After completing his military service in the conflict zone in Donetsk Oblast, Ivan, a 37-year-old veteran, returned home to his wife and daughter. He struggled to find a full-time job and resorted to performing odd jobs at construction sites to make ends meet. Ivan’s extremely difficult financial situation ultimately led him to illegal drug dealing, which ended with his arrest and incarceration in a pre-trial detention center, and eventual probation. During a required visit with his probation officer Ivan was referred for HIV testing since all individuals who are incarcerated or on criminal probation are offered testing services.

The medical professional used a risk screening tool developed by USAID’s Serving Life project to test for HIV and the results showed that Ivan was HIV-positive.

A social worker explained the importance of having his wife also test for HIV. Ivan was reluctant to do so and even refused medical and social services for himself as he had difficulty accepting his diagnosis. The social worker persisted and ultimately convinced Ivan to do a follow up test, which confirmed the original diagnosis. He continued to refuse HIV treatment, but agreed to talk to his wife. The social worker convinced Ivan’s wife to take an HIV test, who also tested HIV positive. After discussing their alternatives with the social worker, the couple visited a doctor together and are now both successfully undergoing treatment.

HIV prevalence among incarcerated Ukrainians is 7.6 percent. USAID’s Serving Life activity is working with the government of Ukraine’s law enforcement system to increase HIV diagnosis and strengthen an integrated approach to HIV, TB, and viral hepatitis treatment services for detainees, prisoners, and individuals on probation across 12 oblasts of Ukraine.

USAID’s Serving Life activity has piloted two innovative approaches to identify HIV positive individuals in state detention and begin a course of treatment. Index case testing (ICT) of incarcerated individuals and partner notification services (PNS) are systematic and voluntary approaches for notifying sexual and injecting partners and children of people diagnosed with HIV about their increased risk of HIV infection; offering them HIV testing; and immediately linking them to HIV prevention services, if negative, or HIV treatment, if positive.

With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID’s Serving Life activity was an early adopter of ICT and PNS in Ukrainian penal settings, first introducing ICT and PNS in penal and probation settings in Mykolaiv Oblast in January 2019 and expanding this approach across other PEPFAR-supported oblasts since October 2019. 

USAID’s Serving Life activity has standardized the approach for identifying and bringing HIV positive individuals who are incarcerated into treatment and developed a Standard Operating Procedure, which the Ministry of Justice’s Center of Health Care approved in August 2019. The Serving Life project has also developed a package of training materials on implementation of ICT in penal settings and conducted a series of  three-day ICT training sessions in August 2019 in Odesa.