Abstract:
Background: Russia’s brutal war of aggression against Ukraine has triggered the largest refugee crisis in Europe since World War II, creating a sustained humanitarian and health-system shock. The Baltic states have received a high share of displaced people relative to population size while already facing a comparatively high HIV burden. Forced migration increases vulnerability to infectious diseases and disrupts continuity of care.
Objective: To examine how the refugee influx from Russia’s war against Ukraine has affected HIV epidemiology and service delivery in the Baltics and to extract transferable preparedness lessons grounded in the AIDS and COVID-19 pandemic experiences.
Methods: We conducted a descriptive policy-epidemiological analysis of regional HIV indicators from WHO Europe/ECDC surveillance (2023 data, published 2024) (1) and WHO assessment on under- and late diagnosis (2), complemented by refugee health access evidence from IOM/UNHCR assessments in Lithuania and Estonia and Baltic-wide SEIS datasets (2024–2025) (4–7), and programmatic review of regional initiatives such as BaltHUB (8). The period analysed is 2022–2025.
Results: In the WHO European Region, nearly 113,000 people were newly diagnosed with HIV in 2023 (12.7 per 100,000), including about 25,000 in the EU/EEA (1). Late diagnosis remains a defining challenge, and un der-testing persists in parts of the Region (2). The same surveillance release notes that Lithuania recorded its highest annual HIV diagnosis count in a decade (1); (Baltic national surveillance data compiled in the accom panying dataset). In 2023, Lithuania registered 267 new HIV diagnoses (9.3 per 100,000) and in 2024—196 (6.8 per 100,000). Estonia reported 183 (13.4/100,000) in 2023 and 133 (9.7/100,000) in 2024; Latvia—188 (10.0/100,000) in 2023 and 180 (9.6/100,000) in 2024. In Lithuania, foreigners accounted for 47.2% of diagno ses in 2022 (Ukrainians 42.9%), 37.8% in 2023 (Ukrainians 25.8%), and 34.7% in 2024 (Ukrainians 25.0%). Migrants accounted for 48% of HIV diagnoses in the EU/EEA in 2023, underlining the centrality of mobility for contemporary HIV control (3). In the Baltics, emergency measures secured ART access and essential care for refugees; IOM and UNHCR surveys show broad health-care reach but persistent barriers in language support, psychosocial care, and service availability outside major cities (4–7). BaltHUB provides refugee-focused HIV information, psychosocial linkage, and support to key populations among displaced Ukrainians (8).
Conclusions: The refugee crisis caused by Russia’s aggression demonstrates that pandemic preparedness de pends on continuity of care for chronic infectious diseases, stigma-reducing multilingual communication, and rights-based leadership (1,2). Integrating migrant health into routine HIV programs, strengthening Baltic/ EU cross-border ART continuity and surveillance (9), and investing in leadership capacity are essential for future pandemics. Post-war antimicrobial resistance, wound infections, and mental-health sequelae represent an emerging “second wave” requiring coordinated regional action (11)
