Ahead of AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series on what HIV prevention looks like today in Eastern Europe and Central Asia — in the context of war, stigma, unstable funding, criminalization, migration and unequal access to services.
This time, the focus is Ukraine, where the full-scale war and the security situation continue to shape whether people can access testing, PrEP, treatment, counselling, mental health support and other services. These issues are especially acute for LGBTIQ+ communities, particularly for those serving in the Armed Forces of Ukraine or living in frontline regions.
We spoke with Vasyl Malikov — a well-known activist and Associate Professor at the National Technical University “Kharkiv Polytechnic Institute” — about what has changed in access to HIV prevention in Ukraine and Kharkiv, why health often becomes secondary to survival during war, how community-led services work, what resources people need “on the ground” and what message should be brought to AIDS 2026 in Rio.
Vasyl, over the past year, what has changed the most in access to HIV prevention in Kharkiv and in Ukraine more broadly?
The war and the security situation continue to determine access to services. They create the framework within which we can talk about whether HIV prevention is accessible or not. From my personal observations, they deepen the problems with access to services specifically for gay men, bisexual men and other men who have sex with men.
I would say that one important trend is that health is becoming less of a priority compared with a person’s physical and economic security — in other words, with issues of basic survival. People from the community are more likely to forget, miss or postpone both HIV prevention and HIV treatment.
I will also talk about treatment here, because treatment is also prevention in a broader context. People face barriers both in access to prevention and in access to treatment, and I think it is important to name both.
The positive development is that there are now more PrEP options available in the regions of Ukraine. Alongside oral PrEP, injectable PrEP has also appeared. It was available in Kyiv earlier, but in the regions, including Kharkiv, it appeared later. Now, if a person needs it, they can seek and receive this service in Kharkiv.
At the same time, the real choice of prevention tools remains limited. It depends on a person’s logistical possibilities, awareness, trust in services and whether they can place health among their priorities in their current life situation.
What problems are currently having the greatest impact on HIV prevention?
One of the problems is data. When I looked at recent materials on Ukraine’s progress towards the 95–95–95 targets, I was struck by the fact that official materials directly acknowledge that it is currently impossible to fully track progress towards these global targets. In particular, we do not know what percentage of people living with HIV know their HIV status. In other words, we do not have a clear answer regarding the first “95”.
And if we do not know the first indicator, what can we say about the next ones? Because of the lack of complete demographic data and reliable data on testing coverage, including among key communities, we cannot fully assess the current situation.
This directly affects prevention. If we do not know how many people know their HIV status, and if we do not understand the real coverage of testing, we cannot accurately assess where the system is failing to reach people.
The second major problem is barriers to HIV prevention and testing. They may look traditional, but in wartime they become more dramatic. We still do not reach the desired level of people’s awareness about the availability of testing and prevention. There are information campaigns, testing days and testing weeks, but this is not enough.
I see this in communication with people from the community. Adults with long experience of sexual relationships come to services at the community centre and get tested for HIV for the first time in their lives. They had simply never thought about it before. And this is a very significant gap.
What barriers do you most often see for people from the community when they try to access prevention or counselling?
Even if HIV testing services are free of charge, access remains an issue. A person needs to physically get to a testing site — whether it is a non-governmental organization or a medical facility.
If we are talking about testing in a medical facility, a person may face stigma. This may include a failure to recognize that the person has a need for prevention, or their reluctance to disclose to a doctor that they belong to the community of gay and bisexual men. A person may not be able to speak openly about what is happening in their sexual life and what questions concern them.
There are also logistical barriers. For example, we cannot say exactly how many gay and bisexual men are currently serving in the Armed Forces of Ukraine, but it is obvious that their number is growing. A person who serves has the same needs for HIV prevention, testing, treatment and sexual health as other people from the community. But access to these services becomes much more difficult for them.
The annual military medical commission is not an HIV prevention programme. Prevention is not only testing. It is counselling, trust, the opportunity to ask questions, receive information, choose a prevention tool and remain connected to a service. At the moment, there is no comprehensive answer to the question of how to reach people from the community who are serving in the military with these services.
This is also about stigma and fear of disclosure. If a service member has a question related to sexual health, he cannot always be open. A person may worry that someone will understand that he belongs to the community. This is also a barrier — both to treatment and to prevention.
What helps preserve access to prevention in Kharkiv today?
I may not be objective, because I am an interested party. But from the experience of Kharkiv, I see that the most effective services are those provided on the basis of the community and by the community itself — through the peer-to-peer principle.
