The war in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission. Ukraine has the highest HIV prevalence in Europe.

An international team of scientists has analysed genetic sequences to reconstruct viral migration patterns and found that the war-related movement of 1.7 million people was associated with the dissemination of HIV in Ukraine. The study, published on the website of the Department of Biology at the University of Oxford, revealed that areas with a high prevalence of risky sexual behaviour were the main recipients of the virus.

Lead author Tetyana Vasylyeva, a DPhil candidate, said:

In a country of 45 million people, an estimated 220,000 are infected with HIV – the highest prevalence in Europe. The epidemic started in the 1990s with an explosive rise in the number of new infections in people who inject drugs, but today 70-80% of new infections are reported to be in heterosexual people who don’t inject drugs. It is a silent epidemic, because about 50% of HIV-infected people are unaware of their infection status and around 40% of newly diagnosed people are in the later stages of the disease.

She added:

The war and internal migration in Ukraine has created a worrying epidemiological situation: new HIV strains might be moving at a higher rate to regions where the conditions for onward transmission are most appropriate.

The researcher pointed out that the work being done to enable the smooth running of treatment and prevention services in occupied regions is therefore of critical importance. Recently relocated people should be linked to care and harm reduction services, and there needs to be additional support for non-governmental organisations and medical facilities to help monitor and prevent local outbreaks in the central and southern regions, and in the whole of Ukraine.

Virus migration has increased rapidly and follows a westward pattern. Donetsk and Lugansk, two large cities in the east of Ukraine, are the main areas and exporters of the virus.

Senior author Dr Gkikas Magiorkinis, formerly of Oxford University/PHE and now of the National and Kapodistrian University of Athens, said:

This study provides evidence that the movement of people in Ukraine during the war was followed by increased risk of HIV transmission. Our analysis suggests that harm reduction services should be scaled up in order to prevent further transmission of HIV in the country, and that international support should be provided to prevent a potential new public health tragedy.

Anti-HIV drugs fail in Ukraine, and the virus resistance there is undermining the effectiveness of HIV treatment across Europe

The researcher said that in the past, the prevalence of virus resistance against drugs used to treat HIV infection was 34%, much higher than in other European countries. For instance, PreP is a drug treatment that can prevent HIV infection in people who are at substantial risk and has recently emerged as an important public health strategy to control the spread of HIV. However, the expert says that in Ukraine, this method may not only become inoperable, but could undermine the effectiveness of HIV treatment in the near future.

Earlier, Science reported that antimicrobial resistance (AMR), a phenomenon when microorganisms are able to survive and multiply in the presence of antimicrobial agents that would normally inhibit or kill them, is a serious problem in Ukraine. This means that some infections do not respond to the active substances or drugs.

Although the experts’ findings regarding AMR were related to bacterial infections, the root of the problem is the same as the decrease in the effectiveness of anti-HIV drugs.

Ukraine has no law or regulation on medicines, and various drugs, antibiotics, painkillers are sold over the counter, leading to misuse. Due to the regular and frequent use of antibiotics, bacteria become increasingly resistant. Excessive use of antibiotics can worsen infectious situations, as it promotes the development and spread of genes that cause drug resistance.

the World Health Organization (WHO) recently warned.

Experts say that in this way, AMR poses a more serious threat than HIV or malaria. Conflict zones are essentially the cradles of AMR.

Dr Jonathan Pearce, Head of Infections and Immunity at the MRC, pointed out that studies that shed light on how a disease is spread are important to enable development of effective prevention strategies.

In this example, we see how the displacement of people as a result of man-made disaster, war, is contributing to the increased spread of HIV in Ukraine. This understanding will help officials shape public health practices to better manage and prevent HIV infection,

he stressed.