Ukraine HIV services severely curtailed by US aid freeze

The charity 100% Life provides treatment and prevention services to marginalised communities—including people who use drugs and people with HIV, tuberculosis, and other diseases—often operating in front-line areas.

Dmytro Sherembei, Head of 100% Life’s Coordination Council, told The Lancet that up to 25% of specialist staff carrying out testing, monitoring, and other tasks would have to be laid off and testing programmes and other assistance for state health-care projects would be stopped. “The funding suspensions stopped our whole programme and it will cause a lot of damage”, he said.

The Alliance for Public Health (APH), one of the USA’s largest health-care NGOs, has been told that funding from the US Centers for Disease Control and Prevention for its HIV case-finding operations had been suspended, despite the waiver.

Andriy Klepikov, Executive Director of the APH, told The Lancet that the removal of funding would be a disaster. “About 35–40% of all HIV-positive cases in Ukraine are found, tested, and referred for treatment by APH and its partners. It will be difficult to find alternative funding”, he said. The APH estimates this could mean that thousands of cases will go undetected during the 90-day period of the freeze.

The funding suspension has also impacted groups providing support for the country’s war veterans, many of whom have life-altering injuries or mental health problems and rely heavily on those organisations, often. Some say they have now had to shut down parts of their operations or branches.

There are also concerns that treatment for more than 100 000 patients with HIV in Ukraine could be interrupted. “Since the beginning of Russia’s full-scale invasion, the Ukrainian Government has not had funds to procure antiretroviral drugs (ARVs), so the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been procuring ARV medications for all patients. We have 118 000 patients on ARV in Ukraine. Preliminarily we have stocks of ARVs for 6 months, but a suspension of funding could impact the next delivery of medications planned for March”, Klepikov said.

Although groups, such as UNAIDS, initially welcomed the waiver as ensuring millions of people living with HIV around the world could continue to receive life-saving HIV medicines, a spokesperson for the organisation was later unable to confirm for The Lancet that it would also cover funding for the distribution of those medicines, nor for further testing and prevention in Ukraine, which has one of the worst HIV epidemics in Europe.

Sherembei said that the waiver would not help his organisation. “[The waiver] only applies to [ARV treatment for HIV] pills, not actual programmes, testing, support, or [funding for] employees”, he said, adding that the funding suspension threatened to reverse decades of progress in combating HIV/AIDS in Ukraine and put those receiving ARV treatment in Ukraine at risk of preventable death. “Patients are terrified, and health-care workers are struggling to provide answers. This funding stop threatens to turn a manageable epidemic into a deadly crisis”, he said.

Ukrainian media have reported that government officials are in contact with US officials to clarify what activities the waiver covers. When asked about the effects of the funding freeze on NGOs providing health-care services in Ukraine and ARV procurement, Mykola Hanich, Head of Communications at Ukraine’s Public Health Centre of the Health Ministry told The Lancet: “Non-governmental organisations in Ukraine play a significant role [in health care], with some relying partially or entirely on [US] support. We were initially concerned by reports regarding the suspension of aid. However, we have noted media statements from Senator Marco Rubio regarding the continuation of funding of essential medicines and health-care services. This gives us optimism for the future.”

By Ed Holt