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The Fight for ART in Ukraine

Authored by Laurel Whidden

Art by Nabiha Zaman


One year on, the conflict of the Russian-Ukrainian war still serves as a prolonged barrier to Ukrainians’ access to healthcare. As of 2023, the WHO has confirmed over 1000 attacks on healthcare facilities in Ukraine since the Russian Federation's invasion in February last year, marking the highest number ever recorded by the WHO in any humanitarian crisis [1]. This equates to approximately two attacks per day on healthcare facilities, workers, and other medical infrastructure, since the full-scale invasion on February 24, 2022 [2].


In addition to this obstacle, Ukraine is a country with the second-largest AIDS epidemic in the Eastern Europe and Central Asia region [3]. Despite non-governmental organizations and the Ukrainian government's aid to healthcare services during the devastating impacts of the war, many areas have still experienced a decline in the quality of healthcare and service delivery [4]. As a result, the conflict of the war has drastically lowered vaccination rates for Ukrainian citizens and refugees [5]. In terms of Ukrainian access to antiretroviral therapy (ART) and other HIV services, supply chains of these essential medicines and services are disrupted in the regions of Ukraine that are under Russian control [4] Many facilities lack running water or electricity. In areas like eastern Ukraine, hospitals can only offer limited essential care, forcing patients to travel longer distances or forgo seeking care altogether [4].


In some areas, medical staff have been evacuated and HIV clinics have closed, including the AIDS Healthcare Foundation’s HIV clinics in Kharkiv and Mariupol [5]. Although HIV centers in Kyiv have mostly been able to operate without significant interruption, those in other areas have experienced problems accessing ART and HIV tests [6,7].


Russia's war crimes extend beyond the widespread attacks on Ukrainian infrastructure, including the use of explosive weapons with wide area effects [2] and the placement of mines and explosive remnants of war [2]. They also encompass attacks and threats directed at the Ukrainian healthcare system. Russia has engaged in acts of verbal and physical violence against Ukrainian citizens, obstructing or threatening violence that disrupts the availability, access, and delivery of both curative and preventative healthcare services during emergencies [3]. During these military conflicts, the affected populations are displaced from their homes. According to the United Nations’ refugee agency, over 3 million citizens have been forced to flee Ukraine since March 2022 [6]. As of July 2023, more than 6.2 million Ukrainians have crossed into neighboring countries in the region including Poland, Hungary, Moldova, Czech Republic, and other countries globally [8]. Refugees with HIV arrived in these countries with little to no medication and are often in need of immediate access to treatments. Increased demand for healthcare amongst the high population of refugees has imposed public health challenges for countries receiving evacuees; this impediment has increased the economic burden in healthcare systems across Europe, as well as staff workload [6]. More challenges include the demand for hospital and outpatient care, and the need to adapt the healthcare system to refugees’ unique requirements related to disease control programs, such as vaccination [6].


The government of Ukraine and civil society partners in support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States President’s Emergency Plan for Aid Relief (PEPFAR), UNAIDS, and other partners have revived a large amount of ART treatment, tuberculosis medicine, and other therapies to provide uninterrupted treatment for everyone [3]. Step by step, whether it is the victims of HIV or any citizen who needs adequate healthcare, Ukraine's population will persistently strive to overcome its challenges, ensuring that the nation remains undefeated against Russia. 


References

  1. World Health Organization. (2023, May 30). Who records more than 1000 attacks on health care in Ukraine over the past 15 months of full-scale war. World Health Organization. https://www.who.int/europe/news/item/30-05-2023-who-records-1-000th-attack-on-health-care-in-ukraine-over-the-past-15-months-of-full-scale-war

  2. Ukrainian Healthcare Center (UHC). (2023, August 10). A horrific milestone: More than 1,000 attacks on health care in Ukraine since Russia’s full-scale invasion. UHC. https://uhc.org.ua/en/2023/08/10/more-than-1000-attacks-on-healthcare-in-ukraine/ 

  3. Kolomiiets, S. (2023, February 23). One year on: We must sustain the HIV response in Ukraine. UNAIDS. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2023/february/20230223_hiv-response-ukraine

  4. Russia’s invasion of Ukraine: An attack on health - the lancet. The Lancet. (2023, February 25). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00387-2/fulltext 

  5. The Lancet Infectious Diseases. (2022, April 8). War and infectious diseases: Brothers in arms. https://www.sciencedirect.com/science/article/pii/S1473309922002353?via%3Dihub 

  6. Massmann, R., Groh, T., Jilich, D., Bartková, D., Bartovská, Z., Chmelař, J., Chrdle, A., Dlouhý, P., Cimrman, Š., Guimaraes da Silva, S., Kapla, J., Kubiska, M., Snopková, S., Svačinka, R., Zlámal, M., Samsonová, O., & Sedláček, D. (2023, October 1). HIV-positive Ukrainian refugees in the Czech Republic. AIDS (London, England). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481916/#R12 

  7. Department of Infectology and Geographical Medicine. (n.d.). HIV-positive Ukrainian refugees in the Czech Republic : AIDS. LWW. https://journals.lww.com/aidsonline/fulltext/2023/10010/hiv_positive_ukrainian_refugees_in_the_czech.7.aspx 

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