On March 4th, the official signing of the agreement for the start of a new project by Expertise France and the Alliance for Public Health Foundation took place. The project aims to provide comprehensive medical and psychosocial support to women with drug addiction under opioid substitution therapy programs, as well as support for victims of violence.

The project is designed for 3 years and focuses on a gender-oriented approach. “Our new partnership with Expertise France aims to expand access to critical medical services for the most vulnerable populations,” said Andriy Klepikov, Executive Director of the Alliance for Public Health. “We will work to overcome gender barriers faced by women receiving substitution therapy treatment.”

The project will be implemented in collaboration with the All-Ukrainian Association of Women Drug Users “VONA” and Frontline AIDS, in coordination with the Global Fund, the Public Health Center of the Ministry of Health of Ukraine, and medical institutions in Kyiv, Lviv, Odesa, Dnipro, and Kryvyi Rih.

It is worth noting that the Alliance for Public Health already has experience collaborating with Expertise France on another important project. This is the “Mobile Treatment Points” (MTP) – mobile units providing comprehensive services in remote and liberated territories near the contact line.

“We are grateful to the French Ambassador to Ukraine Gaël Veyssière, the Director-General of Expertise France Jérémie Pellet, the Technical Director Eric Fleutelot, Arthur Langlois, and Natali Martynenko for their extraordinary support!”

Photo: Veronika Yaresko

Supporting communities in documenting experiences and solutions

Ukrainian state and non-governmental organisations and communities continue to provide crucial services for vulnerable populations in Ukraine, despite Russia’s invasion. Alongside ongoing public health challenges, huge new needs have emerged due to the war that has killed and displaced millions, disrupted supply routes, and destroyed social and medical infrastructure. OAT provision in Kharkiv, shelters for displaced people in Lviv and Krivyi Rih, TB screening in Nikopol, and mobile medical services in de-occupied frontline Kherson oblast are some of the experiences documented in a series of case studies by APH.

The studies, based on site visits and in-depth interviews, examine how organisations and services have adapted to working in both high and lower intensity conflict sites. A unique project in Warsaw, Poland helping Ukrainian refugees access medical and social services abroad is also documented. The experiences of Ukrainian medics, social workers, volunteers and project clients offer valuable lessons for planning and implementation of care provision in emergency environments, and provide a testament to their dedication, courage and innovation.

War response report

On February 21, 2023, an important meeting took place in Brussels, organized by the Alliance for Public Health, Aidsfonds, and Friends of the Global Fund Europe.

The event began with opening remarks by Serhiy Tereshko, Deputy Representative of Ukraine to the EU.

The main topic of the meeting was the discussion on combating HIV/AIDS in Ukraine amidst the full-scale invasion by Russia. International experts participating in the event discussed effective ways of cooperation between Ukraine and the European Union on the path of Eurointegration in this field.

At the beginning of 2022, it was estimated that 245,000 people were living with HIV in Ukraine. According to the Public Health Center of the Ministry of Health of Ukraine, currently, 83% of people living with HIV who know their status receive antiretroviral therapy (ART). At the same time, 95% of them have suppressed viral loads, meaning that the virus in their blood is so low that it is undetectable through laboratory tests.

Christine Stegling, Deputy Executive Director of UNAIDS, highlighted the powerful role of civil society and communities in responding to the HIV epidemic in Ukraine amidst the war.

Andriy Klepikov, Executive Director of the Alliance for Public Health, emphasized that “despite the large-scale war, Ukraine has managed to prevent a surge in the HIV epidemic. How? Primarily through cooperation between the government sector and civil society.”

“It has been two years since Russia began its brutal war against Ukraine. Despite the challenges, we have managed to keep the HIV epidemic under control in Ukraine. How? Cooperation between the government and civil society is key. When 14 million people became internally displaced, we transitioned to providing mobile services, working in de-occupied territories and near the front line. We are implementing artificial intelligence for better detection of HIV cases, and it works! It shows 37% better results compared to the traditional model. The HIV response has demonstrated tremendous flexibility: the number of clients in some areas of Western Ukraine has increased 15 times. We offer them an extended package, which includes not only HIV services but also addressing humanitarian needs, providing mental health support, and combating other diseases,” said Andriy Klepikov.

