The migrant crisis in Europe – and the community's response

My name is Krystyna Rivera, and I am a survivor of hepatitis C, tuberculosis, and breast cancer. Almost 10 years ago, I started working for the All-Ukrainian Network of People Living with HIV, where we implemented projects on access to treatment with the support of Unitaid, protecting the rights of people with HIV, advocacy, prevention, and much more. But with the start of the full-scale invasion of Ukraine, I was forced to flee to Germany with my daughter after I heard a terrifying whistle and saw from my window how a rocket hit a TV tower near my home. That's how my journey as a refugee began — and my story as an expert on migrant health.

I want to share my experience of working with Ukrainian refugees with HIV and tuberculosis in Germany. Today, as the largest war in Europe enters its fifth year, 20,000 to 30,000 Ukrainian refugees continue to arrive in Germany every month. At the end of 2025, the German statistics service noted that there were already 1.33 million Ukrainians in the country. According to estimates by local community organizations, up to 10,000 of them may be living with HIV.

It is well known that Germany has one of the best healthcare systems in Europe, and perhaps even in the world. Nevertheless, Ukrainian refugees with HIV and tuberculosis have encountered a number of systemic gaps that have jeopardized the continuity of their treatment.

And it's not just the language barrier. The lack of health insurance makes it almost impossible to get ARVT—the few organizations that can help people without insurance are working at full capacity and often responded to my request for help by saying, “ARVT costs between $800 and $1,200 a month. We've already run out of supplies.”

Ukrainian refugees are forced to wait three to six months for all their insurance documents to be processed. During this period, they either use the medicines they brought with them from Ukraine or ask for ARVT to be sent to them across the border. But the latter option is illegal, and people who transport ARVT are taking a big risk. People on opioid substitution therapy suffer particularly from the lack of insurance—their drugs are even more impossible to transfer across the border, They are forced to turn to the black market for drugs, which can have serious consequences for their lives, especially since heavy drugs are very easily accessible on the streets in Germany, and people who use drugs often find themselves homeless and in difficult life circumstances.

The second systemic problem I see is the difficulty of accessing testing in Germany. HIV tests are only free for MSM as part of certain projects; for all other categories of the population, they cost between €10 and €27, which is often an unbearable burden on a refugee's budget.

The third systemic problem I unexpectedly encountered is tuberculosis treatment protocols. In Ukraine, my colleagues and I worked hard to ensure that tuberculosis was treated on an outpatient basis. In Germany, people with tuberculosis are forced to spend two to three months in closed wards in hospitals, and refusal to do so can lead to legal problems: they can be taken away by the police and, by court order, sent to a closed facility for compulsory treatment.

I participated in the development of protocols for testing Ukrainian refugees for tuberculosis—there are statistically many cases in this group, and all Ukrainian migrants must undergo X-rays. In the refugee camp where I work as a translator, I met a family who had been billed €200 by the hospital for transporting a man with TB from one hospital to another in a special vehicle. The family tried to contest the bill. Moreover, it is impossible to treat tuberculosis without medical insurance—there is no such mechanism.

I am actively involved in the Ukrainian community of people living with HIV, which over the past four years has mobilized, organized mutual aid groups, peer-to-peer consultations, community interpreters, and actively engaged in advocacy—achieved access to refugee camps (which are closed facilities with enhanced security), and is now actively working to resolve the issue of access to treatment immediately upon arrival.

Thus, I would like to note that the experience of the Ukrainian community of people living with HIV in advocating for access to treatment may be useful for other migrant and refugee communities. Unfortunately, there is no hope that the migrant crisis will end anytime soon, and many countries may face limited access to HIV treatment and prevention for migrants. This is unacceptable from both a human rights and public health perspective. Therefore, the response and readiness of communities to take action may be key in the response to HIV and other infectious diseases.