As part of the regional information and advocacy campaign “EECA Voices at AIDS 2026”, implemented by VirusOFF with the support of the UNAIDS EECA and Asia-Pacific Office, we are speaking with experts, activists and community representatives about the future of HIV prevention in Eastern Europe and Central Asia.
One of the key themes of the campaign is innovation in HIV prevention. But innovation is not only about new medicines. It is also about choice, trust, safe spaces, convenient pathways, telemedicine, community participation and real access for people who are currently facing the greatest barriers.
VirusOFF spoke with Andrii Chernyshev, External Relations and Advocacy Consultant at ALLIANCE.GLOBAL and Co-Chair of the National LGBTI Consortium, about the role of PrEP in Ukraine, the experience of introducing new prevention options, the challenges of war and what the EECA region should bring to the global conversation ahead of AIDS 2026.
Andrii, Ukraine already has experience in introducing different approaches to HIV prevention. How would you describe the role of PrEP today in the prevention system for key communities?
PrEP is currently one of the most important and widely used methods of HIV prevention. Pre-exposure prophylaxis is especially relevant for gay and bisexual men, who remain one of the largest groups of PrEP users in Ukraine. Partners of people living with HIV are also an important group.
But if we look at this more broadly, the key issue is not only the availability of PrEP as a tool. It is important that people have choice: a choice of medicine, a choice of format, a choice of where they can receive the service, and a choice of a pathway that is safe and convenient for them.
For some people, this may be oral PrEP — daily or on demand. For others, a long-acting injectable option may become more acceptable in the future, including cabotegravir, lenacapavir or other new forms of prevention. But choice should not only be about the medicine. A person should be able to receive the service in a safe space, through a community-based organization, at a healthcare facility, in a private clinic, through a pharmacy or with the support of telemedicine.
It is this combination of factors that can bring prevention closer to people and increase access.
Why is choice so important in HIV prevention? What changes when a person has not one standard option, but several possible ways to protect themselves?
When we talk about choice, we are talking about a person’s real life. Not everyone can or wants to receive services in the same way. Some people are ready to go to a public healthcare facility. Others feel more comfortable contacting a community organization or a safe space. Some people want to minimize physical visits and use telemedicine. For some, confidentiality is critical. For others, it is important to have a friendly doctor who understands the needs of the community.
If the system offers only one pathway, some people simply will not reach prevention. Not because they do not need it, but because that pathway is unsafe, inconvenient or psychologically unacceptable for them.
Strong prevention is not one standard route for everyone. It is a system that adapts to different needs, different communities and different life circumstances.
Oral PrEP is already an important prevention tool. What barriers can still prevent people from starting PrEP or continuing it regularly?
Oral PrEP is already well known in communities. Ukraine had experience with pilot programmes back in 2017–2018, and since then awareness has grown significantly, especially among gay and bisexual men. So the issue is not only about explaining again what PrEP is. Information campaigns are still needed, but the barriers often go deeper.
For most people, it is very important that the service feels safe. That there is a friendly doctor. That there is a space where a person will not be judged. That they do not have to travel all the time, wait in queues or explain again and again who they are and why they need prevention.
Today, there are also new challenges related to the war. People are living under constant stress. If a person is evacuating, living under shelling, looking for a place to sleep, food, or basic safety, sexual health may move down the list of immediate priorities. This does not mean that prevention becomes less important. It means that the system needs to see the person as a whole.
If basic needs are not met, it can be very difficult for a person to think about PrEP, regular medicine use or planned visits. That is why HIV prevention cannot be separated from humanitarian, psychological, social and legal support.
CAB-LA is often seen as an important innovation in HIV prevention. For which groups or situations could this option be especially relevant?
Long-acting injectable PrEP can be very important for people who find it difficult to take tablets every day or to store medicine at home. This may be related to confidentiality, stigma, safety or simply the regularity of use.
For some people, an injectable form can reduce barriers. But it is important to understand that the appearance of a new medicine does not automatically mean access. Innovation has to work within a person’s real pathway to services.
When we participated in pilot approaches, social support and case management played an important role. People were informed, motivated, helped to navigate the system and supported in staying connected with healthcare services. When this support disappears, even the availability of the medicine does not guarantee that a person will use it.
That is why CAB-LA, or any other innovative prevention option, should be introduced not only as a medical product, but as part of an access system: with navigation, information, community participation and a clear pathway for the client.
What does Ukraine’s experience with CAB-LA and other PrEP options show for the EECA region?
Ukraine’s experience shows that innovation is possible even in extremely difficult circumstances. But it also shows that innovation requires more than the availability of medicines. It requires communication between all parts of the system: healthcare facilities, the Public Health Centre, civil society organizations, community-based organizations and the communities themselves. It is also important to pay close attention to information about possible side effects, which may occur for some people receiving the medicine.