It is worth noting that since the beginning of the war on March 1, 2022, the Alliance for Public Health, with the support of the Public Health Center of the Ministry of Health of Ukraine and more than 100 international partners, launched initially the chat-bot service #HelpNow for operational assistance coordination for treatment access, and then emergency support hubs for Ukrainians in neighboring European countries. The largest number of Ukrainians traveled to Germany, Poland, the Czech Republic, and Moldova.

An important aspect remains constant international support, as the war lasts longer than expected, and the country’s recovery cannot wait.

It is important that representatives of relevant structures, such as the Directorate-General for Health and Food Safety (DG SANTE), the Directorate-General for European Neighbourhood and Enlargement Negotiations (DG NEAR), and the European Centre for Disease Prevention and Control (ECDC), took part in the meeting.

As a result of the meeting, it was decided to develop fruitful cooperation with the relevant structures of the European Union to ensure the most effective integration and cooperation between Ukraine and the EU in combating HIV/AIDS. A set of political recommendations will be developed and provided to all participants, and advocacy efforts will be directed in the coming months, covering various processes, including the accession process, Ukraine’s participation in relevant instruments, and the development of future financing instruments.

The ICF “Alliance for Public Health” is a pioneer in Ukraine in successfully implementing the SCLR approach. Its uniqueness lies in the fact that initiative groups of communities affected by the war are active by participating in the mini-grant competition and, with the funds received, solve urgent problems of specific people or the community as a whole, starting from digging wells to repairing and equipping shelters, medical points, creation of invincibility points, restoration of water and electricity supply. Community residents and IDPs rally to solve humanitarian needs and support vital initiatives thanks to such activities.

In the period from May 2022 to December 2023, the Alliance, within the framework of various humanitarian projects, together with its partners – regional NGOs, supported 695 public initiatives in 22 regions of the country, providing mini-grants for a total amount of more than 2 million GBP. As a result of the implementation of mini-projects, these public initiatives reached more than 436,000 affected people with various assistance. With the financial support of the Church of Sweden, within the framework of the project “Supporting community initiatives in Ukraine”, it was possible to support 159 public initiatives in 16 regions of Ukraine for over 499 pounds. Thanks to the work done, more than 131,000 Ukrainians received help.

520 children aged 3 to 17, including children with special educational needs, could spend their free time interestingly and usefully in the inclusive “Childhood Island” space in Shevchenkiv, Kharkivska Oblast. This space was created for children who lived in the occupation and did not have the opportunity to thoroughly study and communicate, as well as children who have mental disorders. Through joint efforts, it was possible to equip the room with sensory equipment to help young visitors relax and strengthen their psychological health. Also, the room is furnished with desks, laptops, a projector, bean bag chairs, easels, a karaoke microphone, a set of board games, and specialized equipment for psycho-emotional relief.

Since the primary goal of the SCLR approach is to support communities to improve their well-being in war conditions and develop their capacity to help the community and people in need further, it is the representatives of the initiative groups who actualize the needs of their community and offer their ideas for the implementation of the mini-grant. The Alliance engaged regional facilitators to help community representatives implement their projects. Facilitators became mentors to the initiative groups to unite them, prioritize their community’s problems and needs, help prepare the competitive application for receiving a mini-grant, and accompany the projects at all stages of their implementation.

