Public health considerations over HIV amidst war and COVID-19 in Ukraine: Harnessing contemporary history to address the syndemic

Dear Editor,

As of February 24 2022 the armed forces of the Russian Federation have crossed the border to Ukraine. To date, more than 1.5 million people have been displaced and numerous healthcare facilities have been damaged or committed to serve soldiers and civilians with combat injuries. Public health services including sero-surveillance and harm reduction programs have been derailed. This situation is particularly alarming with regard to the Acquired Immune Deficiency Syndrome (AIDS), because Ukraine has had the second largest Human Immunodeficiency Virus (HIV) epidemic in Europe for the last three decades [1].

Following the collapse of the Soviet Union in 1991, experts have observed an increase in the use of drugs in the country, and particularly in its eastern provinces. Risky drug injection practices have been considered as the major cause of the HIV outbreak all over the country, with the majority of cases being detected in the regions of Luhansk and Donbas. Other causes for the spread of HIV included unprotected heterosexual or homosexual intercourse between people who inject drugs (PWIDs) and their partners and prostitution. Henceforth, PWIDs, sex workers, men who have sex with men (MSM) and prisoners have been recognized as the highest risk populations in this regard [2], [3].

In time, the coordinated efforts of state actors, global charities like the Global Fund to Fight Aids, Tuberculosis and Malaria and non-governmental organizations helped build an effective harm reduction strategy. The main aspects of this strategy included access of high-risk populations to HIV preventive, diagnostic and treatment services, opioid substitution therapy for PWIDs and formal and informal health literacy campaigns. By 2012, the incidence of AIDS associated with risky drug use had decreased significantly [3], [4].

Political turmoil in 2013 and armed conflicts in 2014 negatively affected HIV's epidemiology in the country. The work of non-state actors, the administration of opioid agonist treatment to drug users and a big part of the HIV testing and management supply chain were disrupted in regions that ceased to be controlled by the Ukrainian government. Moreover, internal displacement of people with AIDS contributed to an increase in the seroprevalence of HIV throughout the country [3], [5]. The nexus between the 1991–2012 HIV outbreaks and the development of HIV epidemiology following the 2013–2014 crisis was the disruption of prevention and treatment services, the displacement of patients and the decline in the efforts to educate PWUDs about safe drug administration practices. This is of course combined with the disorganization in the efforts to prevent and monitor HIV transmission associated with sexual practices [6].

The ongoing armed conflict has introduced two additional variables to the equation; the expected surge in Covid-19 among HIV patients and the refugee flows in eastern European countries whose border towns hardly have the capacity to provide adequate Covid-19 and HIV surveillance [4]. Hence, at present it is pivotal to strengthen HIV prevention and control efforts together with ceasefire efforts. HIV prevention and monitoring should also be enhanced in regions accepting refugees.

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The authors declare that the work described has not involved experimentation on humans or animals.

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The authors declare that the work described does not involve patients or volunteers.

Disclosure of interest

The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper.

Funding

This work did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

CT conceptualized and wrote the first draft of this manuscript, LM and DM performed the literature search and edited the first draft, MP and CT critically revised the manuscript and supervised this project. All authors have approved the final version of the manuscript before its submission.

Data availability statement

Data sharing not applicable as no new data generated and the article describes entirely theoretical research.