With disturbing parallels to former conflicts, wartime sex work and increases on HIV rates are sure to rise as a result of the Ukraine-Russia conflict.
Ukraine has the second largest HIV epidemic in eastern Europe and central Asia, with an estimated 250,000 people living with HIV. These rates have, in a large part, been spurred by militarization and conflict in the country, factors which have disproportionally affected women, increasing their vulnerability to HIV infection and exposing them to stigma, marginalization and violence.
The catastrophic destruction triggered by the Russian invasion has rapidly escalated the risk of HIV infection and concomitant violence for women in Ukraine.
Prostitution and Militarization
In 2016, Ukraine had a population of 80,100 women sex workers, with 5.2 percent HIV positive. This percentage increased vastly in conflict areas and was estimated to be as high as 38.2 percent in Donetsk. This elucidates the linkage between prostitution and militarization—which as feminist scholar Cynthia Enloe states “are a natural twosome.” Displacement, destruction and deterioration of the economy caused by war, leave many women, without a home or income.
Prostitution is therefore one of the only available means to make a living, especially for working-class women who have often not had access to education. Their precarious situation also heightens the risk of exploitation and trafficking. OHCHR interviews conducted in 2014 reveal how some Ukrainian women were coerced into sex in exchange for money or food. At this moment, there are also reports emerging of criminal gangs targeting Ukrainian female refugees as they flee the horrors caused by the Russian invasion.
Violence and HIV: A Catch-22 Situation
Research has suggested that seven out of 10 women are exposed to gender-based violence during conflict. In the case of Ukraine, interviews conducted by the OHCHR, indicate that sexual violence has been used in relation to the conflict in Crimea. Sexual violence makes women more susceptible to contracting HIV given the likelihood that perpetrators has abuse multiple victims without taking protective measures against STDs.
A UNFPA report on gender-based violence in the conflict-affected regions of eastern Ukraine, also confirmed women’s vulnerability to domestic violence increased during conflict. Reasons cited include the normalization of violence culture within society, the wider availability of weapons and the fracturing of communities and loss of support networks.
There is a correlation between domestic violence and increased rates of HIV given that women who flee domestic violence often find themselves in vulnerable situations, without shelter or economic security. Many victims also adopt harmful coping practices such as substance abuse to deal with the psychological trauma. These factors make women susceptible to exploitation and forced prostitution, thus heightening the risk of HIV infection.
Gender-based violence is not only a cause of HIV, but it is also a consequence, leaving women and other marginalized genders disproportionally affected by its impact. Post-diagnosis, the probability of HIV positive Ukrainian women facing violence (domestic and structural) is increased on average by 15.5 percent. Although evidence suggests domestic violence rates decrease after a HIV diagnosis, Ukrainian women living with HIV are still 16.3 percent more likely to experience domestic violence than HIV-negative women.
The increase in violence is particularly prevalent in healthcare settings. Fear and mistrust of medical professionals can lead women to conceal their diagnosis, preventing them from accessing HIV treatment. Avoiding healthcare settings also has life-threatening consequences for non-HIV related medical issues. In an interview, one woman told how her fear of seeking medical help nearly cost her her life.
“The doctor began shouting at me and added several derogatory terms. … For a long time afterwards, I was afraid of going to doctors even when I felt pain in my stomach. An ambulance took me to the gynecological ward unconscious and bleeding. As it turned out, I had a tubal pregnancy. They saved my life, but unfortunately, now I cannot have children.”
Cultural violence against women and marginalised genders with HIV is becoming a growing concern in Ukraine. In recent years, the government and civil society have implemented antiretroviral treatment programmes which have been relatively successful. However, in territory controlled by Russia or pro-Russian separatists increasingly conservative legislation has been used to block support for HIV information and support services, especially for LGBTQ+ communities.
This is particularly concerning given that the Donetsk and Luhansk have some of the highest rates of HIV infection in Ukraine. The recent Russian invasion has ignited fears that affected populations will lose access to life-saving treatment, particularly those from LGBTQ+ communities.
Calling Women Everywhere
As the horrors of war unfold in Ukraine following the Russian invasion, women are more vulnerable than ever to the effects of violence and subsequently the risk of HIV infection. While Ukrainian women have been the focus of this blog post, this phenomenon is widespread in conflict zones across the world.
Global feminist action is thus imperative to confront the industrial sexual exploitation of women in war zones and to dismantle the patriarchal underpinnings of militarism that turn women’s bodies into yet another battleground.