The International Charitable Foundation “Center for Social Projects of the Future” from Kramatorsk, Donetska Oblast already has experience in successfully implementing mini-grants. The organization helps medical institutions in the region where, due to active hostilities, there are significant problems with the provision of medical care. To continue the work and provide high-quality essential medical services, it was necessary to purchase a new analyzer urgently. It helps to determine the levels of various biochemical indicators in the blood and is, therefore, very important for accurate diagnosis, treatment, and monitoring of patients in medical laboratories. It also helps doctors make informed decisions about patient care. This is a significant initiative, the result of which was providing high-quality medical services to more than 200,000 residents of Kramatorsk and the Kramatorsk district, which now includes Lyman and Sviatohirsk.

Implementing community initiatives with the help of mini-grants increased trust and interaction with people who asked for help. This helped provide affected communities additional resources to develop and address their immediate needs.

“We help implement “bright” ideas aimed at quickly overcoming the consequences of the war. They come from communities that better navigate the situation on the ground and see the most effective ways to overcome challenges. Thus, mini-grants enable initiative groups to meet urgent needs quickly and are a reliable tool for solving urgent problems,” said Maryna Varban, Senior Manager of the humanitarian support program, ICF ” Alliance for Public Health”.

ICF “Alliance for Public Health”, with the financial support of the Church of Sweden and technical assistance of the charity organization Christian Aid (Great Britain), implements the approach “Supporting community initiatives” (SCLR – Survivor and community-led crisis response) in Ukraine. The mechanism for implementing the approach is to provide initiative groups with mini-grants worth up to 5,000 US dollars to implement mini-projects of assistance to local communities.

Inspired by the successful experience of implementing public initiatives with the help of mini-grants, one of the national Swedish TV channels visited Ukraine and filmed a story about people’s lives in the realities of war to raise funds for the support of the Ukrainian people. You can view the story via the link: https://player.vimeo.com/progressive_redirect/playback/901880758/rendition/1080p/file.mp4?loc=external&log_user=0&signature=6269ec43c5bf9a295ecc5948d0d1d17c48fc9df4129acf7116fb451490aa17de

The SCLR (Survivor community-led response) approach was developed and implemented by the Local to Global Protection (L2GP) initiative. This is an international initiative of workers of humanitarian organizations and activists with diverse experience in humanitarian response. The primary objective of this initiative is to document and support local responses to protection, survival, and recovery during major humanitarian crises. More details at: https://aph.org.ua/uk/resursy/sclr_ua/

For additional information on the implementation of the “Support of community initiatives” approach, instructions for preparing applications, and samples of accompanying documents, contact the coordinator of the community of practitioners Yanyshyn Josef: yanyshyn@aph.org.ua

You can join the community of practitioners by filling out the form via the link: https://forms.gle/anbEbgQKrWdoqEMN6

Alliance for Public Health together with representatives of International Harm Reduction Professional organizations, presents a strategic document: “Emerging priorities for the reduction of harms associated with recreational use of psychoactive substances in Eastern, South Eastern Europe and Central Asia”.

Despite the enormous efforts invested to prevent and eliminate the use of psychoactive substances (PAS), the evidence suggests that a relatively stable proportion of the population continue using PAS. According to global estimates, 5.6% of the world’s adult population has used drugs at least once in the past 12 months (as of 2020).

This strategic document identifies priorities and methods of harm reduction work aimed at addressing the challenges associated with the use of PAS. Harm reduction is considering as a key component of the modern approach to drug use and represents an effective response to a wide range of problems that can arise from the use of PAS.

“The new paradigm of humanity’s relationship with psychoactive substances opens up opportunities for us to use them for the good, based on scientific research. It is important to remember that the modern approach to PAS is based on understanding the various factors and individual needs of communities of people who use PAS. This document is a step to a more balanced and humanitarian approach to the problem of the use of psychoactive substances,” said Vyacheslav Kushakov, Senior Adviser of the ICF “Alliance for Public Health” and the main ideological author of the developed recommendations.