In regions where there are stable contacts between community organizations and healthcare facilities, access works better. We understand where to refer a person, where there is a friendly doctor, where a service can be received and where the medicine is available. But where such contacts do not exist, information often does not reach people.
The problem is not only whether a service formally exists. It is important whether a person knows about it, trusts the pathway, can use it safely and will not face stigma or discrimination.
That is why community participation in the introduction of PrEP options is critically important.
If we talk about people’s real lives, what barriers can long-acting PrEP help reduce — and what barriers does it not automatically solve?
Long-acting PrEP can help reduce barriers related to taking tablets every day, storing medicine at home, confidentiality or fear that someone may find out about a person’s use of prevention.
But it does not automatically solve other barriers. If a person does not want to go to a healthcare facility or is afraid to do so, if they have already had a negative experience, if the facility works at inconvenient hours, if there are queues, or if there is no friendly staff, then even an innovative medicine may remain inaccessible.
In Ukraine, there is now another very serious challenge: restrictions on mobility and safety risks for a significant number of men. For many people, the journey to a healthcare facility itself can be a source of fear. This affects not only clients, but also staff, social workers and navigators who need to work with people in person.
Telemedicine can be part of the response: the possibility to do necessary tests closer to where a person lives, receive a consultation remotely, and receive medicines by post or through another convenient and safe mechanism. But the first contact with the system, testing and certain medical procedures often still require a physical visit. This is exactly where the safest and friendliest possible pathways are needed.
New prevention options, including lenacapavir, are now being actively discussed globally. How should the EECA region already be thinking about such innovations?
The region needs to think about innovation not only as new medicines, but as new opportunities for access. If a long-acting option becomes available, it is important to immediately ask: who will be able to receive it? Where exactly? Through which pathway? Will it be accessible to people from key communities? Will the price be acceptable? Will the healthcare system be ready? Will civil society organizations and communities be involved?
Innovation can either reduce inequality or deepen it. If new options are available only to a narrow group of people who already have access to quality healthcare, this will not solve the problem. But if they are introduced through friendly services, community-based organizations, telemedicine, safe spaces, social support and clear pathways, then they can truly reach people who are currently left outside the system.
What is needed so that innovative prevention options do not remain only pilots or separate programmes, but become genuinely accessible?
Several levels need to be addressed at the same time.
First, there must be a choice of medicines and prevention options. Second, there must be a choice of where services can be received: a healthcare facility, a civil society organization, a safe space, a private clinic, a pharmacy or a telemedicine pathway. Third, there must be clear navigation: a person needs to know where to go, what to expect and what they will receive.
We use different tools to reach people: social media, dating apps, specialized websites, Telegram channels, chats, paid advertising and the work of social workers. Different subgroups need different communication channels. For example, one type of communication works for younger people, another for older people; one approach is needed for people who practice chemsex, another for bisexual men who may be more closed or less visible.
Different methods also work in different communities. In some cases, online booking and a specific appointment time work best. In others, referral through a peer counsellor is more effective. Sometimes accompaniment to a healthcare facility is needed. Sometimes information is shared through trusted contacts.
There is no universal solution. But there is a universal principle: the service should move towards the person, rather than wait for the person to overcome all barriers alone.
What role should non-governmental organizations and communities play in introducing new PrEP options?
Their role is key. Communities understand best where the barriers are, whom the system is not reaching, who is afraid to seek help, where a safe space is needed, and where legal, psychological or humanitarian support is necessary.
Non-governmental organizations can inform, motivate, refer, accompany and help a person move through the entire pathway. They can explain things in a language that a person trusts. They can work with people whom the formal system often does not see or does not know how to reach.
But it is important that community participation is not symbolic. Communities must be involved in planning, implementation and service monitoring. Otherwise, a service may formally exist, but people will not use it.
What key message about PrEP, prevention choice and innovation from Ukraine should be heard in the EECA region ahead of AIDS 2026?
The main message is multiple choice.
People should have a choice of prevention options. People should have a choice of where they can receive a service. People should be able to seek support safely, without stigma and discrimination, in a space they trust.
The second important message is that PrEP cannot be separated from other services. It must be part of combination prevention. If a person comes for PrEP or testing, they should also be able to receive other support: psychological, humanitarian, legal, sexual health counselling, testing and diagnosis for sexually transmitted infections, viral hepatitis and other services.
Prevention works when it is not isolated. It works when it sees the person as a whole.
To put it briefly: what should modern HIV prevention look like if it is to truly work for people in real life?
It should be diverse, safe and close to the person.
Not one option for everyone, but a choice for different needs. Not only a medicine, but a pathway. Not only a medical service, but trust. Not only innovation on paper, but real access in a safe space.
This is how prevention can work for people — not in ideal conditions, but in real life.
