War and infectious diseases: a double threat

How do wars affect the medical care of people with infectious diseases? This was a topic of debate at the AIDS 2022 Congress in Montreal.

Destroyed health system: a massive burden for people with HIV and tuberculosis

Dr Joanne Liu, President of the international emergency medical aid organisation Médecins Sans Frontières, explains that a lot has changed in the last few decades in terms of medical care for people in war zones. As recently as the 1990s, in many places only the treatment of war injuries was taken care of - in the process, many people outside the war, for example with infectious or chronic diseases, became "collateral damage". When trying to treat a victim of sexual violence with PrEP, she was told by a supervisor: "You don't die from rape." Today, doctors and aid workers in crisis areas try to give all patients the medical help they individually need.

According to Dr Liu, patients with HIV or AIDS in war zones are often exposed to a double threat: on the one hand, they are in a constant fight against the virus, and on the other hand, those affected are confronted with a destroyed health care system - all this in an environment that is basically already dominated by factors such as the collapse of civilisation and food shortages. This is also shown by the example of Ukraine: according to current figures, there are about 250,000 people living with HIV or AIDS, of whom more than 20,000 were undergoing treatment before the outbreak of the war. In addition, 19,000 people in Ukraine were receiving medical treatment for tuberculosis, 4,000 of them with Multidrug-resistant TB (MDR TB). 

Dr. Andriy Klepikov, Executive Director of the Alliance for Public Health, notes that the Russian war of aggression destroyed 750 hospitals in Ukraine. This development also had a massive impact on patients receiving medical treatment. In the first weeks of the war, contact was lost with the majority of people receiving HIV treatment. In such a precarious situation, many patients no longer saw any point in continuing treatment. Dr. Klepikov quoted a patient: "I don't know what will kill me first: the bombs or HIV."

Medical care in war zones: humanitarian aid is essential

In some cases, contacts could only be restored through painstaking work by NGOs. The Alliance for Public Health, for example, has ensured that medical care for more than 200,000 people with HIV can continue to be provided in times of war. 556 people at increased risk had started taking PrEP during the first 100 days of war, and the need for HIV prevention among trans* people in Ukraine had increased 6.8 times in some regions. Also in the war zones, doctors were able to treat patients with HIV for 3-6 months with antiretroviral therapy. According to Klepikov, the fact that it was possible to both reach new patients and re-establish contact with former patients in times of war speaks volumes about how indispensable programmes and services organised by NGOs for the prevention of HIV are and remain.

Without the commitment of civil societies and humanitarian aid, the physician emphasises, a large number of patients with HIV or AIDS would have had to interrupt or abandon treatment: since the first days of the war, APH, for example, would have transported 520,000 tonnes of medical supplies to Ukraine, covering 520,000 kilometres and evacuating hundreds of people from the most devastated regions. In order to guarantee long-term medical care in crisis areas, fully financed global funds are indispensable. Dr Klepikov sees another major health hazard in Ukraine in tuberculosis. People below the poverty line are particularly at risk - and even according to optimistic estimates, 9 out of 10 Ukrainians are still at risk of living in poverty this year due to the war. In the eyes of the medical doctor, three goals in particular must be met to support the people in Ukraine:

Infectious diseases often greater health threat than gun violence

Vinnay Saldanha, Director of the Regional Support Team for Eastern Europe and Central Asia at UNAIDS, sees global conflict as a massive threat to the implementation of international health strategies. About 1 in 14 people living with HIV, or 7% of all people living with HIV, live in conflict zones. 274 million people worldwide will be in need of humanitarian aid in 2022 - a dramatic increase compared to the previous year, which already had the highest number of people seeking help in years. In view of the steadily increasing number of armed conflicts worldwide, the UNAIDS director sees an acute need for action, especially in the form of flexible funds to respond to the health needs of people in crisis situations.

At the end of the event, all speakers agreed that infections and infectious diseases are often more deadly in wars than armed violence. Transferred to the care of people with HIV in armed conflicts, the speakers see the following steps as elementary:

However, according to the speakers, these goals can only be fully achieved through joint humanitarian action in consultation between NGOs and politicians in countries providing aid.

You can find more contributions on our AIDS 2022 Special Site.

Prime Session "HIV in armed conflicts". AIDS 2022, Montreal, 30 July 2022