Fears of hidden HIV epidemic in eastern Ukraine as war takes its toll
A drug addict in a warzone, Andriy had both survival and euphoria on his mind in the early days of the Russian invasion.
Before the bombs fell, his condition had been managed by methadone – a heroin substitute which helps to reduce withdrawal symptoms. But when his hometown of Kharkiv, in eastern Ukraine, was reduced to ruin by intense shelling, supplies of the drug quickly dried up.
With his cravings impossible to ignore, Andriy soon went back to shooting up, sharing dirty needles – and blood – with other users in the city’s hollowed-out buildings.
His HIV diagnosis came several months later, in October 2022, long after Kharkiv had been recaptured by Ukrainian forces. “I didn’t know that I could have this kind of sickness,” the 38-year-old says today.
Andriy is not alone. Nationally, 158,000 people were living with HIV in Ukraine at the start of July 2023 (up from 150,000 in January 2022), with 121,200 enrolled on antiretroviral therapy (down from 130,200), according to official government data.
How exactly the invasion has changed the dynamics of Ukraine’s HIV epidemic remains unclear, especially given the lack of data emerging from the occupied territories in the east.
But there is no doubt that “war has had a very bad impact on the control of the infection,” says Valeriia Rachynska, a director at 100%Life, a Ukrainian HIV charity.
During the darkest days of the conflict, testing and antiretroviral drugs were in short supply, with support clinics forced to shut, making it impossible to track and treat the spread of HIV. For those Ukrainians already infected, the risk of Aids also heightened.
Indeed, in Kharkiv the number of known cases in the most advanced stage of the disease has almost doubled, rising from 88 in the first half of 2021 to 167 in the first half of 2023, according to Parus, a local health and humanitarian support charity.
“This suggests that people did not know about HIV for a long time (or knew and did not go to a medical facility) and could also infect partners who are still undetected,” says Olena Ovchynnikova, the director of Parus.
Across the entire Kharkiv region, she adds, the prevalence of HIV is “somewhat higher than in the pre-war period,” fuelled largely by unprotected sex and the sharing of needles among drug users, both of which “increased during 2022”.
Cut off from methadone, turning to street drugs
It is hard to know exactly when Andriy caught the infection, but “I think he started to have HIV after the full-scale invasion,” says Olha Hritsenko, his social worker.
Prior to February 2022, he participated in a pre-exposure prophylactic (PrEP) programme which prevents individuals contracting HIV – even if they come into contact with the virus.
“Before, it was not a problem for him to receive needles,” adds Hritsenko, who works for Blago, a charity in Kharkiv dedicated to supporting people with drug addictions and sexually transmitted infections.
It was only after a friend recommended that he take a HIV test that Andriy became aware of his infection. Before that moment, “I hadn’t felt any illness in my body,” he says.
There are others like him across the city – users who were suddenly cut off from methadone and turned to street drugs out of desperation, only to contract HIV.
Roman Bondarev, 43, another drug user living in Kharkiv, says that among his four closest friends, “two of them are now receiving treatment for HIV”.
Andriy says he also “had a friend who received information of contracting HIV during the war, but he moved from the city and I don’t have a connection with him anymore”.
Yet determining the prevalence of the phenomenon – and when and where people like Andriy acquired their infection – is not easy.
Hritsenko is one of 20 social workers at Blago, each of whom support – and collect data on – different patients in different parts of the city.
However, not all the relevant data from these separate patient networks has been fed into the central database, Blago said – a result of the obvious challenges that come with operating during a war.
The most recently available figures – which indicate that 81 people have tested HIV positive in 2023 so far, compared to 73 for the entirety of 2021 – also largely cover sex workers, not drug users, the charity added.
Based on her own experience of testing patients, Hritsenko believes hundreds of drug users among the 2,000 people in regular contact with Blago have acquired HIV since the invasion began – though she acknowledges “the numbers in our database are changing”.
Worryingly, the charity covers a further 3,000 people across the city, who “have not yet been tested,” says Hritsenko, raising fear there could be many other cases of undetected HIV circulating in Kharkiv and the wider region.
Given the complexities that health authorities and charities are facing in tracking the spread of HIV within a Ukrainian region free of Russian oppression, there is little hope of shining a light on what is happening behind enemy frontlines.
Experts fear a silent epidemic is raging in the occupied territories of eastern Ukraine, where HIV testing has all but stopped – in Luhansk, rates have dropped 98 per cent from 2021 – and health services are severely curtailed.
“Right now we don’t know anything that is happening in the occupied territories with HIV. I’m very concerned,” says Rachynska.
Prior to the war, eastern Ukraine was already home to the country’s highest burden of HIV, “so we can expect that the situation will now be much worse,” she says.
The epidemic in the east, she adds, is likely being fulled by the rape of Ukrainians by infected Russian soldiers, “forced sex work to survive,” a rise in drug use among civilians, and a lack of access to antiretroviral medication.
Anne Aslett, the chief executive officer of the Elton John AIDS Foundation, which is supporting several Ukrainian charities and HIV organisations, fears the worst.
“There is extreme vulnerability in the occupied territories,” she says. LGBT populations and women will be enduring “particularly high levels of sexual violence” at the hands of Russian soldiers, among whom there is a “tonne of HIV,” Aslett adds.
Of notable concern are criminals recruited from prisons across Russia to fight on the frontline. Based on infection rates in captured soldiers, Ukrainian authorities estimate that 20 per cent of these soldiers are HIV positive.
Yet raping – and therefore infecting – civilians in the occupied territories, both men and women, will not faze such individuals. “HIV is being used as a weapon of war,” says Aslett.
Then there are the wounded, “who won’t be receiving care,” and drug users, who cannot access therapy services, she adds. “They are all susceptible.”
She points to the example of Crimea. When Russia invaded and annexed the peninsula in 2014, officials banned local methadone therapy programmes, even staging public burnings of the medicine, a decision that the UN says resulted in 100 deaths from suicide, overdoses or complications related to HIV over the next year.
Andriy’s own experiences in Kharkiv suggest the events which unfolded in Crimea almost a decade ago are now likely being repeated across the occupied territories of eastern Ukraine, especially if access to methadone is limited.
In the rest of the country, some small comforts can be taken from the progress that has been made in restoring Ukraine’s HIV services after the initial shock from the invasion.
Authorities are now conducting more tests for the infection than before the war, which Unaids says has “resulted in the detection of more HIV cases”.
It adds that treatment is again available for all people living with HIV, including internally displaced people, with nearly a hundred mobile clinics offering services and medicine throughout the country. Laboratory diagnostics are also back up and running.
“Ukraine’s national Aids response has demonstrated great resilience,” a spokesperson for the agency told the Telegraph.
Yet the same cannot be said for those pockets of the country which remain out of sight and out of reach, cut off from support and vital medicines. “We will only see the real consequences once this war has ended,” says Rachynska.
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