of the City Programme for the Support of the Public Health System for 2022-2023. After its finalization and approval by the City Council, the road map will be used as the basis for the work plans of all the executors of the initiative.

UNDP continues to support the prevention of violation of human rights of PLHIV. In 2022, the organization prepared the “Guide on the international standards, ECHR case law and national case law on HIV/AIDS and TB: Lawyer’s legal tools”  which supports the work of human rights defenders and community based advocates working with PLHIV, as well as  judges from the judicial system of Ukraine.

The guide includes information resources and legal tools that would be useful to ensure patients' rights to access treatment in Ukraine and abroad and selected cases from the National Case Law and the ECHR. Current developments in Ukraine require human rights defenders to be equipped with the tools that go beyond legal issues. Given the complex conditions in which advocacy is carried out today, this manual gives law practitioners ready-made solutions in the form of  action algorithms, instructions, and road maps to protect the affected people. 

Friedrich Nietzsche once said that what doesn’t kill us makes us stronger. Neither AIDS nor the war will kill Ukraine, which will emerge from the challenges stronger and more resilient than ever before. On this World AIDS Day, let each of us individually and collectively work together to address the inequalities which are holding back progress in ending AIDS. The “Equalize” theme of today is a call to action – a prompt for all of us to work for the proven practical actions needed to address inequalities and help end AIDS.