An interview with Daniel Kashnitsky on migration, trust, Ukrainian refugees, continuity of treatment and the questions from central and eastern Europe and central Asia that need to be brought to AIDS 2026
Ahead of AIDS 2026 and the #RethinkRebuildRise campaign, VirusOFF is preparing a series of materials on what HIV prevention looks like “on the ground” today in the region of central and eastern Europe and central Asia — amid migration, stigma, unstable funding, war and unequal access to services.
One of the key themes of this series is people on the move: refugees, migrants, internally displaced people and those who, because of war, poverty, lack of documents or a difficult life situation, find themselves between healthcare systems.
We spoke with Daniel Kashnitsky, Academic Relations Coordinator at the Regional Expert Group on Migration and Health (migrationhealth.group), and a researcher on migration and health at Cermes3 — Centre for Research on Medicine, Science, Health, and Society, France, about why HIV prevention for migrants remains a systemic weak link, what most often “breaks” when people move, the role of trust and peer navigation and why it is already necessary to think about Ukrainian refugees’ access to healthcare after March 2027.
Daniel, to put it simply: what does HIV prevention for people on the move — migrants, refugees and displaced people — look like today in our region and beyond?
If I answer briefly and simply — it looks rather poor.
If we are talking specifically about prevention for migrants, there are very few such programmes even in European countries. They are practically absent as a systemic approach. Of course, there are project-based initiatives run by NGOs and communities, but I do not know good examples where such programmes are truly integrated into the national system.
The situation with treatment is better: treatment exists, and systemic approaches are being developed that take migrants’ needs into account. But prevention itself — supporting people through the first difficult three to five years after arrival — is almost absent.
And yet this is a very sensitive transition period. Regardless of which region a person has moved from and where they have moved to, they find themselves in a new environment, in a state of uncertainty. For diseases and conditions shaped by social factors, this is a very sensitive period.
When a person moves from one country to another, what most often “breaks” in access to prevention and treatment?
First of all, trust breaks down.
There is a lot of information today. We cannot say that people are in a complete vacuum: as a rule, some information exists in a person’s native language. The question is whether they can trust it. Or do they think someone wants to deceive them, take their last money or take advantage of their difficult situation?
Sometimes people do not go to a doctor not because they have no time or money, but because they do not trust the system. This is especially true when it comes to communicable diseases and conditions — HIV, tuberculosis and hepatitis. Even if a person knows they will not be deported, they may be afraid of losing their job or of information about their diagnosis becoming known.
Self-stigma is very strong here.
And this concerns not only HIV or tuberculosis. It concerns women’s health, surgery, and treatment for other chronic diseases. It is natural for a person to trust the specialists with whom they had built relationships over the years at home, in the country where they used to live.
When a person moves, especially if they move more than once, this trajectory becomes very complicated.
Ideally, what should a person have when they move so that they do not lose access to treatment and prevention services?
First of all, insurance — or a clear pathway to accessing services if access does not depend on insurance.
There should be a system in place that takes into account both people with documents and people without documents, if they are living with a health condition or are part of key populations.
If we are talking about HIV, tuberculosis and harm reduction services, a person must understand where to turn. Information and the right to health are the first things that must be ensured.
How do you assess the situation with Ukrainian refugees in Europe after 2022? What has been built successfully, and where do serious gaps remain?
Looking back, since Russia’s full-scale invasion of Ukraine, I would say that the experience of integrating Ukrainian refugees — not only in the field of health — has been quite positive.
First, there was a situation of shock. People were mobilized, and systems were also ready for rapid change. Host countries did things for Ukrainians that they often had not done for other refugees and migrants.
For example, almost no European country, with the exception of France and perhaps a couple of other states, was well adapted to treating multidrug-resistant tuberculosis. For Ukraine, this is an important issue because it is a country with a high prevalence of multidrug-resistant tuberculosis. Gradually, European countries began adapting their protocols and introducing bedaquiline. There are now more such countries than there were at the time of the invasion in 2022.
This is a good example of how healthcare systems were able to include Ukrainians quickly.
In addition, this is the first example since the Second World War when we are seeing a large migration of millions of people to Europe in which people have an unconditional right of residence but can still return to their country of origin. Ukraine is at war, but it continues to function as a modern state. People return not only for their belongings, but also for medical, family and economic reasons. They continue to live transnational lives — hundreds of thousands of women, children and older people regularly travel to visit relatives in Ukraine.
