“Everything was taken from me”: Life, loss and survival in a Ukrainian shelter
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Background
We have the knowledge and tools to create an HIV-free future globally, yet AIDS-related deaths in the Central and Eastern Europe and Central Asia (CEECA) region have increased by 48% since 2010. The region faces a public health crisis, political instability, war, and increasingly restrictive civil society legislation, combined with global development funding cuts.
Global development funding cuts
The CEECA region is the only region in the world where both new HIV infections and AIDS-related deaths are rising, with an estimated 2.1 million people living with HIV – of which half do not have access to life-saving treatment. Despite this, international funding is steadily declining, with global donors expecting national governments to step in. However, in several countries, less than 50% of HIV prevention programs for key populations, those that are most affected by HIV, are state-funded. This means that global development funding cuts have a direct impact on access to HIV services.
Disruption of HIV services
According to a survey of 47 community organisations across CEECA conducted by ECOM1 and EHRA2 in March 2025, one in four reported immediate risks of service interruption due to their dependence on PEPFAR funding, and 35.7% lost funding entirely. This has forced closures, staff layoffs, and disruption of HIV testing, PrEP distribution, and treatment access. In total, an estimated 250,000 people have already been affected, with up to 400,000 at risk if current trends continue.
Putting communities at the heart of the HIV response
We know that directly supporting communities that are at the highest risk of infection is the most effective approach in the response to HIV. They know best what they need to remove the barriers to prevention and treatment.
Through the participatory grantmaking model, in-country and regional experts determine which key population-led or key population-based organisations in the region receive funding for their activities. That’s why in 2023 we proudly transferred grantmaking responsibilities to two community-based organisations in the region (ECOM and APH). Together with them, we set up a participatory grantmaking model, whereby communities decided on the distribution of grants themselves. With the model, we followed the belief that, more than ever, communities in the region should be at the steering wheel of the decisions on HIV programming and support.
Each year, we made funding available to key population-led and key population-based organisations to ensure:
- Access to HIV prevention, testing, treatment and adherence services for key populations
- Reduced inequalities, including stigma, discrimination and criminalisation, that hinder an effective HIV response
- Community systems strengthening, that allows for increased access to finance, building or joining coalitions and contribution to the overall HIV response system strengthening.
Achievements in 2023
APH
109 small grants up to 5000 euros were provided to 61 community-led organisations and initiative groups in Ukraine, demonstrating their leadership qualities in quick response to the urgent needs of key populations. The grants covered various needs, such as food, medicine, hygiene products, access to treatment, psychological counselling, employment counselling, etc.
As a result, a total of 42,214 people had access to services provided by communities to communities. Among them were representatives of people who inject drugs, sex workers, LGBTIQ people, OST clients, (former) prisoners, people living with HIV and other communities affected by HIV.
APH facilitated knowledge exchange between the representatives of key populations and collaborated with key population-friendly organisations. Because of this, some of newly registered initiative groups managed to reach out to a larger number of people in need of services and were able to apply for other funding opportunities which shows the sustainability of applied approach.
ECOM
28 applications from 10 CEECA countries were approved following two calls for proposals by ECOM to support community-led organisations and groups serving key populations vulnerable to HIV. The calls focused on self-organisation of migration communities; countering repressive laws; eliminating political barriers for migrants with HIV; and providing services to key populations in migration. Two applications each from Azerbaijan, Armenia, Romania and Slovakia; three applications each from Kazakhstan, Kyrgyzstan, Lithuania and Poland; and eight applications from Georgia were approved.
Accordingly, over 3,800 individuals from key populations received services, with over 6,000 consultations from a range of specialists on health and social issues (52%); mental health consultations (39%); and legal consultations (9%). Temporary residence, food aid, employment support, and medical assistance were also provided.
