俄羅斯入侵烏克蘭威脅到愛滋病毒應對措施

資料來源：http://www.thelancet.com/hiv Vol 9 April 2022；財團法人台灣紅絲帶基金會編譯

由於俄羅斯入侵的威脅有可能摧毀烏克蘭愛滋病毒應對的成功，參與烏克蘭愛滋病毒應對工作的組織正在奮力維持其治療和其他服務。

    烏克蘭估計有 26 萬名愛滋感染者，在衝突爆發之前，透過國家機構和非政府組織 (NGO) 在全國範圍內提供了廣泛的治療、支持和預防服務。但自從戰鬥開始以來，一些地區獲得治療的機會越來越有限。抗反轉錄病毒療法 (ART) 供應正在減少，其他支持服務在某些地方已被大規模縮減或完全放棄。

    烏克蘭有超過 15 萬愛滋感染者正在接受抗反轉錄病毒治療，人們越來越擔心安全問題和對基礎設施的破壞可能很快使人們（如果還沒有的話）無法獲得所需的治療。「烏克蘭參與抗擊愛滋病毒/愛滋病的每個人都很擔心」，聯合國愛滋病規劃署烏克蘭地區主任拉曼·海耶維奇告訴《刺胳針愛滋病毒》。該國的衝突使得關於人們如何以及是否接受治療的明確信息很難獲得，特別是要從該國東部地區獲得。接受《刺胳針愛滋病毒》採訪的人說，他們的總體印象是，在烏克蘭西部和中部的許多地區，愛滋病毒治療繼續可用，沒有任何重大限制。但再往東，情況正在迅速惡化。

    轟炸使一些城鎮的居民被迫在地下室度過數日或無法離開家園。接受《刺胳針愛滋病毒》採訪的人還講述了一些城鎮的居民害怕上街，因為俄羅斯軍隊正在射殺任何來到外面的平民。道路也被摧毀，或者，當地人說，被俄羅斯軍車封鎖，無法到達某些地方。與此同時，世衛組織在 3 月 8 日的新聞發布會上警告說，對烏克蘭醫院、救護車和醫療保健基礎設施的襲擊正在迅速增加。

    「在基輔，仍然可以在診所獲得治療，但由於地鐵系統沒有運行，因此很難獲得治療」，基輔地區愛滋感染者網絡100% LIFE負責人 Olena Svyatyuk 告訴《刺胳針愛滋病毒》。「在該國東部地區，在發生戰鬥的地方，在俄羅斯軍隊駐紮的地方，很難獲得治療」。

    頓涅茨克地區一位不願透露姓名的衛生工作者告訴《刺胳針愛滋病毒》，情況「每天都在惡化」，攜進藥品和提供任何形式的醫療保健變得越來越困難。

    海列維奇說，各地的醫生和病人都報告說他們的藥用完了，有些人因為沒有藥而將人們拒之門外。「烏克蘭有抗反轉錄病毒藥物」，非政府組織公共衛生聯盟 (APH)治療主任 Zahedul Islam 告訴《刺胳針愛滋病毒》。「而只是在某些地方不可用，例如存儲它們的倉庫由於安全問題而無法進入，或者因基礎設施損壞使它們無法進入」。

    伊斯拉姆 (Islam) 說，烏克蘭政府和包括非政府組 APH 在內的其他組織，正在討論建立外部藥物供應，這些藥物可以儲存在安全的地方並提供給患者。在烏克蘭哈爾科夫和奧德薩兩個地方所生產用於阿片類激動劑治療 (OAT) 的美沙酮短缺的類似情況，將有望透過將奧德薩可用的產品儲存在安全位置來作為藥物緩衝供應之需。  

    然而，儘管他們處境艱難，但仍有一些人拒絕放棄提供服務，尤其是減害等支持服務。 APH 政策總監 Pavlo Skala 仍在基輔工作，將清潔針具和保險套分發給任何需要的人。他說他知道這只不過是一項基本的預防服務，相較於他和 APH 的其他人在入侵前提供的服務，其中包括移動式篩檢、替代治療以及對關鍵弱勢群體的其他支持相比只是一小部分，但他無能為力做其他別的服務。他現在大部分時間都在提供人道主義援助和幫助疏散危險地區的人們。「基本上只是在這裡進行生存之操作。我們正在幫助任何我們力所能及的人——我們所服務對象的親戚和孩子們，基本上是任何人。我們現在的工作並不是檢查我們所幫助者之愛滋病毒狀況」，他告訴《刺胳針愛滋病毒》。

    斯卡拉承認他會擔心，如果情況在未來幾周和幾個月內進一步惡化，烏克蘭愛滋感染者的治療和服務將會發生什麼變化，並表示在某些地區，醫療服務可能會減少到僅只是緊急醫療照護。國際組織呼籲應確保獲得治療的機會，但警告說，烏克蘭近年來在防治愛滋病毒/愛滋病方面取得的進展可能會喪失。「烏克蘭多年來取得的成就將被逆轉。我們現在將面臨到檢測大幅減少和治療中斷等問題，不幸的是，這種影響將在某個時候顯現」，海利維奇說。

埃德.霍爾特報導

Russia’s invasion of Ukraine threatens HIV response

Organisations involved in Ukraine’s HIV response are battling to maintain treatment and other services as the Russian invasion threatens to wipe out the country’s successes. 

