On 10 April, Tetyana Pryadko (not her real name) was phoned by her doctor, who told her that her antiretroviral therapy to treat HIV had arrived. For Tetyana, who has been on treatment for 10 years, it was an important call. Her treatment hadn’t been interrupted once in 10 years, but now she had only a five-day supply left. She lives in Chernihiv, which was on the war’s front line, cut off from the old supply chains that kept her supply of HIV treatment uninterrupted.
Before the outbreak of the war, antiretroviral therapy was widely available in Ukraine. Larisa Getman, the Head of the HIV Management and Response Department of the Public Health Centre, Ministry of Health of Ukraine, explained that, “The majority of antiretroviral therapy was procured by the state through the National Procurement Agency.” 100% LIFE is the largest organization of people living with HIV in Ukraine, that implements the procurement of medical goods under the Global Fund projects and operates humanitarian aid under PEPFAR programs, including emergency supplies of antiretroviral drugs.
Valeria Rachinskaya, the Director of Human Rights, Gender and Community Development at 100% LIFE, who herself has been on antiretroviral therapy for many years, explained that the COVID-19 pandemic had actually improved treatment adherence, since it has become the norm to have a multiple-month supply of medicine at home, which was mailed to those who couldn’t access a clinic. Remote counselling and the widespread use of mobile applications have also become routine.
“People weren’t without medicines at the start of the war. The worst was for people in the cities that were the most heavily bombed, where not only medical facilities were destroyed but also logistic chains were interrupted,” she said.
“Before the war, the whole procurement and delivery process in Ukraine was quite easy,” said Evgenia Rudenka, Head of 100% Life’s Procurement Department. “Cargo was delivered to the airport, we cleared it at our warehouse and transported it. But the war happened, and it was urgently needed to figure out how to deliver those medicines to the country, and, most importantly, how to deliver them to patients. And we worked out these mechanisms from the very first days of the war with our partners.”
At the request of the Ukrainian Public Health Centre, under support of USAID and CDC, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) agreed to help with the urgent supply of antiretroviral therapy. Chemonics, a purchasing agency of PEPFAR, searched around the world for spare stock and secured vital supplies.
Through the support of the European Union who immediately developed the special humanitarian aid transit procedures for Ukraine, deliveries have begun to take place through neighbouring countries, primarily Poland and Romania. “Through the support of the Railway Service, we have organized the pickup of the cargo at a separate station away from the main delivery point of most Humanitarian Aid that comes to Ukraine. It was done with the purpose to manage the immediate distribution to regions. (As a huge number of humanitarian supplies from different countries goes through the State Agency for Strategic Reserves of Poland, it is quite hard to take the goods immediately from there.) So we have brought in a logistics company that can deliver goods to Ukraine under the humanitarian transit procedure, to a warehouse in Lviv, from where we are able to make the immediate distribution” said Ms Rudenka.
The most difficult and the most important part of the process is delivery throughout Ukraine, including the front-line zones.
According to Evgenia, many logistics companies have stopped operations during the war, and those that remain have increased the cost of their services by two- or threefold.
Commercial organizations are not willing to go to cities such as to Kharkiv, Kherson or Mykolaiv, but volunteer drivers, working in coordination with local authorities, drive there, evacuating people and delivering medicines and other goods.
“Where there is fighting, the volunteer drivers will unload at, for example, the regional administration headquarters, and then we communicate with the medical institutions that are the final recipients, we tell them where to pick up the goods,” she said.
Even so, several volunteers have come under attack, and four have been killed.
“The situation for people living with HIV in Ukraine is desperate. We are trying to deliver medicines, food, and other emergency assistance to people in need, but the work is dangerous and volunteer drivers are putting their lives at risk. If we don’t get more help, I am not sure how much longer we can continue, especially reaching people in the front-line zones,” said Dmytro Sherembey, the Head of the 100% LIFE Coordination Council.