TThe shelling is so intense that on bad days it turns the sky orange. Despite this, Iryna Bondarenko and her team get in their cars and drive through the blasts to deliver life-saving medicines and services to people living with HIV in Ukraine.
They work with the Alliance for Public Health (APH), Ukraine’s largest health-focused NGO, which has continued to support thousands of people living with HIV/AIDS across the country since the Russian invasion began.
It’s vital work as Ukraine has one of the highest rates of HIV in the world: more than 250,000 people are currently living with the virus.
Almost half of them live in cities and regions that are currently being heavily bombed, and therefore there are fears that the war will only worsen the epidemic in Ukraine and even “undelete progress against the virus by twenty years” if Treatment and testing will be restricted and medical care choked off.
Reaching the patients – or clients, as the charity calls them – is the stuff of nightmares, as is servicing areas ravaged by heavy fighting.
In the coastal town of Mykolayiv, where Ms Bondarenko lives and works, she must navigate a shifting frontline as Ukrainian forces have fought back Russian attempts to capture the strategic port city for weeks.
In Kherson, just 40 miles below the Black Sea coast, occupied by Russian forces, the APH team tries to work around the heavily armed Russian soldiers patrolling the city.
Further down the coast in Mariupol, which was under siege for a month and faced some of the heaviest bombing raids, two of Ms Bondarenko’s colleagues are missing.
The telephone network was cut off at the beginning of the fighting. The whereabouts and fate of the two APH employees are still unknown, while the charity believes its facilities were bombed.
“We are concerned that our teams will be hit by shells, airstrikes, rockets, missiles, etc., but our customers are even more afraid. So we have to work, it’s important,” Ms Bondarenko says, describing explosions near her home.
She says they used to run a well-equipped mobile clinic in Mykolaiv, which drove around the region providing testing, treatment and social support services to vulnerable communities, including drug users and sex workers. But since the war raged in their city, they resorted to private cars or traveled on foot because the vans housing the clinics are “large and light and therefore could easily be the target of air raids”.
“We have to work, we have no choice. It’s just as important as what the military is doing on the front lines,” she adds.
Ukrainian medics fear a rise in infectious diseases from tuberculosis to Covid as Russia’s invasion has wiped out parts of the country’s healthcare system and supply networks.
They are particularly concerned about HIV. According to Frontline Aids, a global organization that supports APH and is currently running a major fundraising campaign for the charity, Ukraine was already grappling with the second largest HIV epidemic in Eastern Europe and Central Asia before the war.
They say more than 250,000 people in Ukraine are currently living with the virus, a number rising 15 percent each year.
Ana Korobchuk, regional coordinator for APH in the coastal city of Odessa, says most Ukrainians living with HIV live in cities and regions hardest hit by Putin’s invasion, such as the coast, as well as the eastern and northeastern regions of Kharkiv and Chernihiv.
“Eight of the 10 regions we work in are being bombed: the areas most affected by HIV are also those most affected by the war,” she adds.
It has set back Ukraine’s fight against HIV/AIDS by 20 years, says Natalia of the charity Spodivannya – APH’s partners in the war-ravaged Zaporizhzhia region.
“We are very concerned that HIV/AIDS will get much worse in the war. At the moment the current situation in terms of the lack of syringes, condoms, all the hygiene materials, masks, testing everything is like we went back 20 years,” she says.
“So we’re trying to get whatever supplies we can to those who need them most.”
She says she has similar issues with her teams in the war zones. Spodivannya has had little to no contact with her team members in the now Russian-controlled city of Berdyansk, which lies on the coast next to Mariupol.
“We cannot work in the occupied territories and worry about ours [patients] who are there,” she adds, asking that her surname not be mentioned for fear of retaliation against her associates in areas now in Russian military hands.
“We have also turned our clinics into humanitarian aid centers, providing medicines, medical supplies and food to the most vulnerable,” she continues.
Meanwhile, both charities say they are concerned the mass movement of people during the conflict will contribute to worsening Ukraine’s HIV crisis.
Vladimir Putin’s invasion of Ukraine triggered Europe’s worst displacement and refugee crisis since World War II.
So far, more than 4.2 million people have fled Ukraine and another 6.5 million people have been internally uprooted.
APH’s Korobchuk fears that this will lead to further spread of the HIV epidemic in Ukraine.
“We are currently building facilities in the western city of Lviv to handle this,” she adds.
But the main concern is with the customers themselves, many of whom come from vulnerable, impoverished and marginalized communities.
Most do not have documents allowing them to leave the country if medicines run out, and struggle with addiction when access to illicit drugs or medication to cope with addiction becomes scarce.
Anatoly, who is 39 years old and frail, is being treated for HIV by APH. He doesn’t want to leave Ukraine but fears he will have to if the drugs run out.
As a man of military age, however, he is not allowed to leave the Ukraine due to a general mobilization by the Ukrainian President. After becoming addicted to heroin at the age of 15, he is now six years clean but still struggles with society’s stigma of being a former addict.
“I’m really worried about those stuck in places like Mykolayiv,” he says The Independent while sitting with his social worker Liudmyla.
“When I first met my social worker I couldn’t face being so ill, the treatment saved my life. I am concerned about what will happen to supplies if this continues.”
His concerns are shared by Oleg, 43, who also became addicted as a teenager and found out he had contracted HIV in his 30s.
“In the end it will be the Russians who stop our treatment, which would be catastrophic,” he says.
Meanwhile, the doctors and social workers are working hard to ensure that their services are not discontinued.
For Iyrna, that means finding creative ways to get relief supplies to those most in need despite the shelling.
“Many of us don’t know if we’ll wake up tomorrow, if the next afternoon will come,” she says as she prepares for another day of work in a war zone.
“But today we work because we have to.”
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