The key principles and methods of harm reduction work, according to the recommendations:

• A relatively stable share of the population choses to use psychoactive substances (PAS) despite the significant efforts. Harm reduction is an effective approach that complements supply and demand reduction measures.
• PAS use is a complex phenomenon and harm reduction work must be adapted to the diversity of substances, patterns and circumstances of their use.
• The priority in the countries of Eastern, South Eastern Europe and Central Asia is work focus on highly problematic injecting use.
• Harm reduction services should reach not only those with problems, but also those who are just beginning to experiment with or use PAS recreationally.
• Resources and efforts in the field of harm reduction must be allocated rationally, taking into account different groups ofdrug consumers and their needs.

Summing up 2023, we are proud to be relevant, agile, effective and impactful. In 2023 we managed the largest scope for the entire 23 years of our existence, with % budget increase maintaining the core business and addressing the challenges brought by the war.

In the midst of war Alliance for Public Health (APH) remains to be key civil society partner for the government as well as national response to HIV, Tuberculosis and Hepatitis.

Seems 2024 would not be easy. We are incredibly thankful to all our partners and donors, civil society and communities, volunteers and military, to all social and medical workers, nurses and doctors working on the ground. Together we are stronger. Together we will make the difference. Together we will win!

APH is wishing you wonderful holidays to recharge, as we need resilience, wisdom, inspiration and love to make 2024 a wonderful, successful and victorious year! Let’s win together!

In 2023, World AIDS Day is being observed for the second consecutive year under the shadow of Russia’s war against Ukraine. This conflict has had a devastating impact on people living with HIV in Ukraine

Nearly 20% of Ukraine’s territory has been occupied by Russia, over 10 million people have been displaced within or outside Ukraine, and more than 1,500 medical facilities have been damaged or completely destroyed.

Since the early days of the large-scale invasion, the Alliance for Public Health, along with other civil society organizations, has been working tirelessly to ensure a sustained response to the HIV epidemic and address new humanitarian needs caused by the war.

We share this SitRep on the HIV epidemic in the context of war: read more

We have been fighting for our land, independence, and freedom for over a year and a half. The Russian invasion of Ukraine has caused many critical situations for our society, such as damage to civil infrastructure, energy systems, government and military buildings, medical, educational, and social institutions etc. Thousands of people lost their homes, jobs, documents, and relatives and were forced to start their lives from the beginning in a new place both within the country and abroad.

“Our village was on the line of hostilities, so we constantly suffered heavy shelling from heavy weapons. It was always terrifying because the Russians placed the equipment right before our house. Once, we asked the Russian military to go to a nearby street to get milk (we always had to tell where we were going), and just then, the shelling started. We immediately hid in the cellar, and our house was already on fire. The house was completely gone in the evening,” recalls Oleksandr Mykhailovych, Shestovitsia, Chernihivka Oblast.

Women feel a double burden of responsibility, both for their own lives and for their children’s lives, peace, and health. Many women were forced to leave everything to save the future generation of Ukrainians. In war conditions, children suffer many times more due to the deterioration of their psychological state, loss of already acquired skills, friendships, and family ties, lack of access to safe places, and sometimes even adequate food and water. It is tough now for mothers who have children with special needs because they are one of the most vulnerable categories of the population and need more attention and care.

“Psychological correctional assistance is needed not only for children with special educational needs but also for those children who have experienced stressful situations. Such children include the majority of displaced children who came to a new area from the occupied territories or war zones,” noted the specialists of the “FIDES” Psychological Center, who organized a safe space in March 2022, where during the year, psychological and correctional services 120 children are provided free of charge.

People with hearing impairments face fewer problems during the war because getting the necessary help is tough. After all, there are almost always problems with translation into sign language.

“My husband and I are pensioners; we moved to Dnipro from Bakhmut. Our home is destroyed, and starting over at 73 is difficult, especially if you have health problems. Now, we rent a house and spend almost all the money on paying for the house. In humanitarian aid, we received a tablet with a translator. Now, we can receive remote assistance in translation into Ukrainian sign language, which greatly facilitates our communication with the world around us. When you find yourself in such a difficult situation at our age and cannot ask for help because you are not understood, or you do not understand – this translator becomes the only hope and support”, says 73-year-old Tetiana, IDP.

