CoMPSS: supporting women who use drugs in times of war

The war in Ukraine has deepened the vulnerability of at-risk populations, particularly women who use drugs. They face increased stigma, domestic violence, and sexual abuse. Led by the Alliance for Public Health (APH) and VONA, the CoMPSS project provides them with psychological, social, and medical support, as well as access to opioid substitution therapy (OST). Yevheniia Zakrevska, Senior Manager at APH, and Olga Dolechek, CoMPSS Project Manager, were joined by Tetyana Lebed, Director at VONA, and Kateryna Hrytsaenko, Head of National hotline on drug dependence issues and OAT. They discuss the situation of women who use drugs in Ukraine and the support provided by the CoMPSS project during these times of war.

What is the situation of women in Ukraine, especially those who use drugs?

Tetyana Lebed: I started using drugs at a very young age and still live with this reality today. However, thanks to opioid substitution programs, my life has changed. In 2004, I joined a program that had just been introduced in Ukraine, allowing me to regain control over my life, even though I still rely on daily treatment. Many women in my situation remain invisible, afraid of further marginalization. In Ukraine, women who use drugs are particularly stigmatized. Many fear seeking medical help due to the risk of being judged or losing custody of their children. This is why, in 2018, we founded the Ukrainian Network of Women Who Use Drugs (VONA)—to support women, especially those living in small towns or rural areas, helping them assert their rights and protect themselves from violence. It is crucial, especially in times of war, when stigmatization tends to intensify.

Yevheniia Zakrevska: Women who use drugs are among the most vulnerable populations, alongside people living with HIV or suffering from viral hepatitis. One of the key initiatives of the Alliance for Public Health (APH) is supporting women in starting and remaining on the Opioid Agonist Treatment (OAT) program. The Alliance for Public Health (APH) works to improve their access to care: yet only 12.5% of beneficiaries are women, despite OAT being free. This low percentage is due to fear of judgment, lack of information, and barriers to access. Yet, women are more vulnerable to comorbidities—44% of women undergoing treatment are HIV-positive, compared to 26.26% of men.

The entire CoMPSS project team is gathered.

What challenges do these women face during the war?

Yevheniia Zakrevska: Before the war, Ukraine had approximately 317,000 people who inject drugs, 63.3% of whom had opioid use disorders. Women accounted for one fifth of this population, and eventually only 2,658 had access to OAT treatment. Medical and social stigma is particularly strong, with society and even their families often dismissing addiction as a “bad habit” that they should simply quit. Due to the war, destroyed infrastructure, mass migrations, and economic collapse have pushed these women into extreme precarity. Isolated, without jobs or financial resources, many struggle to continue their treatment. Some have no choice but to turn to sex work to survive. Moreover, war brings violence, torture, and humiliation, leaving deep physical and psychological scars, making these women even more vulnerable and marginalized.

Tetyana Lebed: Domestic violence has also increased. Many men return from the front traumatized, which often translates into violence at home. In this environment, women struggling with addiction feel even less entitled to seek help.

Kateryna Hrytsaenko: Another major barrier is access to healthcare—women have no option but to bring their children to clinics for treatment, as they have no one to care for them. This creates additional challenges.

What measures have been implemented?

Yevheniia Zakrevska: In partnership with Frontline AIDS, we are working on adapting a Gender Good Practice Guide on best gender practices. This guide provides tools, evidence, and best practices to ensure that HIV programming effectively addresses harmful gender norms and stereotypes that hinder HIV prevention, treatment, care, and the realization of SRHR. Additionally, we will develop training materials and conduct sessions for community workers from the partner NGO “VONA,” as well as representatives of men having sex with men (MSM), trans and non-binary people, and people who use drugs. These trainings will equip them with the necessary tools to apply a gender-transformative approach to their work. They will then use this knowledge in their advocacy and on-the-ground efforts to break down barriers to accessing essential HIV treatment and prevention services in specific regions.

Kateryna Hrytsaenko: On the legal front, we have integrated a lawyer into the project so that women can report issues related to police violence, child custody disputes, and other forms of discrimination. We provide legal and paralegal assistance, ensuring they know their rights and how to defend themselves. Building trust through fieldwork is also crucial in convincing them to seek help.

Olga Dolechek: In Lviv, Kyiv, Odessa, Dnipro, and Kryvyi Rih, we have opened, with the support from L’Initiative / Expertise France, “Mother and Child Rooms,” where women undergoing treatment can receive comprehensive medical and psychosocial support while being accompanied by their children. These spaces are designed for their well-being and security, with play areas for children. We have also created safe spaces such as the “Green Room” in Dnipro, where victims of violence—of all genders—receive qualified psychological, social, and legal support.Kateryna Hrytsaenko: Improving access to gynecological care is also crucial. Many women avoid medical consultations due to fear of judgment or past traumatic experiences with doctors. We work with compassionate, trained healthcare professionals to address this issue.

A mother and her child are in the "Mother and Child Space" located in Odessa, in southern Ukraine. — A mother and her child are in the “Mother and Child Space” located in Odessa, in southern Ukraine.

What are the concrete results of your initiatives?

Yevheniia Zakrevska: In 2024, we supported 415 women in our “Mother and Child Rooms,” and 62 survivors of violence in the “Green Room.” Eighty-five percent of women who started opioid substitution therapy remain in treatment, which is an excellent retention rate. We also conduct tuberculosis screenings and monitor children’s wellbeing.

Olga Dolechek: We provided free HPV vaccinations to women enrolled in opioid agonist treatment programs—a first in Ukraine, thanks to the support from L’Initiative. We also offer specialized consultations (gynecology, psychiatry) to help women understand better their bodies, especially during menopause, a long-overlooked issue. Beyond medical support, our priority is to change mindsets—substance use disorder is a chronic disease, not a choice.