Health workers tell of fight to protect Ukraine's needy

Anna Koshikova describes her job as permanently overcoming crisis.

Her organisation, Free Zone, helps Ukranian prisoners get back on their feet and the work is challenging enough even without the constant shellings, air alerts and electricity shutdowns.

Ms Koshikova is among the dedicated health workers fighting to ensure decades of strides in public health in Ukraine are not undone as their country approaches a grim milestone of 14 months at war.

She is one of 10 professionals who recently flew to Melbourne week to share their experiences of working with drug users in conflict zones at the Harm Reduction International Conference.

While millions fled Ukraine for their safety when conflict broke out, many people working with drug users stayed to help, she says.

"While the state structures shifted to providing for the needs of the army and protecting the population, we had to take care of our clients."

Ms Koshikova says the war has highlighted bottlenecks that existed for many years but health organisations have still been able to achieve significant reforms like offering a needle exchange programs in prisons.

"Of course war poses a lot of challenges but it also, I think, gives us a lot of opportunities," she tells AAP. "Because we were strong enough to push the changes that we were supposed to push many years ago."

Free Zone is working with more clients than ever and has shifted to also providing shelter, food and hygiene packages for prisoner's families, meaning access to resources is tighter. 

"People now tend to pay less attention to their health and they would care firstly about their safety and not finding a clean needle or finding condoms," she says.

"It takes our social workers more work to get them enrolled back in care, keep them loyal to receiving services and this also needs more funding."

Volodymyr Kazus endured many months of bombardments in Kharkiv through his work with users from the marginalised LGBTQI and sex worker communities.

Many of his clients were afraid of evacuating and being searched at checkpoints so stayed put even as the area was under siege, forcing many to re-use old needles.

"They were not sure that they can feel safe in shelters because they were afraid of stigma," Mr Kazus says via a translator.

"Vulnerable groups and those who have stigma are usually afraid to get out and ask for help."

The president of Kharkiv Charitable Foundation "Blago" says while some may think war is not the best time to roll out preventative health programs, it is a vital part of the fight to avert a public health crisis in the future.

"We're afraid that after that we will have a new rise of HIV infections so we lost all our efforts," he says. 

"Previously, Ukraine has done quite good progress (since) 1990's AIDS and now we lost some of the good progress."

Nadia Yanhol 's organisation Alliance for public health has also expanded its work and set up as many shelters as possible, in addition to offering medical help and testing through mobile clinics from Ukraine's capital Kyiv.

They are committed to providing more than just basic medical care so are gearing up to offer new long-acting HIV prevention medication later this year.

She says many clients who fled overseas at the outbreak of war have started to return home for a variety of reasons, posing fresh challenges to already stretched services across the country.

"It's still war in Ukraine ... we're just trying to help clients organise facilities but just nobody knows about tomorrow," Ms Yanhol says.