During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues to speak about HIV prevention in Central and Eastern Europe and Central Asia not only as a set of medical tools, but as a system of access, trust, rights and community participation.
For the Eastern Europe and Central Asia region, this conversation is especially important. HIV prevention here has long gone beyond the walls of a medical office: it depends on navigation, peer support, mental health support, legal assistance, sustainable financing and the ability of systems to work with people without judgement.
VirusOFF spoke with Denys Denysenko, Portfolio Lead for Eastern Europe and Central Asia at the Elton John AIDS Foundation, about why even the most advanced technologies do not work without trust, which services should not be seen as “additional”, what donors often underestimate about the role of community-led organizations, and why the funding crisis should become not only a threat, but also a reason to rethink the architecture of support itself.
Denys, you work with the Eastern Europe and Central Asia region. To put it directly: what do you see today as the most vulnerable link in HIV prevention in the region?
In short — trust.
More broadly, we now have almost all modern technologies and medicines. We have PrEP, and we have different service models: public clinics, non-governmental clinics, and community-friendly clinics. But none of this works without trust.
Without trust, without the feeling that you can come for a service and receive it with respect and without prejudice, the service itself loses its meaning.
We saw this, for example, in the experience of Ukrainians in Germany. There are high-quality healthcare services there, and in most cases they are free of charge. But people who fled the war and found themselves in a new system often do not know how to navigate it or how to get help. They come to doctors, face language barriers, and sometimes they are refused services without an interpreter — and this pushes them away from care.
As a result, the service seems to exist, but people do not use it. That is why the most vulnerable link is trust and respect for the person receiving the service.
Donors often assess project success through indicators, KPIs and spreadsheets. How can trust, the role of a peer counsellor and the role of communities be seen in this kind of logic?
Of course, not everything can be put into Excel spreadsheets, KPIs and indicators. But a lot can still be measured.
For example, there are index testing models, where one person, through motivation, psychological support and accompaniment, helps bring their partners, relatives, clients or other contacts to testing. These people are also counted in programme indicators.
But it is important to understand that such models work precisely because people trust each other. And they do not trust the system as an abstraction — they trust a specific person. The partnership is not built between a person and a system, but between one person and another.
This can be measured: how many people were referred, how many contacts were tested, how many people reached a social worker or a healthcare service. Today, with modern technologies, this can also be done anonymously — through an ID, phone number, crypto-code or other identifiers.
In HIV prevention, people often speak about tools: PrEP, PEP, harm reduction and testing. What needs to surround these tools so that they actually reach people?
They need to be surrounded by the very support services that are most often cut during crises. We are seeing this now in the context of the crisis linked to PEPFAR, USAID, the Global Fund and other funding sources.
Often the choice is framed as if there are medical services on one side and a social worker on the other — as if a lever needs to be moved in favour of one or the other.
But from our experience, even if a social worker does not have tests with them, if a person has reached a social worker, they are still highly likely to receive support. Because a social worker is about trust. They know where to refer someone, where to find tests, what services are available and how the healthcare infrastructure works.
If we cut the social worker, then even if medical services exist, a person may simply never reach them.
I often compare this to a bridge across a river with no road leading to it. The bridge exists, but if there is no road to it, no one will use it. It is the same here: we may have modern tests, prevention and treatment, but if people do not use them, they do not make a difference.
Which elements of prevention should not be treated as “additional”, even if they do not look like a classic medical service?
Today, especially in conditions of uncertainty, crises and wars, this is first and foremost mental health support.
In Ukraine, when the new wave of war began, HIV was often not people’s immediate priority. People needed to stabilize their mental health, find housing, food and safety. Health issues moved to the bottom of the list. That is why mental health support is becoming a very relevant part of prevention.
The second element is navigation. In situations of displacement, people enter a new environment and become disoriented: language, systems, documents, infrastructure, routes to support. Navigation also becomes an element of prevention, because if a person does not reach the service, they will not receive it.
And, of course, support for community-led organizations. They know their clients best, they are trusted most, and they understand people’s real needs. These elements cannot be excluded when we talk about financing prevention.
