During the AIDS 2024 conference, the International AIDS Society (IAS) organized a pivotal roundtable discussion titled “Evolving National and Regional Politics in Eastern Europe and Central Asia: How Does It Impact the HIV Epidemic?”. The session brought together key representatives from the region to deliberate on the critical intersection of political dynamics and public health challenges, specifically focusing on the HIV epidemic.
Andriy Klepikov, Executive Director of Alliance for Public Health, Co-Chair of AIDS 2024 & Member of the IAS Governing Council and a Chair of the Roundtable began by acknowledging the solidarity shown towards Ukraine but emphasized the necessity for substantial support beyond moral gestures. He pointed out that Eastern Europe and Central Asia (EECA) remain the most problematic region concerning HIV, as noted in the recent UNAIDS report.
The region has the fastest-growing HIV epidemic globally, with only half people having access to treatment. The epidemic predominantly affects people who inject drugs and men who have sex with men (MSM). Klepikov stressed the urgent need for scaling up harm reduction strategies and interventions such as pre-exposure prophylaxis (PrEP) for MSM. He quoted a colleague, saying, “We will not end AIDS unless we also end AIDS in the region of Eastern Europe and Central Asia,” emphasizing the critical focus on key populations in the region.
Andriy Klepikov highlighted the adverse effects of punitive laws, which shrink the space for civil society, and advocated for evidence-based interventions to counterbalance these challenges. He mentioned the recently published special supplement on EECA in the Journal of International AIDS Society (JIAS) as a valuable resource. He also called for increased funding, particularly from the Global Fund, to support communities and integrate prevention and treatment with human rights initiatives like the Breaking Down Barriers initiative.
Professor Michel Kazatchkine, Special Advisor to WHO Europe, provided a comprehensive overview of the region’s HIV landscape. He noted that EECA, alongside the Middle East and North Africa (MENA), is one of the regions where the HIV epidemic is growing the fastest. Despite minimal progress over the past 15-20 years, certain countries like Ukraine have made strides, even amidst war, while others, such as Russia, have seen deteriorating conditions.
Professor Kazatchkine highlighted the difficulty in obtaining accurate data from Russia, noting manipulation of statistics. He estimated that the region has around 2.1 million people living with HIV, with a 40% increase in new infections over the last decade. He identified Russia, Ukraine, Uzbekistan, and Kazakhstan as accounting for over 90% of new infections, with russia alone contributing more than 50%.
Key factors contributing to the epidemic’s growth include the lack of political leadership, the influence of punitive laws, and insufficient funding. The region’s HIV epidemic is predominantly among key populations—people who inject drugs and MSM—who face significant legal and social barriers. The coverage for prevention and care remains low, with a cascade indicating only 42% of people living with HIV receiving treatment.
Professor Kazatchkine also addressed the shrinking civil society space, exacerbated by political and economic instability, and the profound impact of the war in Ukraine on health systems. Despite these challenges, he acknowledged the resilience of health systems and civil society in Ukraine, which continues to innovate in service delivery.
Natalia Nikitenko, Former Member of Parliament, Kyrgyzstan & Member of the Eastern & Central European Commission on Drug Policy brought her experiences and broader reflections on the region, particularly focusing on Central Asia. Nikitenko highlighted the alarming regression in political and human rights environments in countries like Kyrgyzstan, which once prided itself on progressiveness. She lamented the rapid deterioration in respect for human rights, civil society strength, and media freedom.
Natalia Nikitenko underscored that political will, grounded in human rights, is essential for effective HIV interventions. She noted a concerning trend where political leaders promote discriminatory rhetoric, which hinders public health efforts and stigmatizes key populations, including people who use drugs and the LGBTIQ-community. This stigmatization, coupled with laws criminalizing drug use, sex work, and same-sex relationships, creates formidable barriers to accessing health services.
A critical point Nikitenko raised was the introduction of laws targeting NGOs, similar to Russia’s “foreign agents” law. These laws severely restrict the operation of organizations working with key populations, forcing many to close or shift focus. The law’s broad definition of “political activity” leaves health and civil society organizations vulnerable to accusations and closure, exacerbating the epidemic’s spread.
Natalia Nikitenko stressed the necessity of a robust and inclusive civil society to foster a culture of tolerance and respect for human rights. She highlighted that despite having a competent healthcare system, professionals struggle to provide adequate care in an environment of widespread discrimination and hate. The recent adoption of discriminatory laws and policies, along with the economic influence of Russia and the cultural shift towards traditionalism, has only worsened the situation.
