Ahead of AIDS 2026 and as part of the Rethink. Rebuild. Rise. (#RethinkRebuildRise) campaign, VirusOFF is preparing a series of articles on what HIV prevention looks like today in Eastern Europe and Central Asia — in the context of migration, stigma, unstable funding, war and unequal access to services.
One of the key themes of this series is access to HIV prevention, treatment and support for Ukrainian refugees in host countries. In Poland, this is not only about whether services exist. It is also about trust, language, documents, fear of stigma, financial instability, psychological exhaustion and a person’s ability to navigate a new system. This is where community-led organizations and peer counsellors play a particularly important role, helping people avoid being left alone with the system.
We spoke with Anna Ariabinska, President of HelpNowHUB Fundacja, about these practical challenges. The conversation covers what has changed for Ukrainians in Poland since 2022, what requests peer counsellors most often receive, why simply giving someone the address of a clinic is not enough without support and trust, how migration increases barriers for women and what questions the region should bring to AIDS 2026 in Rio.
In practical terms, what does HIV prevention and access to related services look like today for Ukrainian refugees in Poland? What has changed in recent years?
There have been changes over these years. We can say that there have been some positive developments, but I would like to start with the beginning: in early 2022, there was chaos.
People who were leaving did not know whether they would be able to continue treatment somewhere else; whether, if they disclosed their status, they would be deported; whether they would receive shelter; how this would affect their lives and the lives of their children; whether they would have to pay; or whether services would be free. This whole set of questions put enormous pressure on people and added psychological strain on top of the war and the experiences we were already carrying with us.
Today the situation has improved, but, as always, it is not ideal.
In Poland, as refugees or people under temporary protection, we effectively do not have full access to pre-exposure prophylaxis or post-exposure prophylaxis. Post-exposure prophylaxis can be accessed free of charge only by representatives of certain professions. In other cases, if I apply as an individual, I need to prove that I need it. Doing this within 72 hours is extremely difficult: documents have to be added, or a doctor has to assess the situation as dangerous and prescribe post-exposure prophylaxis.
Ukrainian refugees do not have open access to pre-exposure prophylaxis. Even for Polish citizens, access to pre-exposure prophylaxis is very limited — in practice, primarily for men who have sex with men. This is also very unfortunate and is an important advocacy issue, both in Poland in general and specifically for migrants.
I believe that access to the full cascade of treatment, prevention and post-exposure therapy should not depend on migration status, regularization or health insurance.
At the same time, it is important that prevention services have stopped being completely invisible to refugees. Community organizations have emerged, including organizations created by refugees themselves. We communicate information in plain language: where people can get tested, where testing is free and during which hours.
We also “go to people”: we attend events where migrants gather, or we create such events ourselves and invite people to get tested. For example, last year we took part quite extensively in an NGO picnic in Bydgoszcz, and 74 tests were carried out in one day. It was a completely open activity, and people were not afraid to overcome their internal barriers thanks to the work of our counsellors and the trust in the community.
What requests do HelpNowHUB peer counsellors most often work with? Are they mostly about treatment, social issues, documents, status, psychological support — or all of these together?
In reality, it is all of these together. This is a key feature of working with migrants. A person never comes to us only with the request: “give me an address” or “give me an opportunity to receive treatment”. It is always a complex set of problems.
Approximately 40% of requests are about navigation: explaining in clear language where, what and how something can be done.
Around 30% relate to social issues: regularization, access to health insurance and access to services. Of course, there is the stigma we brought with us and our quite negative previous experience, which prevents people from moving forward.
The most important thing is fear. A person always keeps in mind the possibility of deportation or is afraid that, because of not knowing the system, they may do something that seemed legal in their country but here may be against the law or lead to administrative liability. Every request is stressful.
Another large share of requests relates to psychological support. Our psychologists are completely overloaded right now because the waiting list is very long. There are requests for stabilization, psychological support, work on bullying, finding support points and stabilizing this suspended state.
Legislation is changing in the countries that accepted us under protection, and a person becomes stuck: what should they do? They may be unable to regularize their status or may decide to return home because they cannot continue treatment here. This is a very difficult stage, and without psychological support people make poorly weighed decisions about their health. Unfortunately, health and stability suffer the most. Financial stability also leaves much to be desired.
You work a lot with Ukrainian women and people in vulnerable situations. Which barriers remain especially visible?
All these problems exist, but the main difficulty is that they are always interconnected. We cannot identify one general problem, because for one person the most important issue may be lack of time, for another it may be work, the number of children or a language they do not understand.
Even if a person already speaks conversational Polish, the language used in state institutions or medical facilities is not always clear even to officials themselves. They very often get confused in how to interpret different decisions or regulations. If a person comes in with internalized stigma as well, they may not understand what to do at all, and it becomes easier simply to leave.
First of all, there is financial instability and unstable legal status, which is very closely connected to access to medical services.
We see that among refugees in Poland and other countries, the majority are women with children. A woman has now become the support system — financially, psychologically and materially. She is the only one who has to solve bureaucratic issues and sign permissions for children. And if she is simply told, “Here is the address, go and receive treatment,” that is not support. It is only an additional burden: “Oh, I have not taken care of my health either — and not only my own health.”
If a woman left with a partner, another important factor may be domestic violence, fear of experiencing it, fear of being rejected or being left alone in an unfamiliar country without social contacts or support from relatives, friends or parents.
