Today is 14 March 2022. Russia invaded Ukraine on February 24, 2022-a major escalation of the Russo-Ukrainian conflict that began in 2014. In the days leading up to the invasion, I tried to understand the historical issues at play. Since the military invasion of Ukraine by the Russian Federation, I have read and watched the news to stay informed.
It overwhelms me to know that the largest forced migration of persons in Europe since World War II is currently underway. The United Nations High Commission on Refugees estimates that 2,824,784 individuals have fled Ukraine as of 13 March 2022 (UNCHR, 2022). In reading today's Ukraine headlines, I learned that the pregnant woman we saw being carried on a stretcher from the maternity hospital in Mariupol to an ambulance on March 9, 2022 died, as did her baby (Chernov, 2022). In cities across Ukraine, civilian populations are being attacked; the victims of war are being buried in mass graves (Peter, 2022).
During 2020, in Eastern Europe, Ukraine had the second highest rate per 100,000 of new HIV infections (37.5/100,000), just behind the Russian Federation (40.8/100,000; European Centre for Disease Prevention and Control/WHO Regional Office for Europe, 2021). Further, "Eastern Europe also remains the global epicentre of multi-drug resistant tuberculosis globally. Despite progress in the last ten years, TB prevalence, mortality levels and particularly, incidence of multi-drug resistant tuberculosis remain high in Ukraine which has the second highest number of cases in the region" (Kazatchkine, 2022, paragraph 11). With the mass migration of people, major disruptions in health systems and services within Ukraine, and fragile health systems across Eastern Europe due to the COVID-19 pandemic, it is essential that those remaining in Ukraine and those emigrating for their safety have access to health services, including HIV and TB care and treatment.
As I think about Ukraine, my mind keeps taking me to Rwanda, where I have collaborated with colleagues on HIV stigma research for the last several years. I keep thinking about their genocide, the mass displacement and migration of individuals, and what that meant for the HIV epidemic in Rwanda. In this context, I find myself contemplating what I know from Rwanda and how it might apply to the situation in Ukraine and the region.
After the Rwandan genocide, the incidence of HIV in the country increased. I am worried that we may see an increase in HIV across Eastern Europe in the future. Research conducted by Vasylyveva et al. (2018) documented that the Ukrainian civil unrest of 2013-2014, the annexation of Crimea in 2014, and ongoing military conflict in Eastern Ukraine resulted in large-scale human migration that affected the HIV epidemic dynamics within and among the regions of Ukraine. In the days, months, and years to come, it is critical that the internally displaced persons of Ukraine, and those forced to emigrate, have access to essential health services, which includes HIV and TB prevention, care, and treatment, as well as primary care, mental health care, and other forms of specialty care. Although the media has not reported on the rape of internally displaced women and refugees, we know that displaced women are at higher risk for sexual violence (Vu et al., 2014).
By the time the world convenes in Montreal for the 24th International AIDS Conference in late July, I hope for a cease-fire or an end to the war in Ukraine. And because the world supports the rebuilding of a democratic Ukraine after the end of this invasion, it is critical that HIV and prevention, care, and treatment services be scaled up. Similarly, care and treatment to address what might be a worsening multidrug-resistant TB crisis in Eastern Europe will also be paramount. As in Rwanda after the 1994 genocide, there must also be significant investments in mental health services because so many will experience the posttraumatic effects of war, violence, and internal displacement and migration, as well as grief associated with the senseless loss of human life.
As a global citizen and as a nurse, I want to do something. Although it seems insignificant, a contribution to the International Rescue Committee, UNICEF, Catholic Relief Services, Doctors without Borders, or other relief organizations is helpful. ABC News provides a great resource document on how to help the victims in Ukraine (available at https://abcnews.go.com/International/ukraine-amid-russian-attacks/story?id=83156).
As individuals, we can also contact our elected officials and help them understand the critical importance of HIV and TB prevention, care, and treatment services in Ukraine and Eastern Europe-now and in the future. Additionally, it is important that we remember to take care of ourselves. As a result of the pandemic, contemporary and historical systemic racism, police brutality, and numerous other ongoing issues, many of us already feel overwhelmed and stressed. Bryan Robinson, in his Forbes' article, How The War In Ukraine Is Affecting Our [DOUBLE HIGH-REVERSED-9 QUOTATION MARK]Work Health" With 7 Prevention Tips is helpful (Robinson, 2022).
Disclosures
The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.
Author Contributions
Michael V. Relf was involved with the conceptualization, writing the original draft, and review and editing.
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