Andriy Klepikov provided an insightful overview of the current challenges and progress in the HIV response in the region and specifically in Ukraine. He emphasized the critical role of the Commission in counterbalancing punitive laws and policies of prohibition, highlighting the great work in Kyrgyzstan and Kazakhstan.
Andiry highlighted several critical issues affecting the HIV epidemic in Eastern Europe and Central Asia. He emphasized the alarming increase in new HIV infections and mortalities, which are being exacerbated by the rise in punitive laws, oppressive practices, and human rights violations. Klepikov pointed out a troubling mismatch between these growing challenges and the declining funding, warning that this discrepancy cannot persist without worsening the situation.
The Chair of the Roundtable stressed the critical need for donors and governments to maintain their focus on the region, calling for continued financial support from the Global Fund and private donors to effectively address the HIV crisis. Despite the ongoing war, Klepikov noted that Ukraine has managed to sustain its HIV response through the collective efforts of communities, civil society, the government, and international partners. He underscored the importance of partnerships and prioritizing people health, adapting to emerging humanitarian needs such as evacuation, provision of food, shelters, generators, and mental health support.
Mr Klepikov also highlighted Ukraine’s development of agile and innovative solutions to tackle the challenges posed by the war, such as mobile health services reaching remote areas and innovative solutions like digital assistant. He mentioned the introduction of long-acting buprenorphine and other modern tools to ensure effective public health interventions. Finally, Klepikov stressed that Ukraine’s efforts are being closely monitored by neighboring countries and that its success in maintaining health services amidst the war serves as an inspiration for the entire region.
Anton Basenko Chair of the Board, International Network of People who Use Drugs (INPUD) & representative of the community of people who use drugs in the Ukraine Cabinet of Minister’s HIV/TB National Council shared his personal and professional experiences, emphasizing several key points regarding the HIV epidemic and harm reduction efforts in the region. He celebrated 20 years of opioid agonist therapy (OAT) in Ukraine, noting its significant role in HIV prevention and treatment. However, Basenko highlighted the disparity in OAT coverage, with only about 30,000 patients in Ukraine compared to an estimated 350,000 people who inject drugs.
Anton Basenko pointed out that other countries in the region have minimal or pilot-level harm reduction programs and often face political and funding challenges. He stressed the importance of political will and adequate funding to implement and sustain these programs. He emphasized the need to address stigma and discrimination against people who use drugs and other key populations, calling for the inclusion of these communities in decision-making processes. Basenko also highlighted the joint movement “Rise & Decriminalize” initiated by regional networks to tackle these issues.
Additionally, Anton brought attention to the unique vulnerabilities of women who use drugs, particularly in patriarchal societies like those in Central Asia. He stressed the importance of reaching this hard-to-reach population and providing targeted support. Lastly, Basenko raised the issue of aging among people who use drugs, noting the increased health risks and the need for comprehensive health services beyond just HIV and hepatitis.
The discussion underscored several critical points for addressing the HIV epidemic in Eastern Europe and Central Asia:
- Political Leadership and Human Rights: There is an urgent need for political leaders in the region to prioritize HIV on their agendas and ensure policies respect human rights. Without this commitment, efforts to control the epidemic will remain ineffective.
- Civil Society Engagement: A vibrant and unrestricted civil society is essential. Civil society organizations play a crucial role in reaching key populations and providing essential services. Shrinking space for these organizations due to restrictive laws poses a significant threat to public health.
- Harm Reduction and Prevention: Scaling up harm reduction programs and preventive measures like PrEP is vital. Current efforts are insufficient, particularly in countries with punitive drug policies and low coverage of harm reduction services.
- Accurate Data and Transparency: Reliable data is necessary for effective intervention. The manipulation of HIV statistics, particularly in Russia, hampers the understanding of the epidemic’s true scope and undermines efforts to address it.
- International Support and Funding: Increased and sustained international funding is crucial. Organizations like the Global Fund play an essential role in supporting HIV interventions. However, geopolitical tensions and economic dependencies complicate these efforts.
- Regional Cooperation: Enhanced cooperation among countries in the region, along with support from international partners, is essential. Sharing best practices and coordinating efforts can strengthen the overall response to the epidemic.
The roundtable highlighted the complex interplay between politics, human rights, and public health in addressing the HIV epidemic in Eastern Europe and Central Asia. The region faces significant challenges, including political instability, restrictive laws, and insufficient funding. However, the resilience and dedication of health professionals and civil society offer hope. To combat the HIV epidemic effectively, there must be a concerted effort to foster political will, protect human rights, support civil society, and ensure sustained international funding and cooperation.
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