Over the past month, the conflict in Ukraine has resulted in the displacement of more than 3.67 million individuals, according to the latest United Nations High Commissioner for Refugees (UNHCR) estimates. The corresponding humanitarian response of neighbouring countries towards refugees fleeing Ukraine has been nothing short of inspiring, with people leaving supplies such as child strollers in train stations, and others opening their homes to those who have nowhere else to stay. Despite this, the response to an influx of refugees will need to transition from providing for immediate needs to treating chronic conditions such as testing and treatment for human immunodeficiency virus (HIV). Doing so will save lives and may also mitigate the HIV transmission in areas to which refugees are fleeing, including the five major European markets (5EU: France, Germany, Italy, Spain and the UK) and Russia.
Ukraine has one of the world’s highest HIV incidence rates, with more than 13,000 new infections a year, and the second highest prevalence in Europe and Central Asia, with more than 250,000 people living with HIV (PLHIV), according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). While many of these cases are concentrated in key populations (men who have sex with men, people who inject drugs, and female sex workers), routine HIV surveillance reveals an increasing proportion of women being infected with HIV. The latter now accounts for 46% of PLHIV in Ukraine. Given that a considerable number of Ukrainian refugees are women, a lack of access to HIV testing will lead to an elevated risk of transmission among refugees and host countries. This is particularly relevant for Russia, which already lacks resources for HIV testing and treatment and is expected to reach more than 240,000 undiagnosed HIV cases with a treatment rate of around 47.8% this year, according to GlobalData epidemiologists.
The conflict has also disrupted access to critical antiretroviral therapy (ART) among refugees. Proper and sustained ART not only prevents HIV infection from progressing to acquired immunodeficiency syndrome (AIDS), but also reduces the viral load to undetectable levels, which eliminates the risk of HIV transmission. Such disruptions may, therefore, not only increase mortality among refugees, but also further increase transmission in the 5EU and Russia, where total HIV cases are expected to reach 690,000 and 1.04 million this year respectively, according to GlobalData epidemiologists.
To mitigate a potential uptick in HIV transmission in these countries, it is imperative for governments to make HIV testing and treatment services accessible to refugees fleeing Ukraine. Such services have been shown to reduce HIV transmission and mortality. As such, the extension of such services is a logical step in the humanitarian response to the conflict.