WASHINGTON – Thousands of Ukrainian patients are receiving life-saving drugs to treat HIV and opioid addiction through a US-funded group that is still working despite Russia’s aggression. A complex calculus with low supply and unexpected risk of delivery.
Officials say the quiet work of the Alliance for Public Health shows how US aid is reaching people in the beleagured country at a wavelength different from US diplomatic and military support for the Ukrainian government.
The Ukraine-based humanitarian agency has been operating for more than 20 years. It has received millions of dollars from the US Agency for International Development as well as the Center for Disease Control and Prevention and other federal programs for HIV worldwide.
Executive Director Andrei Klepikov said stopping during the attack was not an option. Ukraine has one of the most serious HIV epidemics in Western Europe and patients need their medication every day.
He said his group had developed a “risk management plan” so that work could continue once the war broke out. However, it did not imagine the scale of the attack by Russian forces and forced the group to adapt.
In areas of Ukraine that have been spared the worst, the agency is still able to deliver medicines through postal and parcel services. For refugees fleeing the country, caseworkers are making connections with aid groups that can recover drugs. In areas under attack but still under Ukrainian control, medical vans are bringing supplies through convoys. Even with the help of intermediaries, the group has been able to get some deliveries in Russian-controlled areas. Tuberculosis drugs are also being distributed.
Asked how long it would last, Klepikov replied:
“We are still serving thousands of people with drugs,” Klepikov said. “It’s over five thousand.”
The group’s medical van fleet has been pressured to transport injured civilians to hospitals that can treat complex cases and provide the necessary supplies for daily living.
U.S. officials say they have been impressed by the attitude of the Ukrainians, who were impressed by the resilience of the British during the London Blitz in World War II.
Ryan Keating, a CDC epidemiologist overseeing Ukraine’s AIDS prevention and treatment assistance, said: “Going to war, I think we assumed the services would probably no longer work and we fully understand.” But “in most cases across the country, our partners continue to work every day.”
Keating spoke to a nurse at a clinic in a severely injured town who, when the air raid siren sounded, first took out HIV drugs and then fled to the bomb shelter. Healthcare workers continue to communicate with customers from the bomb shelter.
For the alliance, each day becomes a test. The group has lost contact with clients in Mariupol, where there is a large population of HIV patients. The coastal city has been hit relentlessly by the Russians, and reports indicate that much of it has been reduced to rubble. Klepikov said an Alliance medical van was destroyed during the bombing.
Normal forms of communication between clients and their caseworkers and physicians are severely disrupted. A clinic or office may be closed. The patients may have moved to a safer place. Messaging apps and online forums have filled some gaps, as telehealth has become the backbone of the first wave of the coronavirus epidemic in the United States.
A website backed by the Alliance has become a place for patients to seek counseling for war injuries. According to one of the group’s periodic situation reports, patients’ main concerns are intense stress, anxiety mixed with grief, fear of death, guilt after moving to a safe area, and guilt for not doing enough.
“The importance of this work increases significantly in the context of war,” said Klepikov, who has a doctorate in philosophy.
The United States has a long-standing relationship with the Ukrainian group through a program called the President’s Emergency Plan for AIDS Relief.
Efforts are under way to restore Ukraine’s drug supply, said Dr. Ezra Barzilla, CDC’s country director for Ukraine. Antiretroviral drugs are used to treat HIV, and drugs such as buprenorphine and methadone are used for opioid addiction. Two Ukrainian factories manufacturing drugs to cure opioid addiction have been attacked.
Medical problems related to HIV and opioid addiction because the virus that causes AIDS can be transmitted through infected needles used for drug injections. The Alliance estimates that 100,000 Ukrainians will be affected by the Russian invasion of HIV-infected cities and districts. At the start of the war, more than 17,000 opioid addicts were receiving treatment.
“If there is a drug in the country, it will not be effective,” Barzillai said. “You may have thousands of pills in one town and not have access to the next town. They are taking drugs from one place to another by car. ”
Program Director Klepikov said he remembers a long time ago with the US ambassador to begin American support for his organization. “I am concerned that what we have achieved in 21 years due to the Russian aggression in Ukraine may be destroyed in a few days.”