In general, all Ukrainians, to one degree or another, faced various challenges and needed or needed help. Sensing the need of Ukrainians, the ICF “Alliance for Public Health” and its 26 regional partners managed to quickly and effectively mobilize their forces and deploy humanitarian activities in almost all regions of Ukraine except the occupied territories in the first months of the war. This became possible with the significant financial support of the British Disasters Emergency Committee (DEC) and the robust technical assistance of the British charity organization Christian Aid.

As part of humanitarian activities, humanitarian aid kits are distributed to people, such as food and hygiene products, household chemicals or certificates for purchasing goods in supermarket chains, and certificates for buying medicines in pharmacies. Also, baby food sets, diapers, and other necessary goods are provided for children. Maximizing access to medical, psychological, and legal counseling, social support, and/or referral to partner organizations and specialized institutions (healthcare institutions, legal agencies, social assistance centers, etc.) became a significant and desired work direction. In NGO offices, shelters, modular towns for IDPs, and volunteer centers based on mobile dispensaries and train stations, in remote united territorial communities and regional city centers, experienced specialists work with people to solve their war-related problems.

• Evacuation and comprehensive advisory assistance

A young single mother, Alina was evacuated from Sloviansk to Dnipro with her newborn daughter. The woman was left alone with the child and needed support. Due to the war, young age, difficult situation, and the loss of her passport, the girl had neither the means to live on nor the ability to issue child benefits and assistance for IDPs. Alina was provided with specialist consultations, free accommodation, and meals in a shelter for three days, after which she and her daughter were transported to Kazatyn, Vinnytska Oblast, for further residence. Currently, she and her child are in a safe place, provided with free temporary housing and everything they need for living.

• Psychological assistance

“I turned to a charitable organization for help, stating that I needed psychological support. The center’s psychologist invited me to a consultation, and later, I started visiting her regularly, although I had never been to a psychologist before. Thanks to the interaction with the psychologist, it is easier for me to coordinate myself in various life circumstances, and my relationship with my children has also improved,” says Alla, a resident of Severodonetsk, who was forced to flee from the war.

Now the woman’s psycho-emotional state has significantly improved, she often participates in charity events, including as a volunteer.

• Medical and social assistance

“Treatment had to be postponed all the time: as a mother, I always worried about the children’s health first, and then about my own, if there was time and resources. Thanks to the humanitarian project, I received help and support through the necessary medication advice from a social worker on dealing with stress and employment. Currently, I have great motivation for employment; I am purposefully looking for a job; I go to interviews,” says 43-year-old Svitlana, a client of the OST program, Poltavska Oblast. – “I want to express my gratitude to everyone who responded to my request for help. Now, I feel relieved because the treatment has started, which is the most important thing. I am sure I will continue it, my health will improve, and it will be much easier to work and provide for my children.”.

“It’s even scary to remember how I ran away from Kherson with my little daughter. That’s what we were in; that’s what we ran when the opportunity arose to free ourselves. There was no money at all, and luckily for us, the employees of a charitable organization helped us get settled in a shelter. The only thing I felt then was helplessness and despair. It seemed to me that life was over, and there was no future. I practically did not sleep and felt fear constantly,” says Nataliya, an IDP from Kherson. When the woman sought help from the СO “СF “Public Health”, she was provided with safe shelter and consultations with all the necessary specialists. During the entire stay at the top, the woman receives free food, medical treatment, and counseling from a lawyer and a psychologist. Now, she has started attending trainings organized for residents of the facility.

During the project’s year of operation, 218,718 people received assistance, including IDPs, families with children, people with disabilities, representatives of groups most vulnerable to HIV infection, etc. Among these, 18,903 people were provided with food, hygiene, children’s kits, and/or medicines/home first-aid kits, 9,046 people found shelter in safe places, and 2,624 received targeted financial assistance.

