Providing care for Ukrainian refugees with HIV

As the invasion of Ukraine continues, refugees with HIV seek support in receiving countries.

Since war broke out in Ukraine, thousands of refugees with HIV have registered with clinics in other countries for treatment. But aid organisations and doctors say fears of stigmatisation and a lack of information, among other factors, might be keeping many more away from the help they need.

More than 5 million people have fled Ukraine since the Russian invasion began on Feb 24, 2022, according to the UN. Of these, UNAIDS estimates that around 30 000 might need to access antiretroviral therapy (ART). The organisation has said that so far, only a fraction of that number—as of the end of April, 2022, HIV clinics in most receiving countries reported registrations in the hundreds—have come forward.

EU states have granted free access to health care, including HIV treatment, for all refugees from the Ukraine war, and at border crossings and transit sites in neighbouring countries information about health care is being made available. Local and regional organisations, such as the Euroguidelines in Central and Eastern Europe Network Group, have also set up websites with information on clinics and other contacts for refugees with HIV and key populations.

“We would be overconfident to think the majority are getting the information they need [about health-care access]”, Eamonn Murphy (Deputy Executive Director at UNAIDS) told The Lancet HIV.

Stigma around HIV status is a problem for some refugees. “What these [refugees with HIV] have is the trauma of the whole refugee experience itself, and then on top of that the trauma of not being able to, or being afraid to, identify [as HIV positive]. There is the issue of stigma and discrimination. We know some countries are not friendly to key populations”, Murphy said.

John (named changed to protect anonymity), fled Kyiv in mid-March and made his way, via Slovakia, to Berlin, Germany, where he is now receiving ART. “When I left, I knew that in some countries HIV is stigmatised, for instance Poland. I did not want to go there and reveal my status”, he said.

Sergiu Grimalschi of the Aids-Hilfe organisation in Berlin told The Lancet HIV that some refugees had struggled so much with stigmatisation in Ukraine they were displaying signs of self-stigmatisation and did not want to reveal their status.

Meanwhile, limits on capacity, provision, and full coverage under state health insurance mean that accessing treatment for related conditions, such as opiate agonist treatment (OAT), hepatitis, and for psychosocial services, can be difficult. “OAT is free in Poland but there are more barriers to access [than for ART]. The number of patients who can receive it at centres is limited so already in some places refugees are on waiting lists”, Magda Ankiersztejn-Bartczak (Head of the Foundation for Social Education in Warsaw, Poland), which is helping refugees with HIV, told The Lancet HIV. “A monthly OAT supply is not always given, sometimes it is daily, and for some refugees getting to a clinic every day is difficult.”

Experts have highlighted the importance of tackling war traumas and severe psychological stress as early as possible given their association with HIV acquisition, violence, and decreased ART effectiveness. Local doctors agree, but say its provision is not easy. “Psychological support for war refugees is important. A lot of NGOs helping HIV-positive people are in daily contact with our centre [about this]. But it is very hard to provide psychosocial support because of the language barrier”, said

Lubomir Sojak (Centre for Treatment of HIV/AIDS Patients, Academic L Derer’s University Hospital, in Bratislava, Slovakia).

Another major difficulty doctors have reported is missing documents when refugees present at clinics. However, this is being overcome by a WHO standardised protocol that allows, with patient consent, medical histories to be sent from Ukraine to other countries.

One of the biggest worries for doctors is long-term provision of services. “Around 200 Ukrainian refugees registered with us since the start of the war. This is manageable, but we expect to see more in the coming weeks and the current pace [of new registrations] suggests the system could overload”, warns Justyna Kowalska (Senior Consultant at the HIV Out-Patient Clinic, Hospital for Infectious Diseases in Warsaw).

“It will be a problem if patient numbers continue to rise, and they stay in our country”, says Lukas Fleischhans (HIV Centre, Bulovka University Hospital in Prague, Czech Republic). “European governments should develop a programme to ensure adequate care for these people.”

Ankiersztejn-Bartczak estimates her organisation alone has helped at least 150 of the around 500 refugees from Ukraine registered for HIV treatment in Warsaw. In Ukraine, the Alliance for Public Health, the country’s largest NGO dealing with HIV/AIDS, says it has helped hundreds of refugees to access HIV services abroad through its HelpNow programme. UNAIDS has issued an urgent call for an additional US$2·42 million in funding for organisations providing HIV services in Ukraine and receiving countries. “Community groups can play a vital role in helping refugees navigate local services. I’m concerned that some refugees might slip through the cracks as demands on civil society groups grow. They need increased funding”, said Murphy.

By Ed Holt