Ukrainian activist discusses Russian invasion’s devastating impact on HIV care and harm reduction in his country

In recent years, due largely to in-country activist networks as well as support from large foreign aid entities like the U.S. PEPFAR and the Global Fund, Ukraine has become an exemplar of good public health around these issues. For a low-income country, it has decent rates of people on HIV medication and injection drug users accessing both clean needles and medication-assisted substitution treatment, such as methadone and buprenorphine. It has dramatically brought down rates of HIV among injection drug users. And activists have fought to make central to these efforts once-maligned “key populations” such as gay men, transgender people, and drug users.

All this has come as an affront to Russia, whose leadership denounces compassionate harm-reduction policies toward drug users as dangerous ideas imported from “the West.” With huge numbers of Ukraine’s population—mainly women and children—displaced either outside the country or to its western region where major fighting has not yet reached, and with normal medical logistics and international supply chains disrupted, all that progress is imperiled. Many cities in the country report they have enough HIV medications to keep patients in supply for several more weeks, but that’s it.

TheBody spoke with Ukrainian Anton Basenko, a program manager for the European AIDS Treatment Group (EATG). Before that, Basenko, himself living with HIV and a former injection drug user, worked for Ukraine’s Alliance for Public Health. That was his latest role in his nearly 20-year career as an advocate for people with HIV and people who use drugs in Ukraine.

Tim Murphy: Anton, thank you so much for making time to talk to us at a very stressful time. How are you and your family and loved ones doing?

Anton Basenko: I moved to Belgium with my wife and son in September 2021 so I could work for EATG and play a bigger and more international role in the fight against HIV/AIDS. But my and my wife’s mothers are still in Ukraine. My mother is still in her apartment in Kyiv, but she’s forced to go every night to a bomb shelter in the basement of a school. It’s not a comfortable place; they’re using wooden tabletops as beds, so you can’t even really sleep on them. My mom is almost 70 and quite weak and sick, and unfortunately she’s alone. I wasn’t able to evacuate her. There are several bomb alerts during the day too, so she’s exhausted walking from her ninth-floor apartment to the shelter with her backpack full of her documents, money, some food, and hygiene products.

My wife’s mother is outside of Kyiv, close to Chernobyl, in a town that is occupied by Russian troops. She’s 80 and lives alone. We have no connection to her currently and don’t even know if she’s alive. We heard a week ago from one of her neighbors that she still was. She has some chickens and a wood stove, so, hopefully, she is eating and warm, but we know that once the Russian troops’ logistical chains are broken, they start to steal food from villagers.

Murphy: That sounds horrible—I’m so sorry. Is there any chance your mother could be evacuated?

Basenko: Someone agreed to host her in Lviv [in central Ukraine], but all my friends who could get her there have already left Kyiv, so we missed that moment. My organization, Alliance for Public Health, has been bringing people to the train station, but then you never know how long you’ll be stuck there waiting for a train to the west. People have been sitting there two or three nights, which is not an option for my mom because she has bad legs. I would try to find someone to pay to pick her up, but it’s hard to find someone you trust now because people are exploiting evacuees who travel with their money or jewelry.

Murphy: We really hope and pray that both your mothers have good outcomes. So—you were diagnosed with both HIV and hepatitis C in 2003, yes? And thanks to the Global Fund and other programs, you’ve been on HIV treatment and also been cured of hep C, yes?

Basenko: Yes. Until 2002, there were a limited number of service points for those things, but the Global Fund brought a massive scale-up, and an entire network of different human rights organizations started to appear in Ukraine.

Murphy: And from then on, there was a reduction in HIV cases among people injecting drugs because of the growth of needle exchange sites, yes?

Basenko: Yes—in 1996, the HIV rate among injection drug users was about 41%, and now it’s about 21.9%. But among people who’ve used three years or fewer, so-called “new users,” the HIV rate has dropped from 30% to just 3.5%.

Murphy: Wow. And how would you describe the quality of both HIV and drug treatment prior to the invasion?

Basenko: I was very optimistic about it. We had the biggest harm reduction program in the region—65% of people who injected drugs were covered by the programs, like 220,000 out of 350,000 people. That’s still quite low by World Health Organization standards but still the best in the region. And we finally switched the paradigm of thinking that people from so-called key populations—sex workers, men who have sex with men, injection drug users—must be left behind.

And all these years, Russia has been using its political influence to counteract harm reduction and medication-assisted therapy programs because they see them as some kind of Western influence. My impression is that before the invasion, Ukraine was the real leader in the development of these programs. If there were no war, we would be on track to reach sustainable goals. But now we’re many steps back. Logistical chains are broken and there’s massive migration within or beyond the country. All men ages 18 to 60 must stay, so it’s mainly women and children leaving.

Murphy: What are you hearing about the breakdown in HIV and other treatment and care since the invasion?

Basenko: Every minute, I have calls and I have messages coming in from the Ukrainian Network of People Who Use Drugs. I think only about 5% to 10% have moved so far to a safer region of Ukraine.

Murphy: I’ve read that there is a short-term supply of HIV and other drugs within the country still, but after that—

Basenko: That’s true. The problem for all medications is that delivery to various regions has become problematic or just impossible. There are limited amounts of drugs in the region already. They’ve already switched to some older HIV meds to conserve the supply of newer ones. WHO is doing a great job getting meds to Poland and to one point in western Ukraine, but then there’s the issue of how to deliver to Kyiv or Mariupol. Hundreds of bridges and roads are destroyed, and it’s just dangerous.

We also know that some of the TB drug supplies are already over, and it’s not always possible to change simply from one drug to another, like with HIV often, because there is multidrug-resistant TB which requires complicated treatment. Hep C is in a better position I think because you only need the drug for about three months anyway before you usually get a cure.

But the situation with methadone and buprenorphine is even worse because they’re controlled substances that are usually accompanied by security, so right now the supply only goes through about August. In Kyiv, it’s only for a few more weeks. The national producers of both drugs are closed, evacuated, and people are already starting to reduce their dosages.

Murphy: I know this is a rather unwieldy question at this moment, but what do you hope to see happen going forward?

Basenko: I hope to see the end of this war as soon as possible, with Ukraine the winner. We’re already the winner—you can occupy some of our territory, but not our minds, hearts, and souls. But I would also like to see the end of this war in terms of HIV and health systems because we’re losing people every day—and losing all our achievements as a progressive country. It’s not just a war of weapons. Russians want a world where there is no place for key [vulnerable] populations, human rights, medication-assisted drug treatment, or harm reduction.

And of course, my simple human wish is to hug my mom as soon as possible, along with my friends who are still there in Kyiv, which is a beautiful city. I have so many friends from places like Germany and the Netherlands, even the U.S. and Canada, who said, “Wow, what a beautiful, modern country” when they first came here. And now the Russians are destroying everything.

For those wishing to donate to relief efforts for Ukrainians living with HIV, TB, and drug addiction, Basenko suggests donating to Ukraine’s Alliance for Public Health nonprofit, which he worked for and remains tied to. Please note that the donation requires an international wire transfer, which is trickier than the usual “Donate” button via a U.S. credit card used by most charities. I was unable to make my donation go through via my bank’s app on my phone and may have to call the bank to do so.

By Tim Murphy