HIV drugs have reached Ukraine. But that’s not the end of the problem

In early April, drugs for HIV treatment financed by PEPFAR reached Ukraine. But there’s another layer of challenge: distributing them to regions across the country. It’s no small feat given how parts of Ukraine remain in active war with Russia, and Russian soldiers have taken control of some areas, making deliveries difficult and at times close to impossible.

Many aid organizations rely on local NGOs for delivery. In the case of antiretroviral drugs, the U.S. President’s Emergency Plan for AIDS Relief partnered with 100% Life to ensure the medicines are distributed within Ukraine. Meanwhile, the Alliance for Public Health, a partner of the Global Fund to Fight AIDS, Tuberculosis and Malaria, started distributing drugs for people under opioid agonist treatment.

The work is challenging, and at times life-threatening. In certain regions, or oblasts, deliveries are only possible with the help of volunteers. In particular areas, deliveries are being made secretly, and some NGOs would rather not discuss them for fear of jeopardizing the little openings they have to get medicines there, and to ensure the safety of their volunteers.

Evgeniya Rudenka, head of procurement at 100% Life, said that as of April 22, approximately 90,000 people in Ukraine have received the PEPFAR-financed ARV drugs, and the supply is enough for six months of treatment. There are an estimated 260,000 people living with HIV in Ukraine. Of that number, 152,000 were on ARV therapy before the war.

A lot of logistics companies don’t want to take the risks, but Rudenka said her organization was able to find a logistic partner able to make deliveries in locations with active fighting, such as in Mykolaiv and Sumy. But there are places where deliveries are “practically impossible,” such as in Donetsk, Kherson, and Luhansk. If they find opportunities to deliver lifesaving treatments to these dangerous places, they would need help securing cars to transport the medicines.

“Because companies of course do not want … their transport to be under the bullets … because no one will compensate [for] the damage [to the] car,” Rudenka said.

But resources are limited for local NGOs, not just for those delivering HIV services.

Of the roughly $1.2 billion humanitarian aid contributions paid or in process to date by governments for Ukraine, 67% is going to United Nations agencies, 10% to the International Committee of the Red Cross, 7% to international NGOs, and less than 0.1% directly to Ukrainian organizations, according to the U.N. financial tracking system as of last Friday, Abby Stoddard, founding partner of the international research consultancy, Humanitarian Outcomes, wrote in an emailed response to Devex.

Needs–funding mismatch

To assist local organizations, UNAIDS launched an appeal for $2.42 million to support local civil society organizations helping people living with HIV in Ukraine and in refugee-hosting countries. Ben Phillips, UNAIDS director of communications, said the overall need is greater, and hopes donors will provide more flexible funding given the extraordinary circumstances, he said.

“There are now ARVs in Ukraine. But that is not the same as ARVs being in the homes of all who need them. The people who turn ‘ARVs have reached Ukraine’ into ‘ARVs have reached the homes of all who need them’ are the civil society-led networks of everyday heroes who are taking them through,” Philips told Devex.

Donors need to put greater trust in them, as the “alternative risk is we see a resurgence of HIV and AIDS in Ukraine,” he said.

The funding isn’t only to deliver lifesaving medicines but to help these organizations address the other needs of people living with HIV, such as food and housing. CSOs also need additional financial support for administrative work, such as rent and the costs of service delivery, according to UNAIDS.

Andriy Klepikov, executive director of Alliance for Public Health, one of the largest NGOs in Ukraine focused on HIV and tuberculosis programs, told Devex the situation became even more difficult for many of the people they were assisting before the war. So in addition to the usual core package of services they provide, they’re also trying to assist these people in response to other needs, such as documentation, housing, transportation, or even evacuation. But he said resources are limited, as they are still working with the same level of resources as they did before the war.