What do international partners often underestimate when they talk about the role of community-led organizations in the EECA region?
If we look at which budget lines are being cut, the logic is often this: medicines will remain, laboratory equipment will remain, and everything else will be reduced.
Advocacy projects? Not needed. The state will decide what is needed. But this is a major mistake.
The key principle is nothing for us without us. It is impossible to do something for communities or clients without listening to the people themselves.
This is why the role of community-led monitoring is growing. To improve a service, it must be assessed not only from inside the system, but also from the perspective of the client. But these are exactly the elements that are often cut.
The same applies to advocacy projects. The state rarely improves services on its own if it does not receive feedback from people. This can be called soft opposition, but people are not fighting against the authorities — they are fighting for their lives and their rights.
Legal barriers remain one of the key obstacles between the service and the person. Therefore, advocacy, community-led monitoring and projects that help improve service quality should not be cut — at least until we overcome the HIV epidemic in the region.
In our region, human rights, criminalization, stigma and political pressure directly affect HIV prevention. How can a donor support services in such an environment without shifting all risks onto local organizations and activists?
It is always a balance between what is realistic, what is necessary, what capacities communities have, whether there is political will or, on the contrary, resistance from the state.
For example, Ukraine and Moldova are now actively moving towards the European Union. The EU sets certain requirements, including in the areas of non-discrimination and respect for human rights. For Ukraine and Moldova, this creates a window of opportunity — for communities and for organizations that can promote the necessary changes.
Both countries have strong actors. Donors can support projects related to reforms, for example the transfer of healthcare in places of detention from the penitentiary system to the public healthcare sector. The experience of European countries shows that this can improve the quality of care.
Issues of decriminalization also remain urgent: HIV, drug use, sex work. In my view, Ukraine has long proved that it is a European country — through blood, effort and resistance. But in some areas, there is still not enough movement forward. Against this background, the persecution of people because of their status, because of sex work or because of digital forms of sexual services looks absolutely unacceptable.
Strong actors who can advocate and defend their rights are important here, as is the readiness of the state to move towards European standards, and donor support. International expertise, legal support, work on draft laws and by-laws are needed. This is especially important in Ukraine, where the country is at war, budgets are limited and international support remains extremely necessary.
We are speaking more and more about shrinking spaces and funding cuts. What mistakes should donors and international partners avoid in this context?
Many people are already sounding the alarm. Reports by WHO and UNAIDS show that funding cuts will primarily affect people’s lives. More broadly, they can undermine previous efforts, because systems take a long time to build and can be broken very quickly.
But any crisis is also an opportunity.
The question is how not to repeat old mistakes when building a new model. How can we make services as fast, anonymous and modern as possible, using technologies, artificial intelligence, the crypto industry and other tools?
We are already working with a number of innovative projects where a client can be encrypted through a crypto-code and receive a service anonymously and quickly.
We need to think about how to shorten bureaucratic chains as much as possible, including within donor systems. Sometimes criticism of international aid, however sharp it may be, contains a rational point: too much assistance remains in administrative costs, and too little reaches people.
The key question is how to make sure that support reaches a person as quickly as possible. From the person or institution that wants to help to the service itself, there should be a minimum number of intermediaries, while everything remains transparent and effective.
If we simply say, “There is less money, but we will continue doing everything the old way,” this will lead to the destruction of services. So we need to ask ourselves: what can we do differently?
We need to build a system with a new economy, new technologies and new business processes. For example, when a person receives a service and can immediately assess it through two or three questions, while the donor can see almost in real time whether their money is working for a specific client — even if the client is fully anonymized.
But support for community-led organizations must not be cut. They are closest to people and best able to formulate the needs that must be met in order to end the HIV epidemic.
Which solutions look most promising today for HIV prevention in the region? Innovation, community work, flexible financing, new partnerships — or all of these together?
There is no universal answer. What works in Ukraine may not work in Kazakhstan. What works in Kazakhstan may not work in Uzbekistan or Georgia, but may work well in Romania.
