During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series of materials on what HIV prevention looks like today in Central and Eastern Europe and Central Asia. We spoke with Dmytro Tygach, Director of Policy and Advocacy at the charitable organisation 100% LIFE, about what is currently putting HIV prevention in Ukraine most at risk, why civil society remains a driver of change, what risks funding cuts create and what it means to truly integrate prevention into public policy.
Dmytro, speaking directly, what is currently the biggest threat to HIV prevention in Ukraine, especially among key communities?
The biggest threat is that prevention programmes are still mostly purchased with donor funding. That is the first issue. The second is that these programmes are not integrated into the state budget as a national priority.
We at 100% LIFE will work to strengthen the capacity of state procurement within the Global Fund framework, so that the state can purchase everything needed for prevention. But for now, this is still a donor-funded story that has not been integrated into the budget.
Another important aspect is drug policy. In Ukraine, it still has not been properly addressed. Regions generally do not fully understand how to engage in financing prevention programmes. There are individual examples that we are trying to scale up, but this is not yet working systematically.
The main problem is money and the integration of prevention into the state system. Because when it appears in the budget, when national funding is allocated for the procurement of condoms, lubricants, syringes, needles, wipes and other materials, the country officially recognises that it is working on HIV prevention and with the communities for whom these services are needed.
The task for the next three years is exactly this: to integrate this system so that it truly works. Unfortunately, community organisations do not always have enough strength and resources to advocate for such decisions at the highest level. But without this transition, prevention will remain vulnerable.
Where do you see the biggest gap between what Ukraine declares in its HIV response and what a person actually receives on the ground?
In fact, Ukraine has done a lot. For a post-Soviet country that is not an EU member state, what we have built is a major achievement. We have programmes at the state level, although resources often come through donors. Methadone is being procured, opioid agonist therapy sites are developing, services are available in every region and community organisations work in every oblast.
We have built a large service and prevention system. Now the final leap is drug policy and the transition from donor funding to state funding.
So we declare many of the right things. But the main barrier that needs to be addressed is the integration of prevention into the state budget and public policy. Without this, the system will always depend on external decisions and external money.
Ukraine has extensive experience of the patient movement and community movement. Are we now at risk of losing this capital because of funding cuts and bureaucracy?
There is a serious gap here.
Civil society in Ukraine has played a key role in healthcare reform, drug policy reform, the creation of programmes and, more broadly, in driving change. Many reforms in Ukraine would not have happened without civil society.
But there are risks. The first serious signal was the closure of some programmes and funding cuts. This is a risk of political misunderstanding, a risk that programmes can be closed unilaterally — without consultation and without an understanding of how to preserve the sustainability of services.
Donors do not always take into account the strength and power of the civil society movement in their programmes. Often, the focus is on service programmes, state institutions and the role of officials. But in Ukraine, there have been repeated cases where indicators assigned to state structures in the healthcare or social support systems were not achieved. At the same time, civil society has constantly set the direction of change.
During the war, this is even more evident. Civil society continues to work as a powerful driver of reforms and response. And in my view, we have still managed to preserve the strength of civil society and its influence on key programmes, so that they develop in the right direction.
Does Ukraine have a mature partnership between the state, civil society and donors? Or do we more often see a situation where each actor is trying to save its own part of the system?
It is not possible to generalise about the entire system. But I can say that today we have one of the ministers of health who has been most open to civil society in many years. Whatever concerns may exist, we have a minister who listens to civil society, understands its strength and understands what accountability to it means.
At the same time, at other levels of the state system, the picture is not so positive. There are many problems that still have not been resolved. These include, for example, the drug strategy and the laboratory strategy. They directly affect prevention.
Ukraine still does not have a full-fledged laboratory strategy. For us, it is important that it provides for an open market for private laboratories that can be involved in the process: they often have lower prices, better speed, good logistics and high-quality results. Where the state has a complete monopoly, this often becomes a problem area.
Overall, Ukraine has both major gaps and very significant achievements. The fact that civil society has a voice and influence today is not accidental. It is the result of many years of work.
What most often falls out of the official language on prevention when we talk about key communities?
For me, the central issue is drug policy.
Whatever prevention looks like, when we talk about people who use drugs, we have to see the full complexity of this issue. This is one of the key communities that directly affects the dynamics of the epidemic. And the needs here are multidimensional: it is not only about syringes or needles. It is psychological counselling, testing, social support, work with close networks, access to treatment and support.
