BACKGROUND: The full-scale war launched by Russia against Ukraine in 2022 caused serious challenges for national HIV response. HIV antiretroviral therapy coverage declined from 83% to 77%. Access to HIV care is particularly challenged for people living with HIV (PLHIV) from Eastern and Southern regions at the war frontlines. This study documented wartime experiences of PLHIV in obtaining healthcare, as reported by clinicians from Donetsk region.
METHODS: This exploratory qualitative case study employed in-depth interviews with healthcare workers (HCWs) from healthcare facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) in Donetsk region. A directed content analysis with inductive and deductive approach was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed.
RESULTS: HCWs described how the war increased motivation among PLHIV to protect their health. Yet, many clients desperately feared interruptions in healthcare access. Several described using private encrypted messaging to counsel clients who fled their homes, including where to get care and what medication regimen to request. They described hearing from clients who became refugees outside of Ukraine about their fear of seeking HIV care as it may jeopardize their temporary residency as well as on how language barriers prevented healthcare access:
“We couldn’t give out ART for longer time initially. PLHIV were crying and asking to give them medicine for six months, but we could only do two. People who fled abroad also didn’t want to disclose their HIV status. They cried: «What if they find out? They can kick us out, they won’t give us a place to stay?». We tried to send medicine with mail or their relatives picked it.”
For clients who stayed in Donetsk, HCWs described acute concerns for clients like lack of public transportation between rural towns and clinics, lack of power, lack of safe water as well as a high burden of trauma, depression, and anxiety.
CONCLUSIONS: HCWs presented a picture of disruption in healthcare services for many PLHIV from Eastern Ukraine. They described PLHIV fears about losing access to HIV treatment layered onto the psychological trauma of displacement, loss of lives, homes, and livelihoods.