As part of the regional information and advocacy campaign “EECA Voices at AIDS 2026”, implemented by VirusOFF with the support of the UNAIDS EECA and Asia-Pacific Office, we are speaking with experts, activists and community representatives about the future of HIV prevention in Eastern Europe and Central Asia.
One of the key themes of the campaign is the community-led HIV response in the context of crisis, migration, shrinking civic space and unstable funding. For people from key communities, the formal availability of services does not always mean real access. Fear, stigma, discrimination, criminalization and unsafe environments often stand in the way of prevention, testing, treatment and support.
VirusOFF spoke with Lyubov Vorontsova, Community Engagement and Advocacy Adviser at the Eurasian Women’s Network on AIDS (EWNA) and a representative of the Rise & Decriminalize campaign, about why decriminalization is part of an effective HIV response, what role community organizations play, and what message should be heard from the EECA region at AIDS 2026.
Lyuba, we already spoke with you about Rise & Decriminalize in 2024 — right after the campaign was launched and during the press conference. At that time, it felt like a very important advocacy start. How would you describe Rise & Decriminalize today? What has changed since the launch, and why does decriminalization remain so critical for the EECA region?
Rise & Decriminalize is a space where we discuss news affecting all key populations. It is a space where we talk about criminalization, about our communities and about everything that affects their safety, rights and access to services.
Over the past year, we have strengthened the component focused on the criminalization of civil society activists in our region. This is especially important given the increasing control over foreign funding in many countries.
We have also launched a monitoring system and prepared the first regional report on shrinking civic space. In this report, we describe the processes currently taking place in the region. Based on the monitoring results, we see that civic space continues to shrink.
If we look at the political context, pressure is affecting media organizations, human rights organizations and, alongside them, organizations protecting the rights of LGBTIQ+ communities, women, sex workers and other communities facing marginalization and vulnerability.
We see organizations changing the way they work in order to reduce risks. Organizations that previously registered openly as organizations supporting people living with HIV, women, feminist organizations or LGBTIQ+ organizations are now changing their profiles. Over the past two years, we have seen a lot of self-censorship in public reporting because people and organizations feel unsafe.
But despite this pressure, communities continue to work. They come together in coalitions, continue to document human rights violations and remain visible on international and regional platforms. Sometimes we speak with each other’s voices, because it is unsafe for some people to speak. But we still speak, and that is important.
This is the strength of coalitions and of movements such as Rise & Decriminalize: sometimes we can become each other’s voice.
How does the shrinking of civic space affect HIV prevention, testing and access to services?
There are direct examples, such as the criminalization of sex work or the criminalization affecting LGBTIQ+ communities. In such conditions, it becomes impossible to create information spaces and communication channels or to share information. And we know that information is a very important part of prevention.
Naturally, we cannot talk about sustainability through state budgets if state budgets cannot support something that is prohibited by law in a country. In such conditions, we cannot talk about transition or about transferring service funding from the Global Fund to the state. There can simply be no real sustainability in this situation.
The second issue is the shrinking opportunity to receive international funding. This immediately raises questions about human rights services and community-led monitoring. If we receive funding from the same source whose services we are supposed to monitor and provide feedback on, that is a conflict of interest.
We are part of civil society. We are not just part of the health system. Any civil society needs space to express its position and defend rights. In our countries, it is almost impossible to organize peaceful assemblies or direct action. We cannot do this now, and yet this is also an important part of our work.
There are financial issues as well. Sometimes it is unsafe simply to receive money. Even when an organization wants to support us, we are not always able to receive funding. For example, serious difficulties are already emerging in Georgia.
Why does safety remain the first barrier for women, sex workers, women who use drugs, women living with HIV and other key communities — even before they can access any services?
The groups you listed are, in most cases, people who have either already experienced violence or are currently in situations of violence. Violence, discrimination, stigmatization and criminalization are all parts of the same process. And this is a major barrier to accessing services.
To give an example, we conducted a study monitoring different forms of violence. More than half of the women living with HIV who participated in the study and were in situations of violence said that the violence began after they were diagnosed. In other words, more than 50% of women reported that situations of violence happened to them to a greater extent after they learned their HIV status.
LGBTIQ+ communities, including transgender people and trans communities, are people who face a high risk of violence every day in our countries.
That is why sometimes double efforts are needed — and if we speak about intersectionality, sometimes triple efforts — to access services. If I am a woman, if I use drugs, if I sometimes do sex work, if I live with HIV, how much harder will it be for me to access services compared with a socialized cisgender heterosexual man? Much harder.
