A VirusOFF interview with Ruslan Poverga on HIV prevention after AIDS 2026, access to innovations, the role of communities and lessons from Moldova for Eastern Europe and Central Asia.
As part of VirusOFF’s information campaign “From Rio to Geneva: HIV Prevention Choice, Access and Mobility in Practice”, we explore how global discussions about HIV prevention choice, access to services, mobility and the role of communities translate into practice in Eastern Europe and Central Asia (EECA). In Rio, the global discussion about HIV prevention increasingly centred on choice, access and sustainability. But for countries in the region, the main question remains practical: how can new tools, digital solutions and community-based services actually reach people — especially those who face the greatest difficulties accessing support through the formal system?
VirusOFF discussed these issues with Ruslan Poverga, head of Inițiativa Pozitivă in Moldova. The conversation was not about conference slogans, but about what happens between the emergence of an innovation and real access to it: where communities lose momentum, why service quality must not be sacrificed in the name of “optimization”, and what message the region can bring to IAS 2027 in Geneva.
Ruslan, you attended AIDS 2026 in Rio and took part in various sessions and meetings. What was the main message you brought back for Moldova and for Eastern Europe and Central Asia?
Ruslan: I had mixed feelings. On the one hand, it seems that we have achieved a certain degree of success: overall, things are not bad. Of course, there are still issues that need attention, but the overall picture no longer looks catastrophic. And this state of affairs — “things are not bad” — can become the enemy of something better.
I have attended similar conferences before, and there used to be a spark: initiative, interest, ambition and heated discussions. Now I feel that something of that is being lost, particularly when it comes to communities, which have always been the driving force behind these processes. I think we are losing that fuel.
At the same time, there is a lot to be encouraged by. We live in a world of technology, and many opportunities are already within reach: digital solutions, innovations, community-based clinics and new pharmaceutical technologies — tests, medicines and various tools. That is certainly encouraging.
I put it this way: there is motivation and there are opportunities, and when they come together, results follow. Today there are more opportunities, but motivation and the driving force seem to be weakening. So, for me, the challenge is how to ensure that communities remain a driving force. And I am not speaking only about the conventional understanding of communities. The question is how to renew the community movement and take the dialogue among communities, experts and donors to another level. We cannot live in yesterday and expect to achieve new results. Even technological solutions will not help, or will help only very slowly, unless we return to this formula — but in an updated form.
You mentioned digital solutions and new prevention tools. What is needed for these to be put into practice in Moldova and the region and become genuinely accessible to people?
Ruslan: When new solutions emerge around the world, they have to go through a whole sequence of bureaucratic processes before they become accessible to those who need them: discussions, decisions and political will. When it comes to medicines, they need to be registered, procured and integrated into the system. These processes will slow down access.
A solution has emerged, people need it — and we need to speed up the journey. We need to be able to identify quickly: here is a tool, this is where it is needed, these are the people who need it, and access must be ensured. In the past, the discussion was simpler and more forceful: provide treatment, give people medicines, stop relying on donor funding to procure them, and start using government funds, because this is a matter of sustainability and people’s lives.
Now, when we talk about long-acting medicines, for example, a different risk emerges. The system may say: “Well, things are not so bad as they are. Let’s see, let’s wait.” And this is where the main question lies: how do we get past the series of barriers when a bureaucratic government system, guided by its own ideas of what is good and bad, slows down access to something people already need?
International funding is shrinking. What breaks down first when organizations, especially community-based organizations, lose resources?
Ruslan: The first things at risk are the quality and accessibility of services. When donor funding is reduced, unless the transition has been prepared in advance, we risk losing what actually works: people’s trust, access to the most vulnerable groups, professional expertise and the quality of care. The task is not simply to replace one source of funding with another, but to preserve service quality and scale.
Sometimes we hear suggestions such as: why not have addiction treatment services provide harm reduction? And then the question arises: what has changed? Why were they not doing this before? What makes us think they can now provide the same level of access? It is easier for the state to fund a state institution, but that does not mean the service will become more accessible to people.
Harm reduction programmes should be delivered where there is genuine access to people, community trust and the necessary professional expertise. For us, preserving and developing community-based services while building effective cooperation with public medical and social services is fundamental. The same applies to community-based PrEP: what matters is not only that a service exists, but also its ability to reach those who need it.
Which services must be protected even when funding is being reduced?
Ruslan: We must protect services that work with people who find it hardest to reach the system. This is not only conventional harm reduction. It also includes care, support and helping people maintain adherence to antiretroviral therapy.
I do not support a one-size-fits-all approach in which every person living with HIV automatically needs long-term, intensive support. After diagnosis, it is important to help someone overcome internalized stigma, establish treatment adherence and feel supported. At the same time, many people living with HIV are independent: good medical care, accessible information or digital tools are enough for them. The intensity of support should be determined by each person’s actual needs.
But there are people facing multiple vulnerabilities: people with emotional health needs, people living in rural areas, those experiencing social isolation or those who do not fully understand their diagnosis. They need much more attentive support. Sometimes case support means more than a consultation or referral: it means staying in touch, helping a person continue treatment when they move or face difficulties in life, and finding safe and confidential ways to provide assistance.
People facing multiple vulnerabilities must remain visible to those who are ready to seek them out, find them and fight to make sure they receive help.
What does Inițiativa Pozitivă do to turn prevention and treatment from services that are formally available into real support for an individual?
