In early February, 29-year-old Anastaysia, from the town of Nemishaieve, west of Kyiv, was diagnosed with HIV.
She was terrified, she told The Telegraph, and unsure what the diagnosis meant for her future. Two weeks later, Russia invaded Ukraine.
“I don’t know what will kill me first: HIV or bombs,” she said from her temporary shelter in Vinnytsia.
Anastaysia is one of an estimated 260,000 adults and children living with HIV in Ukraine.
In 2020, Ukraine had the second highest rate of newly diagnosed HIV infections in Europe. Over half of the new HIV diagnoses were attributed to heterosexual transmission, and 38 per cent from injecting drug use.
Over half, or nearly 150,000 people, were being treated with life-saving antiretroviral treatment when the conflict started, including more than 2,700 children.
Now, as the war approaches the end of its fifth week, the six-week supply of HIV medication – delivered to patients before Vladimir Putin invaded – is starting to run thin.
Andriy Klepikov, the executive director of the NGO Alliance for Public Health, said the situation was a “disaster”.
“We’ve calculated that nearly 100,000 people with HIV – and 59,000 on antiretrovirals – live in areas affected by the ongoing conflict. It’s most difficult to deliver treatment to those in active military territories, where they are being bombed every day,” he said.
“Logistics are difficult there. Patients have some medicine, because before the war they were given one or one and a half’s month support. That supply is running out now.”
Disrupting or stopping treatment can lead to complications including drug resistance, which poses a risk to a patient’s health and makes the disease more difficult to treat.
Mr Klepikov added that stopping the treatment could lead to HIV positive patients contracting tuberculosis, one of the leading causes of death among people living with HIV.
“It’s even more dangerous [in terms of] tuberculosis,” he said. “In Ukraine, we have over 4,000 patients with multi-drug resistant TB. If HIV treatment is interrupted, it really means risk of life.”
Mr Klepikov said delivering treatment is increasingly challenging, because of logistical issues and losing contact with patients.
“It’s difficult to provide accurate estimates, but we have lost contact with at least several thousands, maybe even ten thousand, patients,” he said.
His organisation is struggling to reach almost all patients in Mariupol, where almost 5,000 people were estimated to have been living with HIV.
Mr Klepikov said: “In Mariupol – which Russia has turned into a Ukrainian Aleppo, destroying 90 per cent of the buildings – we have lost contact with our patients, doctors, social workers. Our office and partner organisations have been bombed. Our mobile clinics have been completely destroyed. It’s a real disaster for patients.”
Some patients forgot supplies when fleeing from their homes, while others say medication has been destroyed in attacks.
“It’s so scary when the bombing starts, people leave their homes in 20 minutes, some have forgotten their medicine,” Mr Klepikov said from Kyiv.
Anastasia was evacuated when the bombing hit her town. She said: “My life has become divided into two parts – before and after. I couldn’t imagine that I would wake up one morning and the war would have started. I had only learned about my HIV status just two weeks before. It was all really very scary.
“I tried to stay home, hoping [the invasion] would pass. But then I had to look for bomb shelters, it was not possible to stay.”
Anastasia said she only has a short supply of treatment, but that she receives regular communication and support from social workers.
The Telegraph also spoke to 47-year-old Iryna, who was diagnosed with HIV in 2020, after taking a free test at a mobile clinic. She was recently evacuated from Mykolaiv to Dnipro.
Iryna said: “I was very shocked, but I got help from the social workers. Now I take my therapy in the AIDs centre, and meet with a doctor every three weeks. At the moment, I’m not sure where I will next take it. But I am not nervous, I have known the social workers for two years, they will help.”
Mr Klepikov confirmed that his team, along with other aid agencies and health workers, are continuing to provide support and attempt to dispense medication.
But doing so has become a dangerous feat. “A couple of days ago our partner organisation faced a situation where a van with volunteers delivering medicine and humanitarian aid was shelled and two people unfortunately died,” he said.
Hospitals and mobile clinics have been wrecked in indiscriminate attacks, too. Seventy hospitals have been destroyed, while other hospitals are under pressure as supplies run out, the Red Cross told The Telegraph.
Nonetheless, Anastasia and Iryna remain hopeful. Anastasia said: “I hope and believe Ukraine will win the war soon. I am sure it will happen. I hope I will be able to go home and continue my life.”
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