And this is normal for Ukrainians. Under a standard asylum procedure, a person does not have the right to travel to the country they left because of war or persecution. Under temporary protection, Ukrainians are allowed to do this. It is also possible to move from one EU country to another if things do not work out.
For me as a migration researcher, it was very interesting to study this. We also saw that Ukrainians by no means always choose the wealthiest countries or the countries with the strongest social support. Many prefer to stay in Poland — a country that is rather restrained in terms of social support compared with Germany, France and many other EU countries, but is close to Ukraine. It turned out that for many people it is critically important to be close to Ukraine and to have the possibility of going home.
Overall, the systems coped well. For healthcare organizers and researchers, this is an important lesson: if people are not forced into overly rigid frameworks, there is no mass abuse of the welfare system or of treatment.
People arrive, and they need to live, organize their lives and look for work. We can see, for example, in Poland and Czechia that Ukrainians have made an economic contribution: they have brought more money into the system than they have taken from it.
Overall, European countries received Ukrainians quite inclusively. This is a major achievement.
But if we speak more broadly, migrants in general are still poorly integrated into HIV and tuberculosis programmes. Progress in creating programmes that are sensitive to migrants’ needs remains quite limited. There are structural difficulties here.
Which difficulties became particularly visible?
One of the difficulties with integrating Ukrainians into the healthcare system was not so much the language, although that is the first thing on the surface.
A very large number of people were placed in refugee reception centres or provided with social housing in small towns where there are no services adapted to communities. For example, to receive harm reduction services, a person may need to travel two or three hours to the nearest administrative centre.
When such trips have to be made regularly, while public transport is almost nonexistent and people do not have cars, this becomes a major problem. People feel isolated, without others nearby who have similar experiences. Other community members may be available only online, while a person is sitting in a small town or village with no one to share similar problems with and no one with whom to build a network of trust.
This is why online support is so important — the kind of support provided by the Polish Fundacja HelpNowHUB and other similar organizations founded by migrant communities representing key populations. They help not only locally, but also provide online counselling to people who are formally in the same country but, in reality, have very limited mobility.
Migrants are mobile by life experience, but in everyday life they are often very constrained. They spend long hours at work, rarely go on holiday, and live and work in one place. Ukrainians also spend money on trips home to visit relatives who remain there.
That is why regular trips to a regional or provincial centre, or to a large city, are a serious problem. People need to take time off work and spend money on travel. It is not easy.
What prevents countries today from building proper cross-border continuity of care so that a person does not fall out of the system when moving?
First of all, coordination between countries.
What the Public Health Center of Ukraine did — creating an electronic database with diagnoses and the possibility to quickly restore data upon request — is precisely an example of very prompt cross-border cooperation between Ukraine and host countries, which did not exist before.
Migrants from other countries often have to undergo all tests from scratch. It takes a lot of time to restore continuity of treatment — both for HIV and for harm reduction.
Initiatives such as electronic databases that make it easier to recognize diagnoses greatly accelerate continuity of treatment, especially when wartime refugees arrive without medical documents, which happened quite often in 2022.
And here the role of communities in host countries, especially migrant communities, is enormous. When you can turn to people with similar life experience and they accompany you, this often saves weeks that are otherwise lost because of not knowing the system, waiting for specialist appointments or not knowing how to book a doctor’s appointment.
Such administrative barriers are often overcome thanks to “their own” people — peer consultants, social workers and community specialists.
If there are no established independent migrant organizations in a country, these may be hired specialists with migrant experience working in clinics or hospitals. In France, for example, I tend to see this situation.
Integrating civil society organizations and specialists with migrant experience greatly supports continuity of treatment and costs the healthcare system very little.
Why can even a good medical system fail to work without peer organizations, consultants and navigators?
It will work, but there will be many failures and misunderstandings.
Very simply: a person may not find the way. University hospitals and medical complexes can be so complicated that while a person is looking for the right building or office, they miss their 15-minute appointment. The next appointment may be a month later. During that time, the person may become ill with something else or end up in hospital by ambulance.
Navigation in the most routine sense — taking someone by the hand and accompanying them the first time, while they do not yet know the way — is very important.
Language is a problem, but it is often solvable with online translators. Much more difficult are not knowing the place, not knowing the system, and not knowing how to book a doctor’s appointment online. When there are more experienced people nearby who can help, it saves a person time and health.
One focus of our campaign ahead of AIDS 2026 in Rio is prevention amid unstable funding. What happens to people on the move when programmes providing accompaniment, navigation, legal support or social support are cut?
I will put it paradoxically: because there have never been many programmes for migrants, dismantling this system will not be all that dramatic.
