During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series of stories on what HIV prevention looks like today in Central and Eastern Europe and central Asia: not only in strategies and international discussions, but also in the real lives of people for whom access to prevention depends on rights, safety, trust, sustainable funding and the work of communities. We spoke with Medea Khmelidze, Executive Director of the Eurasian Women’s Network on AIDS (EWNA).
Medea, from your regional perspective, what does HIV prevention look like for women in Eastern Europe and central Asia today? What has changed most in recent years?
HIV prevention for women in EECA today exists in a shrinking and increasingly fragile space. While biomedical tools exist, real access is being reduced by funding cuts, weakening political prioritization, and shrinking community-led systems. The biggest change in recent years is not technical progress, but the erosion of sustainable, community-driven prevention infrastructure..
The biggest change in recent years is not technical progress, but the erosion of sustainable prevention infrastructure based on community participation.
When we talk about HIV prevention, women are often not seen as a priority audience unless they fit into very narrow categories. Why does this happen and what does it mean in practice?
Women are still not treated as a priority unless they fit narrow “risk categories”. This reflects persistent gender bias in HIV programming and fragmented thinking.
In practice, it means limited access to information, PrEP, PEP, testing and psychosocial support for many women — especially those who do not fit dominant service narratives.
Which groups of women are most likely to remain invisible in HIV prevention programmes in our region?
Women living with HIV, women who use drugs, sex workers, migrant women, women in prisons or detention, women experiencing violence, young women and trans women remain the most invisible.
In reality, many women exist at the intersections of these identities, but programmes rarely reflect this complexity.
What are the main gender-related barriers that prevent women from accessing HIV prevention and related services?
Key barriers include stigma, criminalization, gender-based violence, economic dependence, lack of childcare, fear of status disclosure, migration status and instability linked to conflict and displacement.
These are structural barriers, not individual choices.
Why is HIV prevention for women impossible to separate from sexual and reproductive health and rights?
Because women’s HIV risk, prevention and treatment are directly shaped by sexual and reproductive health and rights realities, including pregnancy, contraception, violence, reproductive coercion and access to respectful healthcare.
Without sexual and reproductive health and rights, HIV prevention is incomplete.
How is obstetric violence against women living with HIV connected to HIV prevention?
Obstetric violence and coercion, including violations of women’s autonomy around breastfeeding, deeply undermine trust in health systems.
When women fear mistreatment, they delay or avoid care. This directly undermines HIV prevention, testing and continuity of services.
What does “prevention choice” mean for women in our region? Is it real?
“Prevention choice” is still largely formal rather than real. Women are not consistently offered a full, safe and accessible package of options, including PrEP, PEP, condoms, harm reduction, U=U-informed care, integration of sexual and reproductive health and rights, and psychosocial support.
Choice exists on paper more than in practice.
What role do women-led organizations and organizations working with communities play?
They are the backbone of real HIV prevention. They provide trust, navigation, peer support and continuity where formal systems fail.
However, they are increasingly underfunded, overburdened and affected by activist burnout due to shrinking civic space and funding cuts.
What is often misunderstood by donors and policymakers?
That HIV prevention for women in EECA is not just a service delivery issue. It is deeply shaped by criminalization, inequality, shrinking civic space, migration, war and intersecting stigma.
Without addressing these factors, technical interventions alone cannot work.
The theme of AIDS 2026 is Rethink. Rebuild. Rise. If we apply it to support for women and HIV prevention, what do we need to rethink, rebuild and strengthen?
We must rethink approaches that rely only on biomedical tools; rebuild sustainable funding for systems created and sustained by communities, as well as integration of sexual and reproductive health and rights; and rise by strengthening women’s leadership across HIV, drug policy, migration and violence responses.
What message have you brought to AIDS 2026?
Women in EECA are not lacking tools — we are facing collapsing access, shrinking rights and weakened systems created and sustained by communities.
Prevention will work only if women’s leadership and community leadership are fully funded, protected and centred.
Please complete the sentence: “HIV prevention for women in Eastern Europe and central Asia will not work if…”
…it continues to exclude community leadership, ignore structural violence and operate under shrinking funding, shrinking rights and criminalization.
Is there anything important you would like to add?
What is often left out is the scale of intersecting crises: funding cuts, shrinking civic space, criminalization, war and migration, and systemic discrimination.
Combined with stigma — including around drug use, HIV status and gender identity — this creates a prevention environment where access is continuously destabilized, even when tools exist.