If we look more broadly, many European countries have long been moving towards decriminalising certain aspects of drug policy. This is not about ignoring the problem. It is about ensuring that the state does not break a person through criminalisation where support, rehabilitation and access to health are needed.
When a person is criminalised for small amounts of substances, this places a burden on the budget, destroys the person and does not solve the issue of drug use. A person should have a choice — rehabilitation, support and an opportunity to improve their health.
We can see that many countries have had different approaches for a long time. Ukraine has taken an important step by legalising medical cannabis. This is a major breakthrough for the post-Soviet space, and the state would not have done this on its own if civil society had not pushed for it.
For me, this is a very personal issue. During the war, there was a period when medical cannabis helped me maintain my emotional state, reduce tension and avoid breaking down. I respond poorly to antidepressants and sedatives — I can have the opposite effect. But at that time, I could not simply go and legally buy medical cannabis in a pharmacy. By the time I had stopped using it, it had only just been legalised.
The state does not always think in terms of people’s real lives. But it is through changes like this that we gradually move from stigma to policies based on health, rights and common sense.
There is now a lot of discussion about new prevention technologies, including long-acting PrEP. What needs to happen so that innovations do not become a privilege for those who are already closer to the system?
I will put it briefly: such tools must be available to everyone who needs them.
If a person has an increased need for HIV prevention, they should have access to modern methods. And the less often a person needs to go to a medical facility, the simpler and longer-acting the format is, the more strongly I support its integration.
It is like technologies in other fields. At one time there were only petrol or diesel cars, and now more and more people are switching to electric cars because it is simpler, cheaper and more convenient. Technology is developing.
Prevention and treatment should develop in the same way. If tools appear that reduce the burden on a person and make access simpler and more convenient, they should be integrated into the system.
If donor funding decreases even further, which elements of the HIV response must not be lost?
There are two points here.
On the one hand, science is moving forward, and we all hope that over time there will be solutions that radically change HIV treatment and the very logic of the response to the epidemic. If such solutions become real and accessible, this will force us to rethink many programmes.
On the other hand, even if medical technologies change, questions of behaviour, stigma, sexual health, drug use, mental health, access to services and work with society do not disappear.
We cannot look at HIV in isolation. When a person uses a condom, we are not speaking only about HIV, but also about other sexually transmitted infections and sexual health more broadly. When we talk about programmes for LGBTIQ+ communities, not everything there is tied only to HIV either — there are other issues that also need to be addressed. When we talk about people who use drugs, we are not speaking only about HIV transmission, but also about the broader impact of drug use on a person’s health and social life.
This is why programmes need to be rebuilt so that they reflect people’s real lives. Because our goal is not for programmes simply to exist and absorb money. Our goal is for HIV not to kill people, for HIV to stop being a tragedy and for people to receive real support where they need it.
The theme of AIDS 2026 is Rethink. Rebuild. Rise. If we apply it to Ukraine, what do we need to rethink, what do we need to rebuild and where do we need to become stronger?
I connect this with the previous thought.
If we are talking about the future, we need to rethink the programmes that exist today. The world is changing, technologies are changing and approaches to treatment and prevention are changing. We need to think now about which programmes will be needed tomorrow and which ones need to change.
We need to rebuild programmes so that they are not tied only to one topic or one disease. Issues related to behaviours that can increase HIV exposure, sexual health, drug use, mental health, stigma and social rejection will not disappear. The emphasis may simply change.
It is similar to how hepatitis C treatment once changed: before, there were difficult regimens, interferon and severe side effects. Now a person can complete a course of treatment and return to life. Breakthroughs like this change the system. And we need to be ready for the fact that approaches in HIV will also need to be rebuilt.
We need to become stronger in not holding on to programmes simply because they are familiar or because they are funded. Unfortunately, both in the state and non-state sectors, there is sometimes a temptation to attach oneself to money. But the task is not to maintain the system for the sake of the system. The task is for people not to die, for them to have access to health and for prevention to correspond to their real lives.
To complete the sentence: HIV prevention in Ukraine and in our region will only work when…
…when we, as a society, fully understand that people who need prevention often suffer not only from medical problems, but also from social rejection.
Many people still do not see a person who uses drugs as someone with problems that should be addressed through support and health. Many still do not accept people who have a different sexual orientation or identity. All of this creates barriers.
When society changes, a demand emerges for the state. We have already changed enormously. But this is a complex process: changing social attitudes, modern drug policy, transition to state funding and the real integration of prevention into the system.
Only then does this become an issue that the state truly has to address.
