War in Ukraine impacts people living with HIV and key populations, join our call to action!

On 24 February, the Russian Federation started an unprovoked war against Ukraine. Since then, the whole world has borne witness to the humanitarian catastrophe that has followed this invasion. Russian aggression has led to thousands of civilian casualties, while an estimated 18 million people are affected by the conflict, and the number of people in need of humanitarian assistance has increased to 12 million.

Humanitarian access in Ukraine is extremely constrained, as the war has forced most international humanitarian responders to suspend operations within Ukraine and scale up at the border areas, but a number of national community-based and community-led organizations are still distributing urgent relief aid in the country. Priority needs for the affected populations are health and nutrition, water and sanitation, and, critically, shelter and protection from the conflict.

People living with HIV and key populations have common humanitarian needs but face additional complications and challenges. According to the latest UNAIDS estimates, 258,000 people live with HIV in Ukraine, equivalent to approximately 1% of the population. Population size estimates suggest that there are 366,000 people who use drugs in the country, with more than 20,000 of them receiving opioid agonist therapy (OAT), along with 86,000 sex workers and 179,000 lesbian, gay, bisexual, transgender, queer, and intersex people ^{[ 1 ]}. These populations will all be represented both among refugees fleeing Ukraine and those who remain behind, which means that access to antiretroviral treatment, HIV prevention, and harm reduction will be needed by refugee populations and by people still inside Ukraine.

Recalling that the Global AIDS Strategy 2021-2026 has specifically noted the imperative need to meet the needs of diverse migrant and mobile populations that cut across its strategic priorities and result areas, it is the obligation of UNAIDS to react to the needs of people on the move. People living with HIV, gay men and other men who have sex with men, sex workers, and their clients, transgender people and people who inject drugs, and people working with them inside the country also face additional threats, given Russia’s longstanding hostility to LGBTI people, people who use drugs and harm reduction programs.

The situation for trans and non-binary people is extremely precarious, and they suffer disproportionately through the current war conflict. Hormone replacement therapy prescriptions should be standard in the support of the trans population. News reports have also surfaced that non-European nationals from Africa, Asia, South Asia, and the Middle East fleeing Ukraine faced racial discrimination within Ukraine and at EU borders, reminding us that systemic and structural racism remains a public health and human rights issue of concern in humanitarian settings.

Alongside this humanitarian catastrophe, the Russian Federation’s bombardment and invasion of Ukraine is leading to the destruction of the HIV treatment and prevention infrastructure that has been developed by civil society, communities, and the Ukrainian government over the last two decades, with support from numerous UN agencies and international donors.

In this context, the PCB NGO Delegation, together with civil society and community organizations from around the world, are demanding the following urgent actions from the UNAIDS to protect the health and lives of people living with HIV and key populations in Ukraine:

Act now to save lives

We urge UNAIDS to develop and share a concrete emergency plan, setting out what action each of the co-sponsors needs to take to ensure that people living with HIV and key populations of diverse backgrounds can access HIV and co-occurring disease treatment, prevention and testing, and harm reduction including opioid agonist therapy (OAT), both within Ukraine and among the refugee populations, and that they can exercise their right to health and their rights as internally displaced persons and migrants be protected as outlined in the Global Compact for safe, orderly and regular migration.

We also call on UNAIDS to coordinate the current humanitarian response with the Inter-Agency Standing Committee and to appoint highly independent experts to facilitate system-wide coordination in humanitarian settings. For the current situation in Ukraine, we request UNAIDS to appoint an independent expert from the Council of Europe Special Representatives of the Secretary-General on Migration and Refugees and/or other appropriate bodies to support its current humanitarian efforts. It is also evident that the Regional Support Team cannot properly conduct an effective emergency response for the Eastern Europe and Central Asia region located in the capital of the Russian Federation, where some of its work and messaging can be considered illegal. Every day that the current ineffective response continues, it harms the lives and well-being of our constituencies and puts UNAIDS staff based in Moscow at risk. We are, therefore, joining other global civil society networks in calling for the immediate relocation of the Regional Support Team from Moscow, where its work is neither possible nor credible.

We also demand that UNAIDS looks to strengthen its capacity to respond to other humanitarian crises that may directly impact people living or affected by HIV in a comprehensive and timely manner, recognizing vital needs that currently exist in other locations, such as Tigray in Ethiopia, South Sudan, Afghanistan, Myanmar, Palestine, Syria, Yemen, and many others.

Finance and support the HIV and humanitarian response in Ukraine and across all humanitarian settings

In 2020, UNAIDS, ILO, and UNICEF issued a global Call to Action for countries to scale up social protection programs to cover populations being left behind, including people living with, at risk of, and affected by HIV and TB in humanitarian settings.

