4. The Impact of the Russian Invasion of Ukraine on Needle and Syringe Distribution by Harm Reduction Organizations

Russia’s unprovoked invasion of Ukraine may undermine HIV prevention efforts with its already alarming, intertwined HIV and opioid epidemics by disrupting service delivery and fueling a major refugee crisis. We explore evolving challenges faced by Ukrainian harm reduction (HR) organizations and responses to those We purposively recruited and conducted in-depth interviews with Ukrainian workers at HR sites from three areas: occupied regions, transit regions near conflict, and destination regions in the West.

Displacement of clients and staff has produced significant challenges in the distribution of injection paraphernalia (IP). For internally displaced clients, financial strains have impeded pharmacy purchases. Injectable psychoactive drugs (e.g., amphetamines, bath salts, Dimedrol) have increased from wartime stresses and diminished illicit opioid access. HR organizations have reduced encounters and increased IP distribution, straining supply chains that are burdened by an influx of displaced clients. Staff displacements have further impeded IP distribution by increasing staffing shortages, thereby limiting IP distribution. Despite these decreases, organizations have encouraged secondary distribution to promote greater access. As staffing levels shrink, some social workers have learned to work remotely to support clients (e.g., Mykolaiv) while others have hired new but unskilled staff to meet demands (e.g., Kherson). Network support to clients has been hindered by staffing shortages and client displacement in occupied and transit regions, further inhibiting IP distribution. In Kherson, internet networks have been replaced by Russian occupiers, disabling organizations from communicating with clients. This has resulted in physical and sometimes dangerous outreach to clients.

These findings show that client and staff displacements have caused major challenges in IP distribution and HR support to clients. HR organizations should distribute links to an HR locator throughout Ukraine that provides up-to-date information about sites and service delivery strategies to address evolving needs throughout Ukraine.