    Ukraine has an estimated 260,000 people living with HIV and, until the conflict broke out, a wide range of treatment, support, and prevention services had been provided across the country through state bodies and nongovernmental organisations (NGOs). But since fighting began, access to treatment has become increasingly limited in some areas. Antiretroviral therapy (ART) supplies are dwindling, and other support services have been massively scaled back or abandoned completely in some places. 

    Over 150,000 people with HIV are taking ART in Ukraine, and fears are growing that security issues and damage to infrastructure could soon leave people, if they are not already, unable to access the treatment they need. “Everyone involved in the fight against HIV/AIDS in Ukraine is worried”, Raman Hailevich, UNAIDS Country Director, Ukraine, told The Lancet HIV. The conflict in the country has made it difficult to obtain clear information, especially from the east of the country, about how, and whether, people are accessing treatment. People who spoke to The Lancet HIV said that the general impression they have is that in many regions in western and central Ukraine, HIV treatment continues to be available without any major limitations. But further east, the situation is deteriorating rapidly. 

   Bombing has left residents of some cities and towns forced to spend days in basements or unable to leave their homes. People who spoke to The Lancet HIV also gave accounts of residents in some towns being afraid to go on the streets because Russian troops were shooting any civilians who came outside. Roads have also been destroyed, or, locals say, are blocked with Russian military vehicles, making it impossible to get to some places. Meanwhile, WHO warned on March 8 at a press briefing that attacks on Ukrainian hospitals, ambulances, and heath-care infrastructure were increasing rapidly. 

    “In Kyiv, treatment is still accessible at clinics, but it is very difficult to get to these because the metro system is not running”, Olena Svyatyuk, head of the Kyiv region network of people living with HIV 100%LIFE, told The Lancet HIV. “In eastern parts of the country, in places where fighting is going on, and in places where Russian troops are stationed, it is difficult to access treatment.

    ” One health worker in the Donetsk region who asked not to be named told The Lancet HIV that the situation was “getting worse every day” and bringing in medicines and providing any sort of health care was becoming increasingly difficult. 

    Hailevich said doctors and patients at various locations had reported they were running out of drugs, and some were turning people away from clinics because they did not have medicines. “There are ART drugs in Ukraine”, Zahedul Islam, Director of Treatment at (APH) NGO, told The Lancet HIV. “But they are just not available in some places, for instance warehouses where they are stored are not accessible due to security problems, or infrastructure damage makes them inaccessible.”

    Islam said discussions were underway between the Ukrainian government and other organisations, including APH, on creating an external supply of drugs that could be stored in a safe location and given to patients. A similar situation with shortages of methadone for opioid agonist therapy (OAT), which is manufactured in two places in Ukraine—Kharkiv and Odessa—will hopefully be resolved by taking what is available at Odessa to be stored in a safe location for use as a buffer supply. 

    However, despite the difficult situation they are in, some are refusing to give up on providing services, especially support services such as harm reduction. Pavlo Skala, Policy Director at APH, is still working in Kyiv, handing out syringes and condoms to anyone that needs them. He says he knows this is no more than a basic prevention service, and a fraction of the services he and others at APH provided before the invasion, which included mobile testing, OAT, and other support for key vulnerable populations, but he can do little else. He now spends much of his time delivering humanitarian aid and helping evacuate people in danger zones. “It’s basically just running a survival operation here. We are helping anyone we can—relatives and children of our clients, basically anyone. We aren’t checking the HIV status of people we are helping”, he told The Lancet HIV. 

    Skala admits to being concerned about what will happen to treatment and services for people with HIV in Ukraine if the situation deteriorates further in the coming weeks and months, saying that in some areas health services could be reduced to little more than emergency care. International organisations have called for access to treatment to be safeguarded but have warned that the progress Ukraine has made in recent years against HIV/AIDS could be lost. “The gains Ukraine has made over the years will be reversed. We will now face, among others, a huge reduction in testing, and interruptions in treatment, and the effects of this will unfortunately be seen at some point”, said Hailevich. 

Ed Holt