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With the collapse of socialism, the number of nongovernmental organizations in Eastern Europe increased dramatically, as part of democracy and capitalism building. In the West, NGOs have served as key players in shaping the response of the HIV epidemic, reflecting both the withdrawal of the state from service provision in line with neoliberal reforms and the activist roots from which many of these organizations originated. As a result, AIDS NGOs and the people who work in them are often characterized as engaging in an activist endeavor in order to affect social and political change that will enable better prevention and care. This article explores the extent to which a similar framework applies to AIDS NGOs in Poland and Eastern Europe, more generally, where the notion of "anti-politics" and disengagement from political activism remains strong. As they developed in Poland, AIDS NGOs have focused on caring for clients, cultivating a professional identity, and abstaining from politics, to the eschewal of advocacy activities on behalf of their clients. This orientation has implications for the types of HIV prevention programs these organizations offer, as well as the possibilities for collaborating with researchers and service providers from the West.

This article explores the history of HIV activism in Poland from the socialist period through the early 1990s transformation as a means of examining the reconfiguration of rights, obligations, and responsibility as Poland redefined itself as a market democracy. Drawing on archival materials, in-depth qualitative interviews with current and former HIV activists, and participant observation at HIV prevention organizations in Warsaw, Poland, I sketch the ways in which the socialist system's failures to protect the health of its subjects led to the terms through which state-citizen engagement was defined in the postsocialist period. Uncertainties and anxieties surrounding who was responsible for protecting the health and well-being of citizens in the newly democratic Poland gave rise to a series of violent protests centered on HIV prevention and care for people living with HIV/AIDS. Resolution of these political and social crises involved defining democracy in postsocialist Poland through claims to moral authority, in alliance with the Catholic Church, and an obligation by multiple stakeholders to disseminate technical/scientific knowledge. By comparing the responses to the epidemic by diverse institutions, including the government, the Catholic Church, and the fledgling gay rights movement, this analysis reveals the ways in which democracy in postsocialist Poland tightly links science, democratic reform, and moral/ religious authority while at the same time excluding sexual minorities from engaging in political activism centered on rights to health and inclusion in the new democracy.

AbstractIntroductionRussia's invasion of Ukraine in February 2022 has severely impacted the healthcare system, including the provision of HIV care. The ongoing war is a human‐caused mass trauma, a severe ecological and psychosocial disruption that greatly exceeds the coping capacity of the community. The bioecological model of mass trauma builds on Bronfenbrenner's concept of interaction between nested systems to argue that social context determines the impact of life events on the individual and how an individual responds. This paper uses the bioecological model of mass trauma to explore the impact of Russia's aggression against Ukraine and the ongoing war on HIV‐positive people who use drugs in Ukraine, a particularly vulnerable population that may be negatively affected by disruptions to social networks, healthcare infrastructure and economic conditions caused by mass trauma.MethodsData were collected between September and November 2022. A convenience sample of 18 HIV‐positive people who use drugs were recruited from community organizations that work with people living with HIV, drug treatment programmes, and HIV clinics through direct recruitment and participant referral. A total of nine men and nine women were recruited; the age ranged from 33 to 62 years old (mean = 46.44). Participants completed a single interview that explored how the war had affected their daily lives and access to HIV care and other medical services; their relationships with healthcare providers and social workers; and medication access, supply and adherence. Data were analysed using the Framework Method for thematic analysis.ResultsThe war had a profound impact on the social, emotional and financial support networks of participants. Changes in social networks, coupled with limited job opportunities and rising prices, intensified financial difficulties for participants. Relocating to different regions of Ukraine, staying at somebody else's home, and losing connections with social workers impacted medication adherence and created lengthy treatment gaps. Participants also experienced a decreased supply of antiretroviral therapy, concerns about accessing medication for opioid use disorder, and overwhelming fears associated with the war, which overshadowed their HIV‐related health concerns and negatively impacted medication adherence.ConclusionsOur analysis reveals the complex impact of war on social networks and healthcare access. Maintaining support networks and competent healthcare providers will be essential amid the ongoing war.