That is why it is important not to choose one model and say, “This solution should work everywhere.” It is important to build a chain that allows us to test, evaluate and scale what actually works.
We have an innovation fund where we test new solutions for specific countries. We have a replication fund, where working models are expanded to places where they are applicable. We have the Equity Challenge Fund, where we try to address structural barriers related to stigma, rights and access.
From our experience, index testing works, advocacy projects work, and models where communities defend their own interests work. There are projects with gamification and vending machines, where a person can receive PrEP, condoms, an HIV test or other services simply by using a card and minimizing contact with a system where they may face stigma or discrimination.
There are also projects using artificial intelligence. For example, in Kazakhstan, an approach is being tested where a smartphone can assess, through the retina and face, a person’s level of depression and the state in which they may interrupt therapy. A signal is then sent to a doctor or social worker so that they can contact the client and prevent treatment interruption.
There is community-led monitoring, where data received from communities is integrated into a central database so that decisions are made based on client feedback.
There are no universal solutions. It is important to create a chain in which models that truly work remain and continue to be funded.
AIDS 2026 is taking place under the theme Rethink. Rebuild. Rise. If we apply this to HIV prevention financing in our region, what needs to be rethought, what needs to be rebuilt and what should become stronger?
Rethink is definitely about the model of financing and involving clients in programmes and services.
Organizations often work with the communities they have already reached and gradually try to expand coverage. But the community is much wider than the current clients of an organization. We need to rethink approaches to engaging new people.
Modern technologies, smartphones and access to information are already being used by business. Business understands what a person is searching for, what they need, and gently offers relevant products. Why can we not offer testing, social services or psychological support in the same way? People are already searching on Google for what they need. We need to understand these requests better and respond to them.
Rethink means revisiting approaches to reaching new clients so that we can truly move towards the 95–95–95 targets.
Rebuild means rebuilding the financing chain so that support reaches the client as much as possible. From the willingness to help to the actual assistance, there should be a minimum number of bureaucratic steps, while everything remains transparent, open and understandable.
Standard prevention programmes also need to be rebuilt. Drug scenes are changing, new substances are appearing, behaviours are changing, and communication channels are changing. We need to include modern technologies, social media, TikTok — the spaces where young people receive information and where culture is shaped.
We need to rebuild decision-making systems so that they are based on data, not on the habit of doing things the way we have always done them.
I often recall the joke about a man looking for his keys under a streetlight. He is asked, “Where did you lose them?” He replies, “Over there, in the dark corner.” “Then why are you looking here?” — “Because there is light here.”
We often do the same. We keep looking where there is light, where everything is familiar, where programmes and trained social workers already exist. But clients may be waiting for us where it is dark. That is why we need to look for new pathways and rebuild the system of engagement.
What key message from the EECA region would you like the international audience to hear during AIDS 2026?
It is important to defend community-led organizations. The principle of “nothing for us without us” matters not only as a slogan. It matters in its essence.
Decisions cannot be made on behalf of people for whom these decisions are a matter of life. That is why community-led organizations must continue to receive support.
It is also important to move beyond the boundaries of our own sector. Previously, we had a familiar model: USAID, PEPFAR, a certain number of intermediaries, and final organizations delivering services in countries. But the world is changing. New technologies, new economic sectors and new sources of financing are emerging.
We need to move beyond traditional donor funding and look towards the corporate sector, private donations, private donors and new financial instruments. For example, how many organizations in the region today have crypto wallets on their websites for donations? Most likely, very few. But this is already a large donation market.
During the war, we saw major donations coming in cryptocurrency. This is a new market, and we need to look at it too.
We need to move beyond the expert NGO bubble and look more broadly — at technologies, new approaches and new sources of financing. We should not be afraid to unite and, in some cases, set aside our own ambitions. Sometimes it is better for two or three organizations to unite into one with strong potential than to compete with each other for a small piece of funding.
Let us finish this sentence: HIV prevention in the region will not work if…
HIV prevention in the region will not work if there is no access to the people who need this prevention.