The project actively supported community initiatives – this is when solving problems in a specific community is undertaken by the residents of the community, who have rallied on their own. Such motivated initiative groups could participate in open competitions held in 16 regions of Ukraine and receive funding for a mini-project aimed at overcoming specific problems or meeting the needs of community residents.

“Thanks to the implementation of the project “Glove – a warm and safe overnight stay at a police checkpoint for the needy,” we managed to equip seven police checkpoints and create places for people to spend the night, which are equipped with generators, heaters, folding tables, benches, machines for hot drinks and chairs for a comfortable stay. This made it possible to help more than a hundred people who left the occupation and did not have a home, as well as those who, due to the lack of light, electricity, and heating, did not have the conditions to spend the night at home”, – shares the results of the work of the initiative group from the NGO “Melitopol Voluntary Group “PATRIOT” “, who won funding to set up seven “Points of Invincibility”, which operate 24 hours a day and are free of charge for the temporary stay of people evacuating from the occupied territories.

From September 1, 2022, to August 31, 2023, funding supported 199 mini-projects of initiative groups from 20 country regions. Mini-projects related to solving a wide variety of community problems: from repairs, arranging temporary shelters for IDPs, bomb shelters, children’s playgrounds and premises for groups, repairing communications, providing fuel, opening sewing workshops, public laundries, kitchens, bakeries, and educational, corrective, rehabilitation measures. The results of such initiatives are still gratefully used by 153,935 residents of various communities.

For example, an initiative group of residents of Zastugna, Kyivska Oblast, thanks to the victory in the mini-grant competition, was able to furnish the premises of the village center of culture with furniture and equipment for holding various children’s groups, master classes, and teaching children from several nearby villages. In addition, separate rooms were equipped with a medical office. It provides free medical services not only to residents of Zastugna but also to other villages. “Our initiative group takes care of the improvement of the village, constantly compiles lists of needs, discovers new problems that need to be solved, and sets ambitious goals. We are happy that in such a difficult time for the country, there are projects of social orientation that help improve the lives of underprivileged sections of the population,” says Tetiana Pasichnyk, the head of the village.

A recent real-time assessment conducted by the international faith-based organization ACT Alliance has shown that an approach involving people and initiative groups to solve the problems of their communities is a best practice to support and strengthen plans to localize humanitarian aid in Ukraine.

“During the project, we were able to make sure that micro-grants enable initiative groups to quickly meet urgent needs and use the various opportunities of their communities to solve pressing problems. All initiatives come exclusively from communities that know the situation better and see the most effective ways to overcome challenges. This confirms the individuality and importance of this approach. We witnessed countless vivid examples of local ideas aimed at quickly overcoming the consequences of the war in Ukraine. It’s time to even more actively support people who do not sit idly by, but solve problems with their efforts, involving their community”, – Marina Varban, Senior Manager of the humanitarian support program, ICF “Alliance for Public Health”.

Summing up the year of activities of the project “Integrated Humanitarian Response in the Conditions of War and Post-war Reconstruction”, we can say that it was a good start; we have overcome this path with dignity and helped thousands of needy people. We have become stronger and wiser. But there is still a lot of work ahead. A large part of this work will consist of creating opportunities for forming and developing local initiatives, ensuring the availability of resources and assistance in their effective use to support all who will need them.

To this end, the ICF ” Alliance for Public Health” will continue to provide sub-grants to regional partner NGOs and will regularly announce open mini-grant competitions on its website https://aph.org.ua/uk/tendery/programni-konkursy/

Additional Information:

For 23 years, the ICF ” Alliance for Public Health» team has been helping people gain access to the prevention, diagnosis, and treatment of HIV, hepatitis, and tuberculosis, protecting human rights, and providing humanitarian support. The organization has extensive experience in successfully implementing complex, large-scale interventions in all regions of Ukraine in fruitful cooperation with NGOs, key communities, state, communal, and private institutions, business structures, etc.