Ruslan: We try to think in terms of programmes rather than projects. We understand that someone may face multiple vulnerabilities. Unless we take them into account, even the most essential prevention tools may not be enough. Condoms, syringes and testing remain extremely important, but they may not be a person’s priority if they are living on the street, have been struggling with depression for years or have nothing to eat. We have to look at the whole picture.
You cannot simply say: go to social services, they will help you there, and we will give you some syringes as well. It is the same for people living with HIV. What use is a pill on its own if someone cannot get out of a crisis, has no food to bring home to their children, is dealing with court cases, debts, documentation problems and mental exhaustion?
That is why we support comprehensive assistance and integrated approaches. Everyone says they are client-centred. But true client-centredness means looking at a person and understanding that their priorities may be completely different from what is convenient for you. If you fail to consider their real needs, you will put in a great deal of effort and achieve very little.
We try to work as comprehensively as possible: from conventional harm reduction to psychosocial support, legal assistance, support for economic stability, opportunities for personal development and employment, and, when someone needs rehabilitation, assistance in that area too.
We opened a clinic because we realized that simply referring someone to a public clinic is not enough. Even if free care is available there, people may never make it. You have to seize the moment: someone has come to you, they have placed their trust in you, a small spark of motivation has appeared — so the issue needs to be addressed here and now. If we truly believe that a person’s life matters and understand that vulnerabilities cause people to get lost along pathways to care, then we have to invest in the individual case. And even if we set the humanitarian argument aside, the public health argument remains. That is enough for us to really dig into a case and look for every possible way to help.
What successful experiences can Moldova share with the EECA region? And what lessons or warnings can it offer?
Ruslan: Historically, Ukraine was very advanced and knew how to showcase its work. Moldova was advanced too, but we were often more modest and spoke less about our experience. Yet we have plenty to show.
Government funding for harm reduction services is already developing in Moldova, and the task is to ensure a sustainable transition to national financing mechanisms by 2030. The state contributes to the provision of antiretroviral therapy; there has also been notable progress in access to hepatitis treatment, including within the prison system. Some harm reduction measures and opioid agonist maintenance therapy programmes operate in correctional institutions. But it is important to evaluate not only whether programmes exist, but also their actual coverage and continuity of care.
One of the important achievements in recent years has been community-led monitoring. That is what we call it now, but in essence it has always existed. It has simply become more structured, systematic and understandable. In Moldova, we have built a very strong community-led monitoring cycle: communities identify priorities, monitoring sites and tools, collect data, draw conclusions from those data, set advocacy goals and achieve changes. It is a spiral process that brings about change.
We have also made progress with digital solutions. Service registration systems generate substantial datasets on the assistance provided and clients’ needs. Subject to confidentiality, consent and personal data protection requirements, this information can help analyse risks, plan support and develop electronic case management. When a social worker is responsible for 300 people, they need tools that allow them to identify a need for additional support in time. Artificial intelligence should strengthen a professional’s judgement, not replace it.
But there are lessons too. A certain divide has emerged between government services, traditional civil society and communities. At some point, misunderstandings pulled apart three powerful components that ought to be working together if the situation is to continue improving.
Another lesson concerns community-led monitoring and advocacy. It is important to ensure the independence of monitoring, transparency in decision-making and the management of potential conflicts of interest. We experience this difficulty ourselves: we both provide services and engage in advocacy. Sometimes it is hard to have a critical dialogue with the same institution with which you are discussing funding for services. That does not mean service providers should withdraw from advocacy; rather, clear rules, roles and mechanisms for independent evaluation are needed.
Looking ahead to IAS 2027 in Geneva, what message should Moldova and the EECA region bring to the global stage?
Ruslan: Our aim is to arrive with concrete results. First and foremost, we want to present a new model for community development. Today it is no longer enough for a handful of activists to represent thousands of people for years on end. We need mechanisms for continuous feedback, transparent decision-making, accountability and the involvement of new participants. Communities must do more than speak on people’s behalf: they must ensure their meaningful participation in decision-making.
We are working on a coalition model in which communities join forces not only for advocacy, but also to create accessible care infrastructure — above all, community-based medical and medical-social centres. The experience of our clinic shows how important it is for a person to be able to receive comprehensive care in a place where they are trusted and where they trust the professionals. The next task is to understand how we can develop this model together with partners from other countries.
The second area is accelerating access to innovations. Today, years can pass between the emergence of a new solution and its availability to an individual. We want to build mechanisms that shorten that journey by bringing together community needs, expert knowledge, the practical experience of medical centres and engagement with government systems. By the next conference, we hope to present the first pilots and preliminary results of this work.
The third area is digital transformation. We are exploring the possibility of creating digital twins of organizations and projects and, eventually, digital models of patient support. Such tools could help us better understand people’s needs, anticipate risks, plan resources and improve service efficiency. In international cooperation, it is especially important that digital systems can interact securely without violating national data protection requirements. Among other things, we are considering federated learning technologies that enable organizations to draw on shared experience without transferring the underlying personal data between them.
And finally, artificial intelligence. We want to move towards a model of collective AI grounded in the knowledge and practical experience of communities and professionals. This would not be a system that makes decisions instead of people, but a tool that helps them make better-informed decisions, with transparent rules, human oversight and data protection built in from the outset.
For me, all of these are parts of one task: bringing together renewed communities, accessible services and modern technologies in a way that genuinely improves people’s lives. These are the practical solutions, rather than just new concepts, that we would like to bring to Geneva.