At the close of the International Fast-Track Cities Conference in Berlin last month, I had planned to make my third trip to Ukraine since the full-scale Russian invasion. Housing Works has been supporting several Ukrainian organizations serving people living with HIV despite the extraordinarily challenging circumstances they face, and I wanted to see firsthand how they were doing. I was therefore delighted when Valeria Rachynska, the Director of Human Rights, Gender and Community Development at 100% Life, invited me to join her and her 14-year-old son, Tim, on an overnight train from Warsaw to Kyiv.
Under normal circumstances, the journey takes about 15 hours. Passengers are gently rocked to sleep, waking only twice to hand over their passports, first to Polish immigration officials and then to their Ukrainian counterparts. Most travelers sleep so soundly that they do not even notice when the train cars are lifted and fitted with new wheel assemblies to accommodate Ukraine's wider Soviet-era rail gauge. This trip, however, proved to be anything but normal.
That night, the Russians had apparently decided to target rail lines and trains operating in western Ukraine. Instead of steadily rolling toward Kyiv, we were repeatedly alerted to the need to evacuate. Gathering only our valuables, we climbed off the train and moved roughly 100 yards away from the tracks. After a period of waiting, we would be allowed back aboard, only to sit, waiting for an all-clear signal. The cycle continued throughout the night and into the next day. By the time we finally arrived in Kyiv, 34 hours after leaving Warsaw, I was so utterly exhausted that, upon reaching my hotel, I turned off the air-raid alert app on my phone so I could sleep uninterrupted.
After an all-too-brief nap, I spent Tuesday afternoon visiting the national headquarters and primary care center of 100% Life, formerly known as the All-Ukrainian Network of People Living with HIV/AIDS. What I saw was shocking.
Only a few weeks earlier, a Russian missile strike had blown out all the windows on two sides of the administrative building and shattered the entire front of the health center. Fortunately, the missile struck a factory across the street at five o'clock in the morning, when no one was present at the facility. Some repairs had already been completed, but much more work remained.
Valeria then took me into the basement of the health center, where an aging Cold War-era shelter still sits. It would cost approximately $10,000, she explained, to restore the shelter to working condition, and another $5,000 to furnish it so staff could continue working during air raids. Even as she described these needs, employees remained at their desks upstairs despite a "Code Yellow" alert, the designation indicating that people should take shelter immediately.
On Wednesday, I met with the Board Chair, Olena Stryzhak and staffer Olena Schepeleva, at Positive Women Ukraine. In the past, the organization has provided refuge to HIV-positive women and their children fleeing Russian-occupied territories. Their building had suffered a similar fate. The windows were boarded up following a recent bombing, and no guests were staying there. With only plywood covering the openings, heating the building through the chill of late autumn would be prohibitively expensive. Staff members worry that potential donors will hesitate to fund repairs because the nearby factory could be targeted again.
Thursday morning brought a meeting with Nataliia Isaieva, the Executive Director of Legalife, the Ukrainian national sex worker rights organization. She described two urgent challenges:
First, U.S. government support for HIV prevention services has been sharply curtailed, limiting access to condoms, PrEP, and other prevention technologies primarily to pregnant and breastfeeding women. As a result, many sex workers no longer have reliable access to essential HIV prevention tools.
Second, approximately one-third of the country's professional sex workers have fled Ukraine. Many have been replaced by internally displaced women engaging in survival sex to meet basic needs. Unlike experienced sex workers, these women often lack the knowledge and resources necessary to protect themselves from HIV and other health risks.
That afternoon, we embarked on a nine-hour drive to Lviv in western Ukraine. Widely regarded as one of the country's most beautiful cities, Lviv is also one of the few major Ukrainian cities whose historic center survived World War II largely intact. Its centuries-old central square remains surrounded by magnificent churches and historic buildings that reflect the city's rich cultural heritage.
After spending the night on the edge of the Old City, where we once again chose the comfort of our beds over repeated air-raid alarms, Valeria took me to visit a shelter operated by 100% Life for internally displaced people.
The shelter is unique. It is the only facility of its kind, having dedicated itself to house and provide treatment to individuals living with HIV, tuberculosis, and HPV, and it is also the only shelter that welcomes people who use drugs, all people that other shelters refuse to accept. Case managers at this facility work with residents find employment and transition into permanent housing. But a number of their residents have disabilities and will likely remain at the shelter as long as possible.
Nearby, 100% Life operates a clothing workshop where participants learn professional tailoring skills. They produce everything from shirts and blouses to jackets, suits, and bustier. Some of these garments are sold in some of Lviv's finest retail shops. Participants earn income from each sale while developing skills that can help them secure long-term employment.
It sounds like a remarkable success story. Unfortunately, there is a catch.
The shelter and workshop depend heavily on support from the Global Fund for their core operations. Following a reduction in U.S. contributions, the Global Fund has been forced to revise its priorities. As a result, this lifesaving shelter is scheduled to lose its funding and close at the end of December.
Today, I am back in my office in New York City, but my mind remains in Ukraine.
I keep thinking about the shattered windows at 100% Life. I keep thinking about the shelter in Lviv that may be forced to close in a matter of weeks. I keep thinking about the women who have turned to survival sex, the people living with HIV and tuberculosis who will have nowhere else to go when their shelter closes in two months, and the staff members who continue showing up for work during air-raid warnings because the needs of their communities simply cannot wait.
The war has not only destroyed buildings. It has strained and, in many cases, shattered the systems that keep vulnerable people alive. Yet even as bombs continue to fall, another threat is growing: neglect.
As governments and donors shift their attention elsewhere, life-saving programs are being pushed to the margins. Funding reductions that may appear insignificant on a spreadsheet in Washington, Brussels, Genva, or New York translate into closed shelters, interrupted treatment, lost prevention services, and lives placed at risk.
The shelter in Lviv is not closing because it failed. It is closing because the resources needed to sustain it are disappearing. The organizations I visited are not asking for luxury. They are asking for windows, shelters, medications, prevention tools, and the ability to continue serving people who have already endured more than anyone should have to bear.
What I witnessed in Ukraine was not a humanitarian crisis waiting to happen. It is happening now.
The people living with HIV and tuberculosis, people who use drugs, sex workers, displaced families, and countless others caught in the shadow of this war cannot afford to wait until the fighting ends before the world remembers them. If we wait, many of the services that keep them alive today will simply no longer exist tomorrow.
The question is not whether the need is real. I have seen it with my own eyes. The question is whether those of us with the ability to help will act before it is too late.
-Charles King, CEO of Housing Works