The Global Fund for AIDS, TB, and Malaria has provided additional emergency funding to Ukraine9 and made the available funding inside the country flexible so that it can be focused on priority needs, such as access to HIV and TB treatment, basic services and provision of opioid agonist therapy (OAT), but also can be allocated to meet emergency humanitarian needs. We remain aware, however, that the current needs cannot be covered from this funding stream alone, with further flexible funds still amply needed for emergency assistance, direct humanitarian support, mental health, safety, and evacuation, and work with internally displaced people inside Ukraine and refugees outside the country. We urge Member states, UNAIDS, and all other donors to follow the example of the Global Fund and to ensure that sufficient funding and support are provided to Ukraine and neighboring countries with the aim of serving and protecting people living with HIV and key population communities inside Ukraine and among the refugee population outside. This includes both making additional emergency funding available and ensuring that both existing and additional funding streams are flexible so that they can be used to deliver HIV responses and meet humanitarian needs.

Community and civil society response systems are doing their very best to meet the current level of need, but the damage caused by the war is enormous, and the need for assistance exceeds what communities can provide with current resources. They can and want to do more, but they are stretched to their limit and need additional funding for continuing life-saving work in Ukraine and neighboring countries. We call on donors to recognize local civil society as essential humanitarian actors, ensure that emergency funding is directed to them to support them in their vital work, and community-led responses and monitoring to ascertain member states, donors, and humanitarian mechanisms are fulfilling their responsibilities to protect the lives and health of those whom they serve. Furthermore, we urge UNAIDS to ensure that these calls for solidarity and flexible funding are taken seriously by advocating with Governments and donors to meet the financing needs.

Alongside financing, action is also needed to tackle the crisis in OAT supplies. Approximately 85% of OAT clients are male, so most have remained in-country. At present, they face constant instability and anxiety over OAT stockouts. Since the beginning of the invasion, contact has been lost with 2,138 clients, with a further 6,000 clients at risk of treatment disruption, many of whom have been forced into abrupt withdrawal because their OAT doses have been reduced, at a time of already deep crisis and when there are very few places to go for expert advice on opiate withdrawal. One of the major OAT production centers in Ukraine (in Kharkiv) stopped operations due to Russian military attacks. While commitments have been made to ensure a shipment of OAT into the country, it is essential that these are honored, as more than 20,000 people are affected. We ask donors and UNAIDS to work together to ensure that a reliable and adequate supply of OAT can reach Ukraine and to work with community-led and civil society organizations to ensure that OAT services are accessible to all who need them, including in neighboring and receiving countries. Given the strict controls and tight regulations on OAT access worldwide, work must be done to ensure that these barriers to entry are lifted in the short and long term so that the right to health of people who use drugs is protected.

UNAIDS: Improve the coordination of humanitarian aid and community-led monitoring

Experiences in the field, both in Ukraine, its neighboring countries, and in other crisis settings, have shown that the needs of people living with HIV and key populations are often left unmet or de-prioritized in general humanitarian responses. The recent example of Venezuela taught us that it is necessary to ensure early on that people living with HIV and key populations are recognized as “populations of concern” by the Health Cluster responsible for coordinating the health response during humanitarian crises. As Venezuela again has shown, it is also vital to ensure the full participation of the community in the cluster itself and in relevant committees and emergency response teams, along with representatives of community-led and civil society organizations. Only realizing the principle of ‘Nothing about us without us’ can bring successful results.

To protect the health and lives of people from our communities, we ask for more proactive engagement by the UNAIDS in the Health Cluster and other relevant groupings and for more visible and effective coordination between UNAIDS, the co-sponsors (particularly WHO, which is leading the Health Cluster) and other humanitarian actors. We also call for closer dialogues between the co-sponsors and community-led, key population-led, and civil society organizations working in the health and humanitarian response, including people living with and affected by HIV, to ensure that their voices, perspectives, and needs based on community-led monitoring outcomes are reflected in the plans and decisions of the Health Cluster and other key groupings, ultimately helping to make work on the ground more effective and to ensure that the health and lives of people living with HIV and key population communities are prioritized and protected.

Doing so will support UNAIDS and UN member states in realizing its commitments as noted in:

• The 2016 Political Declaration on Ending HIV/AIDS, where member states have committed to pursuing the continuity of HIV prevention, treatment, care, and support and to providing a package of care for people living with HIV, tuberculosis, and/or malaria in humanitarian emergencies and conflict settings, as displaced people and people affected by humanitarian emergencies face multiple challenges, including heightened HIV vulnerability, risk of treatment interruption and limited access to quality health care and nutritious food;
• The 2021 Political Declaration on HIV/AIDS, that promotes full access to effective health emergency responses with full respect for human rights and ensures that 95 percent of people living with, at risk of, and affected by HIV are protected against health emergencies that 90 percent of people in humanitarian settings have access to integrated HIV services and that 95 percent of people in humanitarian settings at risk of HIV use appropriate, prioritized, people-centered and effective combination prevention options;
• The 2030 Agenda for Sustainable Development, that contributes to intersectoral efforts essential to reach the global health goals and ensure progress across all settings, including humanitarian, to fulfill the overarching goal of leaving no one behind, with the full involvement of Member States and relevant stakeholders.

Signed

¹ National assessment of the situation with HIV/AIDS in Ukraine as of the beginning of 2021. Grabovyi S.L., Kuzin I.V., Matyushkina K.O., Marchynovska V.O., Antonenko Zh.V. – Kyiv: Public Health Center of the Ministry of Health of Ukraine, 2021. – 56 p. Download PDF document