Community-based and community-led testing services are crucial in the HIV/AIDS, viral hepatitis, and sexually transmitted infections response, particularly in reaching populations where diagnosis and linkage to care are lower than the national average. However, providing these services can be challenging, especially in environments that may be hostile towards community-based and -led service delivery, and where policy and legal barriers exist.
In 2022-2023, the COBATEST Network supported six member organizations in countries where the environment is particularly challenging for community-based and community-led service delivery. In the following interview with Fulkrum UA, one of the 6 organisation supported, we asked the organisation to tell us about their work, the challenges they face, and how they are working to improve community-based testing services for HIV/AIDS, viral hepatitis, and sexually transmitted infections in their communities.
Within your project you provide self-tests. How popular is self-testing in Ukraine and what is the level of access to it?
In fact, self-testing is quite popular in Ukraine because, whatever it is, people still fear stigma and prefer anonymity and privacy. In addition, the postal service in Ukraine is very good and fast, even despite the martial law. So it's a convenient and fast option for people. But not many organizations provide this option, and there are only two links to this option on the website of the Public Health Center of the Ministry of Health of Ukraine - https://phc.org.ua/kontrol-zakhvoryuvan/vilsnid/testuvannya-na-vil. So it is very important to be able to provide this service, because not all people are ready to go directly to a doctor or medical facilities.
How would you describe the challenges faced by the LGBTQ+ community in accessing HIV testing services in Ukraine?
If we're talking about LGBT+ people who live in small towns and villages, then of course this is a problem. Due to martial law, there are about 5 million internally displaced people in Ukraine. In addition, infrastructure facilities are subjected to massive shelling by Russia on a daily basis. So all this worsens access to medicines, testing, services, consultations, etc. Moreover, part of the territory of Ukraine is under occupation, and it is impossible to deliver, for example, self-testing boxes or therapy there at all. So we will face many more negative consequences after the war ends.
What particular activities have you implemented within your project? Did you have any special strategy for reaching the target population?
We offer both self-testing and in-person HIV/STIs screening. The Friendly Doctor project has been operating since 2014, and its services have never been interrupted. Therefore, beneficiaries are familiar with us and choose our services. Over the years, our project has become a brand, so there is always demand for our service. We use social media to spread information about the availability of services.
No that the project is over, how would you evaluate its results?
The project results are positive because we could provide services to those who needed them. During the war, it is difficult to be sure of anything, and the fact that we helped people take care of their health is priceless. Of course, we see that the demand for HIV testing remains and will remain, so it is important for us to continue our work, especially given that our people and territories currently under occupation will return to us.
What are the gaps in HIV prevention in Ukraine and where community response could play a stronger role given the opportunity?
The main gap is the lack of sexuality education in Ukraine, which should be organized at school. But, for example, LGBT+ organizations do not have the opportunity to conduct sex education for students, so they can only work in the information field. That's why we do collabs with bloggers and various media projects on social media to spread information about sexual transmission and methods of protection and prevention. On the other hand, there is still a lot of stigma attached to sexually transmitted diseases. Paradoxically, people are afraid of HIV, and therefore believe that it is better not to be tested and not to know their status, which is more dangerous. Therefore, work must also be done to overcome myths about sexually transmitted infections.
This support was possible due to small grant programme as part of the project "Community Led and Based HIV Services - Key to Ending the HIV Epidemic in Europe and Central Asia" implemented by AIDS Action Europe, LILA Milano, and CEEISCAT in the framework of the COBATEST Network and supported by the "Zeroing In - Ending the HIV Epidemic" Programme funded by Gilead Sciences.