We have lost a lot of social capital. Even if we have been here for several years, we have not yet built enough of it to be able to trust someone with very intimate issues.
Even within our own communities, when Ukrainian women gather with other Ukrainian women, there may be fear of talking about one’s status. A person immediately encounters myths and their own painful stigma: if I am living with HIV, then I must be “not respectable”, then “God punished me” or something similar.
Migration highlights many of these factors. It is difficult here. Even if a person had a tolerant attitude towards different issues in their own country, when they are in a migration situation and are experiencing many hardships themselves, the sense of injustice and of not being understood becomes much sharper.
And, of course, there is post-traumatic stress disorder and fear of seeing psychiatrists. Psychologists are currently unable to cope with the full volume of need, and people cannot go through this alone. Previously, we somehow coped with stress, considered it normal and moved on. Now there is neither time nor opportunity for such recovery. People need to seek support from specialists.
What is especially important to consider when we talk about HIV prevention for women in migration? Why is it not enough to say “see a doctor”?
Poland is a particular context. There are many issues related to sexual and reproductive health. Even if a woman comes for a consultation with a gynaecologist, there is no guarantee that the doctor will be tolerant, will listen or will offer an HIV test as part of a general appointment without presenting it as something negative.
There have been cases where women themselves came and asked family doctors or gynaecologists for a referral for testing or simply for information about where they could get tested. And doctors, wide-eyed, asked: “Why?” Stigma reproduced even by doctors prevents a person from lifting their head and taking care of their health.
In addition, as I have already said, a woman is now often the main breadwinner in the family. She has to go to work, solve issues related to children, education, kindergartens and health. Often women simply have no strength left. The only dream is to get to bed and sleep at least a little, because tomorrow they have to get up again at four in the morning and go to work or stand in line at the embassy.
There is also a lack of understanding of the basics of the medical system in Poland. No one will simply receive you, even in difficult situations. You have to stand in line, register online — and that is if you have legal status.
Unfortunately, if legal status has been lost, this opportunity effectively does not exist. People without legal status, or people aged 60 and older, after the new provisions of the special law came into force, lost access to all medical services if they do not meet the requirement of earning at least half of the minimum wage.
You yourself lead an organization created by women from the community and by migrant women. What role do such organizations play? How are they different from ordinary support services?
I would say they are a bridge of trust. For me, community-led organizations are precisely bridges of trust between a patient and a doctor, between the community and the medical system.
We are the link that can connect a person to the treatment system and, in practice, bring them into it if they need this.
We are also a zone of trust. We create safe spaces where a woman or any migrant can come and talk about their problems. They can be sure that they will not be reported to the police, social services or other institutions that, under pressure, may also violate migrants’ rights. This is actually not rare; we have many such cases.
Peer-to-peer counselling gives a person an extended hand of hope. When someone comes to a peer counsellor, I can say: “I have been through this. I know how to make it easier and faster. Come, I will help you. I will be with you.” And the person is no longer alone.
There is support. There is a person who speaks the same language, knows your cultural code and understands the stigma and problems we brought with us. They know which words can reach a person so that they can adhere to treatment, get tested, regularize their status without pressure and navigate the Polish system.
This approach is very complex. It is not always clear from a website what services are provided, whether they are free or paid, what rights we have as migrant women, and what rights our children and loved ones have in a specific situation.
The theme of AIDS 2026 is Rethink. Rebuild. Rise. If we apply this to support for Ukrainian refugees and HIV prevention, what needs to be rethought, rebuilt and united around?
For rethinking, I think the main principle is this: we need to understand that prevention for refugees is not charity. It is a basic need. It is not something that should be handled only by NGOs or donors. It is about the health security of residents. The person must come first.
We need to rethink the very approach to access to prevention and treatment for refugees. We also need to rethink the understanding of who a refugee woman is, who a migrant is, in order to counter disinformation claiming that migrants supposedly “bring diseases” and to avoid building a false image of migrants.
A migrant is a person who brings cultural enrichment and financial resources to a country. In Poland, we can see that Ukrainian migrants have significantly supported many Polish companies. Migrants often take jobs that are not very prestigious, jobs where citizens of those countries do not always see their own future. For a migrant, this can be a ticket to the future. That is why we take different opportunities and are often very conscientious workers.
What I would like to rebuild is the funding system. The most important area of funding, as I see it, is organizations created by the community. We are building services in a new country with our own hands.
If a community-led organization based on peer counselling also provides services and has stable funding, this can support the full integration of migrants: into the health insurance system, the social protection system and, most importantly, the employment system.
If I am healthy, if I am doing well, if my mental health is stable, if I have treatment and my children are in school, I gladly go to work, receive a salary and pay taxes. That is also important.
We need to unite around people. This is my main principle. Refugees, including Ukrainian refugees living with HIV, should not depend on whether they are or are not able to receive treatment. For me, this is a matter of human dignity.
Please complete the sentence: “HIV prevention for people in migration will not work…”
…if there is no access to peer counsellors and community-led organizations.
I see this as our great strength: the ability to build a bridge of trust between patients and the medical system. This is where peer counsellors and community-led organizations play the most important role.
Migrants, like people in general, go to their own — to a person who has already had a similar experience and can be trusted. A person understands that the counsellor is speaking with them from the same position, not from above, not from the position of an institution that has to issue recommendations or decisions.
Our main strength is equality between the patient, the client and the counsellor.
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