In conditions where state prevention programmes do not work everywhere as they should, responsibility for the health of the community again largely falls on the community itself. What we are trying to do now relies precisely on the community — on building a culture of prevention.
What works best is a live connection with the community. The “snowball” principle works, when people respond to requests and talk to others in their circles about testing, PrEP, prevention and counselling. Through trust and personal contact, it becomes possible to bring into services people who might otherwise remain outside the system.
The comprehensiveness of services is also important. A person from a key community who has experienced stigma or discrimination is not always ready to voice their problem immediately, even to a peer counsellor. And this does not always happen during the first consultation. That is why it is important to have many points of contact.
Someone comes simply for testing — and over time may agree to PrEP. For someone else, the entry point is an event at the community centre: a film screening, board games or a community meeting. For another person, it is psychological counselling. And in the process, the person learns that there are other services that may be important for them.
Which approaches should be scaled up in Ukraine right now?
I would name three things: comprehensive services, reliance on communities and community-led organizations, and resources.
Comprehensiveness means that we do not look at a person only through one request. If we focus on a broader range of community needs, we can engage more people in HIV prevention as well. This is not only about testing or PrEP. It is also about mental health, psychosocial support, humanitarian support, crisis response, community activities and social cohesion.
Social cohesion may sound abstract, but in practice it is about connections between people in the community. And these connections are very productive for talking about HIV prevention, engaging people in testing and simplifying access to services.
The second thing is reliance on communities, community-led organizations and community centres that can work comprehensively. In Kharkiv, there are now very few places that consistently bring the community together. Classic outreach, when a counsellor can physically go to a space where people gather, practically does not work because there are few such spaces, or they disappear quickly.
The third thing is resources — in the broad sense: funding, remuneration, support for volunteers and workers who can reach closed groups, work with people who are becoming increasingly disconnected from the community and build trust where standard tools do not work. Prevention cannot rely only on the enthusiasm of individual people.
What message would you like to bring to the international audience ahead of AIDS 2026?
With every year of the full-scale war, it becomes increasingly difficult to mobilize the resources of the community of gay and bisexual men itself to respond to the HIV epidemic. We understand that without the participation of the community, ending the epidemic is impossible. But every year it becomes harder to mobilize these resources.
More and more people from the community are forced to join the Armed Forces of Ukraine and defend the country. But in this same context, resources are needed so that someone can protect their health — including their sexual health.
While more and more people from the community are giving their strength, time and health to defend Ukraine, additional resources are needed to care for their health: both for those serving in the Armed Forces and for those who remain civilians.
I think HIV prevention needs to be understood in the broader context of sexual and reproductive health, as well as overall care for a person’s health and well-being. This helps overcome stigma and see not only one medical indicator, but the whole person.
My message is this: we need to increase efforts and bring in more external resources for HIV prevention in Ukraine now in order to reduce the burden of the epidemic in the future. Because today, more and more people from the community remain outside prevention services. And it is the people who work or volunteer in this field who create the connection between the community and social and medical services. Supporting these people makes it possible to preserve and strengthen HIV prevention for the key community.
The theme of AIDS 2026 is Rethink. Rebuild. Rise. If we apply it to HIV prevention in Ukraine, what needs to be rethought, rebuilt and strengthened?
We need to rethink HIV prevention itself — not as a separate set of services, but as part of broader care for sexual and reproductive health, mental health, social well-being and a person’s safety.
We need to rebuild access pathways so that they reflect people’s real lives during war. Standard schedules, working hours and classic offline formats do not always work in the context of air alerts, instability, displacement or military service. What works are solutions that allow flexibility, remote counselling, online navigation and the possibility of staying connected with a person even when they cannot physically come to a service.
Community-led infrastructure must become stronger: community-led organizations, community centres, peer counsellors, volunteers and everyone who creates trust. They are often the link through which a person reaches prevention at all. And this link needs resources, stability and recognition.
Please complete the sentence: “HIV prevention for the community will not work if…”
…if the community does not embrace HIV prevention as part of its life, well-being and health.
This is about overcoming HIV-related stigma, and also about the engagement of the community itself. But it is important not to shift all responsibility onto non-governmental organizations or individual workers, as if they simply “did not do enough”. Today, almost all responsibility for the health of communities and the functioning of prevention programmes is often shifted onto specific people and organizations.
So for me, the sentence sounds like this: HIV prevention will not work if the community does not embrace it as part of its life, well-being and health — and if the system does not support the people who make this prevention possible every day.
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