HIV patients in Ukraine face treatment ‘apocalypse’ as US funds in limbo

Ukrainian HIV patients are worried their life-saving drugs will run out amid uncertainty over U.S. funding.

President Donald Trump’s massive ax in January to projects funded by its international development agency USAID hit NGOs and government-run projects in Ukraine working to tackle one of the largest HIV epidemics in Europe. 

The U.S. administration later reversed cuts to life-saving humanitarian assistance for 90 days — while it conducts a review of foreign aid — bringing a reprieve to these Ukrainian services. But with no long-term funding decision in sight, and with supplies of medicines only sufficient until November, health staff and patients are fearful they will have no means to control the deadly infectious disease.

“We’ve never had such an apocalypse before,” said Anzhela Moiseyenko, who heads the Chernihiv Network, a Ukrainian organization of people living with HIV. 

Ukrainian services have already had a bitter taste of what might come.

The temporary pause left the country scrambling to maintain treatment for over 116,000 people with HIV, while some testing and prevention services have scaled down and may close, as urgent treatment needs take priority. 

The Chernihiv Network ran an HIV testing service through three years of war. But at the end of January the USAID-funded project abruptly stopped for two months as funds ceased, Moiseyenko said.  

Deliveries of antiretroviral therapy (ART) to Ukraine were stranded en route by the stop-work order, said Dmytro Sherembey, who heads NGO 100% Life. Some stocks, including for children, are now running short, he said. Contracts with pharmaceutical companies had to be cancelled then restarted, while funding uncertainty affects procurement, which has to be planned months in advance.

“We have no guarantee they won’t announce a halt again. There is no system through which we can plan for the future,” said Sherembey, who was among the first 100 people in Ukraine to start ART in 2002 with U.S. funding. The therapy has to be taken daily for life.  “You can’t put life on hold,” he said. 

Jeopardizing progress

Before the war, the story was quite different.

While Ukraine has the largest HIV epidemic in the European region after Russia, by 2022, nationwide testing, prevention and treatment were on track to control the infection. New cases were dropping and many people’s disease was controlled with medicines. 

But after Russia’s full-scale invasion more than 50 percent of the country’s budget was allocated to defense. International funding kept health systems afloat.

“Because the country is at war, there is no other source of financing,” Moiseyenko said.

The U.S. president’s Emergency Plan for AIDS Relief (PEPFAR) took over the purchase of all antiretroviral therapy for people with HIV — previously 80 percent funded by Ukraine — contributing close to $16 million for medication and test kits in 2023-2024. 

Following the blanket stop-work order, all national HIV services were interrupted for at least two to four weeks. Now care providers are trying to second-guess why U.S. funding for most projects has been resumed — and, critically, for how long. 

“It’s not finally clear, and we are not asking — it got released, so we just keep working,” said Andriy Klepikov, executive director of the Ukrainian NGO Alliance for Public Health which, together with 100% Life, manages prevention and support services through local partners.

The 90-day review period has been extended for another 30 days, Devex reported, which ends May 20.

The U.S. State Department told POLITICO in an email: “While the Department has acted swiftly, and finished a comprehensive review of all of its existing awards, this process remains ongoing.” The Office of Management and Budget is conducting a review.

The department referred to statements from Secretary of State Marco Rubio that PEPFAR is an important and life-saving program that will continue, but which should be reduced over time.

Adapting services

In the meantime, Ukrainian health authorities have reallocated drugs to regions with the most need and prioritized combinations of available medications in order to prevent treatment interruptions. According to the Ukrainian Health Ministry’s Public Health Centre, Ukraine can continue providing ART for all current and new patients until at least the end of November. 

 “The policy is to preserve the whole range of life-saving services without reduction or suspension, even under conditions of martial law or unstable external financing. The ministry, [the Public Health Centre] and [its] partners are all working to find a stable solution and source of support to continue HIV services in full,” the Centre wrote in a response to POLITICO.

The future of testing and prevention programs is even less certain. They are affected not only by dwindling commodities such as rapid test kits but also by new U.S. rules on diversity, equity, and inclusion and reproductive health. 

The Chernihiv testing service worked with HIV-vulnerable groups like men who have sex with men and people involved in sex work, who fall into new exclusions. In early April the service restarted on a smaller scale and with a new policy. “Now we don’t highlight the groups that raise concerns,” Moiseyenko said.

Although planned to run until 2026, the service’s funding has resumed only until the end of September. 100% Life has laid off a quarter of its staff from reduced or halted projects.

Over the last two decades, seasoned Ukrainian NGOs have weathered several U.S. policy changes affecting HIV funding priorities, while keeping services running. “It’s important to acknowledge how massive and critical U.S. support has been,” said Klepikov of the Alliance for Public Health.

The reach of the current cuts, however, is unprecedented. The second major donor for HIV and TB response in Ukraine is the Global Fund, an international financing and partnership organization. A third of its financing comes from the U.S. and is unlikely to be replaced from elsewhere, according to Klepikov, who warned this cash may be reallocated to medicines at the cost of prevention. 

Meanwhile, WHO’s Ukraine mission is 17 percent U.S.-funded and has already seen a $8 million reduction, said WHO Ukraine representative Jarno Habicht. The mission has cut staffing, training and technical support that had been building Ukraine’s capacity to respond.

Habicht suggested that Ukraine and its partners can balance other international funding streams to protect crucial services. But many countries are cutting support as they bolster defense and security.

Klepikov hopes countries will see that stopping the spread of diseases like HIV is in line with these new priorities. “The programs we implement are contributing to global security and economic stability,” he said.

Uncertainty and apathy

The funding uncertainty is compounding the negative health impact of the war in Ukraine. 

In spring 2022, when Chernihiv was surrounded by Russian troops, Moiseyenko recalled how patients would travel long distances, risking shelling and capture, to get their HIV medication. Now, apathy is setting in, and people are more likely to miss treatment doses.

Ukraine registered over 10,000 new cases of HIV in 2024. In the last two years, 75 percent of new cases in the Chernihiv region were in late stages of the infection — making it harder to treat and easier to pass on. 

Late diagnosis and less adherence to treatment will only increase, according to Moiseyenko. “It’s already hard to motivate someone, when after three years of war they can’t see any future,” she said. “Cutting programs will lead to more deaths.”

For the moment, patients and health care providers are awaiting a final U.S. decision — and watching as the U.S. attempts to end the war.

“For 20 years there was this huge effort to stop HIV,” Sherembey at 100% Life said. “If you put this on hold it means that 20 years of effort went for nothing, and very quickly we’ll be back where we started.”

Correction: This story has been updated to correct the amount of funds the WHO Ukraine mission receives from the U.S.