In general, cuts to community programmes are felt where there was a large share of donor funding. In Moldova and Georgia, this is felt more strongly than in Poland or Germany, where the state largely covers the costs of the social system.
I would not say that cuts in donor funding have already collapsed the system of assistance for migrants in France, Poland, Spain or Italy. The problem is rather elsewhere: the support system for migrants — not only Ukrainians, but migrants and refugees in general — was insufficiently developed from the start.
Community specialists are brought in too rarely and irregularly. It is very important to create municipal, city and national funds that would finance migrant NGOs. International donors are, of course, important, but often they support targeted innovative projects. They help test something, but then local systems must take it on.
Local subsidies are needed for migrant NGOs that would help hospitals and medical centres reach those migrants who otherwise would not come to them.
And this is not only about people who have just moved and need continuity of treatment to be ensured. It is also about those who arrived two or three years ago and have faced a difficult life, depression, isolation and fear around the topics of HIV, tuberculosis and drugs.
These may be people who use drugs and are sceptical of NGO support. They may also be people who once encountered unfair treatment even from community-based organizations — unfortunately, that also happens.
People isolate themselves, lose trust, and become cynical toward systems. In the end, they lose their health.
The atomization of people in migration is a major problem.
The theme of AIDS 2026 is Rethink. Rebuild. Rise. If we apply it to access to HIV prevention and treatment for people on the move, what do we need to rethink first?
First of all, services related to HIV and other conditions affecting public health for people without documents.
Systems more or less cope with those who have a residence permit and insurance. There are World Health Organization guidelines that help take into account the needs of people from another culture and with another language. This dialogue is taking place at the level of international organizations.
But what should be done with people who are stuck without documents?
There are also quite a few such people among Ukrainians. This does not mean that a person has no right to medical care. But, for example, a local prefecture may fail to issue documents for months, and a person cannot renew their insurance. They are stuck and have lost faith that it is possible at all.
Low-threshold centres are needed that will test, treat and help. The system must have a plan B and a plan C. If it is not possible to finance assistance in the traditional way, there must be other mechanisms to help pay for treatment for a person who has simply lost documents.
And restoring documents can be so difficult that a person may spend years doing it.
There are many such people everywhere. They may be Roma people within the European Union. They may be Russian-speaking residents of the Baltic states. Among them, for example, are many people who use drugs and are in a very difficult situation in Germany. This is one of the groups facing serious problems.
Many people, for different reasons, find themselves in situations of social marginalization. Social workers are needed to help restore documents. But there also needs to be a system ready to accept people as they are — simply because they are human beings and because we are talking about diseases that affect public health.
The main issue is making systems more flexible. For migrants, for citizens, for internally displaced people, including in Ukraine.
If you were to formulate the main questions from the region to AIDS 2026 on migration, HIV and prevention, what would those questions be?
The first question is: when will there be funding mechanisms for local organizations to finance prevention programmes?
This is very badly lacking. We could even stop here, because this is the key question.
The second question is mental health. Psychological and psychiatric care is very difficult to pay for, and it is difficult to access. The barrier is very high — both financial and administrative.
Migrants are often forced to survive by earning enough for food and housing. Issues related to mental health are pushed into the background. Accessible and systemic mental health support for migrants is badly lacking — at least in the main host countries.
The third question concerns the near future: when will people be given a clear understanding of how Ukrainians should build their lives further?
If the Temporary Protection Directive is discontinued, people need to understand how to act. Return to Ukraine — but where? If a home has been destroyed, what should they do? Can they obtain documents for long-term stay in a country on that basis? Or must they leave anyway?
There are many questions with no answers. People are in limbo. This in itself is extremely exhausting and creates substantial background stress.
This is exactly what the #HealthBeyondMarch2027 advocacy initiative is about: raising the issue of continuity of healthcare for Ukrainians after the end of temporary protection in advance, rather than waiting until the final months before March 2027.
It is not enough simply to extend temporary protection for one more year. Russia’s aggression continues; the war has not stopped. But there must be longer-term ways to transition to more permanent documents and to have stable medical care.
And finally, please complete the sentence: “HIV prevention for people on the move will not work if…”
…if we try to assume that people came for a while and will then leave.
If we try to assume that migrants are eating up your taxes.
And if other myths about migration are spread.
Systems must be flexible enough both for citizens and for newcomers — especially when it comes to public health issues such as HIV, tuberculosis and drug use.
They must be more inclusive.
#RethinkRebuildRise #IAS #AIDS2026 #EECAATAIDS26