UNAIDS is concerned that stocks of antiretroviral treatment for people living with HIV in Ukraine will soon run out, and that people inside Ukraine and those on the run could face challenges in refilling their supplies amid the war with Russia, putting them at risk of developing resistance to the drugs they’re currently taking.
Club Eney, a community-based organization providing HIV prevention services to people using drugs and sex workers in Kyiv, has also expressed concerns that the current available supply of drugs in the capital such as methadone and buprenorphine, which are used for opioid substitution therapy, may last for just one more week.
“For now people can get the treatment, but we don't know what our situation will be later,” Velta Parkhomenko, the organization’s chair, told Devex from Kyiv.
“I don't know about safety. But for now, we are safe, we are alive, and we are working because if we do not help our community, who [will] help them?” she said.
Health care in Ukraine is under “
severe pressure,” according to the
World Health Organization, which has verified 22 attacks on health care to date since the Russian invasion last month. The aid agency has voiced concerns on depleting medical supplies,
particularly oxygen. Shipments of medical supplies, including trauma kits, have arrived in the country.
During a
press briefing on Wednesday, WHO Director-General Tedros Adhanom Ghebreyesus said the U.N. aid agency has 400 cubic meters of medical supplies at its logistics hub in Dubai, “waiting to be transported to Ukraine.”
But a key challenge is getting the supplies to areas where there’s heavy fighting between Russian and Ukrainian forces. Dr. Michael Ryan, executive director of WHO’s health emergencies program, said Wednesday there are approximately 1,000 health facilities on the front lines, or within 10 kilometers (6.2 miles) of the front lines, and some hospitals are being abandoned.
“This is becoming an extremely complex health response with frequent population movements, shifting lines of control, increasingly difficult access, and a very asymmetric type of warfare also building up,” Ryan said.
WHO has called on Russia to “commit to a peaceful resolution” to the crisis, and allow for safe, unimpeded access for humanitarian assistance.
ARV treatment disruptions
New stocks of antiretroviral treatment, financed by the
U.S. President's Emergency Plan for AIDS Relief, were supposed to arrive in early March in Ukraine, but with the war, the delivery of these lifesaving drugs in the country have become “problematic,” Raman Hailevich, country director for UNAIDS in Ukraine, told Devex from Chișinău, Moldova.
“Because it could not be delivered directly to Ukraine, it will have to be delivered to one of the neighboring states, and then will have to be transported to areas that are controlled by the government. And the most challenging task will be to deliver it to areas [where there’s] fighting between [the] Russian and Ukrainian army, and … places where roads are blocked by the Russian army,” he said, citing the cities of Kharkiv, Mariupol, Chernigov, and Sumy.
The Ukrainian government has been working to provide people living with HIV with ARV drugs for up to three months, Hailevich said, so several patients likely have some stock remaining for a few weeks or a few months. But the problem is when those supplies run out.
According to the UNAIDS country director, the drugs are produced in India, and will now be shipped to Poland and to be transported by trucks to Lviv in Ukraine.
“The issue is … how to refill and where to refill, and particularly if you are on the run, and if you're on the run out of Ukraine,” he said.
In Moldova, the government has made ARV treatments available for 300 people coming from Ukraine, but that may not be enough to cover the number of people in need, Hailevich said.
UNAIDS estimates there are about 250,000 people living with HIV in Ukraine, including in non-government-controlled areas and including those who are unaware of their status. Ukraine has a high HIV epidemic, second to Russia in Eastern Europe and Central Asia. In the government-controlled areas, before the war, the organization estimated about 130,000 people living with HIV are on ARV treatment.
Hailevich said it’s impossible to come up with a precise figure on how many people who are living with HIV are currently in Ukraine and are at risk of running out of treatment. But he thinks that the majority of them are still inside the country. In 2020, UNAIDS estimated that more than half of adults over 15 years of age living with HIV in Ukraine were men, and at the moment, men who are 18 to 60 years old are currently not allowed to leave the country.
If those living with HIV are unable to refill their supplies, then their treatment will be interrupted, putting them at risk of drug resistance. That means that once they resume taking the drugs again, these may no longer be effective, and they may have to take another treatment regimen. But if the next line of HIV drugs is not readily available, it adds additional complications to treatment, Hailevich said.
“It's a lifelong treatment. If your remaining lifespan is 20 or 30 years … and you already cannot take certain drugs that are effective against HIV, that limits the prospects for your life,” he added.
OST therapies lasting 7 days
HIV prevention supplies in Kyiv are also in danger of running out.
Opioid substitution therapy involves the prescription of alternative medications for people dependent on opioids, and is known to be an effective
treatment for opioid dependence and in the
prevention of HIV transmission. In Kyiv, Club Eney, together with several organizations, are helping people who use drugs to access this therapy in private and public clinics.
However, since the war broke out, Parkhomenko said private health clinics providing this therapy have closed. Government-run clinics continue to operate, but they can not accommodate additional people due to limited drug supplies.
An additional challenge is transport. Public transportation is not functioning well, and taxis are unavailable, making it difficult for those who need to access these therapies.
Parkhomenko does not have an idea if new stocks will come in, but she’s hoping that other countries will send in supplies.
As part of its harm reduction services, Club Eney, which Parkhomenko said was assisting an estimated 30,000 people before the war, is also providing syringes and needles for people using drugs. But these too could soon be depleted.
“We have … needles and syringes for one week more in Kyiv,” Parkhomenko said. They have stocks in another location, but it’s challenging to access that because of the fighting, she said.
“We need money for direct financial help of our clients … and also for peer consultants. We need food for our clients. We need syringes. We need needles. We need OS therapy for Kyiv. We need fuels for our cars,” she told Devex.
She doesn’t want to entertain the thought of supplies running out in a week’s time, and believes Ukraine will “win” the war in 10 days, easing the situation.
“I don't want to think about this,” she said.
“We hope that in a week we will have supplies for people, because if not, we will have a really high level of HIV epidemic and all our progress for many years … for [the] prevention of HIV will be stopped,” she added.