That is why this remains a question of access to healthcare. In terms of medicine itself, things are now more or less in place: we have medicines, we have tests. We have managed that. Now we need people to reach these services. And that is the main question.
Do community-based organizations and peer counsellors remain the first entry point to services? Or do healthcare institutions now inspire more trust than they did, for example, five years ago?
They remain the first entry point. And they will always remain so. Community organizations will always be first in prevention and testing. Treatment may remain a medical issue. In some cases, PrEP may also partially move to the community level. But initial access will always be more effective through communities.
Even in countries with low levels of criminalization, there are community centres, drop-in centres and safer-use spaces. These will always remain important services.
Communities will always be the first entry point into services because communities facing marginalization are part of society. They have always existed and will continue to exist. This is not good or bad — it is simply a reality. Sex work existed long before us and will continue to exist after us. Drug use may one day transform into something else, but certainly not in the near future.
Even when the level of the HIV epidemic becomes low, even when we are finally able to significantly reduce new HIV infections, we will still need communities to sustain this progress.
Right now, communities are needed in order to begin doing something about the HIV epidemic in Eastern Europe and Central Asia. In conditions of criminalization, people move deeper and further away from services, and only communities can reach them.
Against the backdrop of war in our region, instability and reductions in donor funding, which services must remain continuously supported and sustainably funded so that people do not fall out of the system?
Treatment, prevention and testing must always be funded. This is not even up for discussion.
We are now facing the question of prevention: how to provide it and how to implement it. This is where sustainable funding for community systems becomes extremely important.
How to do this is, for me, a question of transformation. Yes, receiving state funding for prevention and testing for communities is not a bad thing. We have countries that are achieving significant success in this area and working with the state. This is also one way to change the state’s perception of our work.
If we have never worked with state funding, how can the state see our effectiveness and understand that we are an important part of the response to the epidemic? Only through cooperation, through working together, through making mistakes and learning from them.
In this sense, the withdrawal of the Global Fund is both negative and not only negative. This is our reality. This is what we will all now have to deal with.
But the second point, which I have already mentioned, is that sustainability is impossible without safety. Without safety and without respect for human rights. If human rights are not respected, if basic political and social rights are not realized, we cannot talk about sustainable HIV treatment, prevention and testing services.
What do international donors and partners often underestimate when they talk about the sustainability of HIV services in our region?
Exactly what I have just said: sustainability is impossible without safe civic space and strong community organizations. It is impossible.
If we are talking about transitioning from Global Fund financing to state financing, we cannot do this without strengthening civil society. First, we need to make sure that a country is left with truly strong civil society that is able to work and is safe to work.
If activists are under pressure, if we have no opportunity to work, then even if money is invested in community sustainability, it will not work.
First come human rights. Then come sustainable community systems: strong national organizations, strong regional organizations, strong local organizations that have the capacity to deliver all these services. Only then can we talk about sustainability.
Sustainability based only on state services is impossible. Who will provide feedback to the state? We would end up in a monopoly situation, and then we would probably not be able to talk about service quality or about ending the epidemic.
What experience from the Rise & Decriminalize campaign may be important for other regions of the world where criminalization and stigma still block access to HIV services?
One of the main lessons is that the fight against criminalization requires unity and coalition-building.
There are several factors here. First, increasing pressure. Second, the need to come together in coalitions in order to use resources effectively, especially because there are not many resources now. And, of course, intersectionality.
If a person has several behavioural characteristics, diagnoses, dependencies or identities, it is impossible to solve the problem by decriminalizing only one thing — for example, HIV transmission or sex work. The problem of access and respect for human rights will not be solved in this way.
Another important experience is monitoring and documenting violations — what we call “name and shame”. We speak about what is happening, and that is very important.
We also have good experience of working with various international human rights mechanisms. Sometimes national advocacy is unsafe, and then it is possible to use different UN treaty body committees and other international mechanisms.
We can be each other’s voice and use international mechanisms when it is unsafe for someone to speak inside their own country.
What should be heard from communities in our region at AIDS 2026 — about decriminalization, access to services and the role of communities?
The main message is very simple: we will not be able to end the HIV epidemic in conditions of criminalization.
As long as people continue to face criminal prosecution for who they are, how they live or what medical services they receive, we will not be able to end the epidemic.
Decriminalization must be part of a public health strategy.
We see, for example, that the new Political Declaration does not mention decriminalization at all. But without this, it is impossible to move forward.
And if we speak about community organizations, we should not be seen as contractors simply carrying out a technical assignment. We must be equal partners.
We know our needs better. We know what is happening. And we are able to ensure access to medical services through a human rights lens. That is when the response will be sustainable.
