Before the Russian invasion, Ukraine was already facing a serious HIV epidemic. According to UNAIDS, over a quarter of a million people are now infected, of whom an estimated 120,000 are women, with an HIV incidence of 0.41 per 1000 in the 15-49 age group. Often people do not even know they carry the virus.

This also applies to the Ukrainians who have fled the war in their country. More than five million refugees have sought refuge in other countries, the majority of them women and children. An estimated 8000 of these women are unaware of their HIV status; in total 18,000 need treatment.

This puts a huge strain on medical care in the host countries, especially in Poland, which has taken in more than 1.5 million refugees. The capacity of Polish HIV clinics may have to be doubled in the near future, expects UM researcher Kai Jonas, who analysed the current situation with a Polish and Dutch colleague.

Unique situation

They say that lessons can be learned from refugee crises in Africa and the effects of large natural disasters, on HIV epidemics. Yet, what makes this situation in Europe unique is the expansion of the risk population - mainly consisting of men-having-sex-with-men (MSM) - to include heterosexual females. Tackling this situation will require some adjustment in the provision of care, especially in Western Europe where the main focus lies on MSM and migrants from other geopolitical regions.

This calls for a shift in communication about HIV prevention programmes and healthcare providers will need to refocus to understand the new target group. The priority for these refugee women will probably not be getting an HIV test or treatment, especially if they are unaware of their HIV status. Therefore, healthcare providers in general and community activists working with refugees should actively offer testing and ensure access to care.

The good news

Yet, this humanitarian crisis also presents an opportunity to eradicate HIV once and for all by 2030, the researchers say. If the host countries succeed in offering refugees easy access to HIV testing without stigmatisation, a large proportion of those who have not been tested and are unaware of their HIV status could be diagnosed and receive care.

The burden of the HIV epidemic in Ukraine is now shared by several countries. This gives us the opportunity to significantly improve the overall situation of the epidemic - even if it means more demands and challenges.