KAMIANSKE, Ukraine — When the air raid sirens stopped, Olena left shelter and returned to the roadside, waiting for clients seeking sex.
As Russian bombs crashed down, social workers saw H.I.V. treatments dwindle, and the people who need them disappear from the streets.
And when soldiers approached Tetyana, usually carrying guns, they often asked for discounts that she didn’t feel safe to deny. “Soldiers say, ‘Tanya, come for an hour,’” she said, but then ask for more time. “I come and entertain them all night for the same money.”
Russia’s invasion has affected every city, industry and occupation in Ukraine, killing thousands of civilians and forcing millions from their homes. Those who sell sex, an especially vulnerable population even in peacetime, find themselves in greater jeopardy of poverty, coercion and health risks, with implications for Ukraine’s struggle to stem the spread of H.I.V., prostitutes and social workers say.
Prostitution is illegal but widely tolerated in Ukraine, one of Europe’s most popular destinations for sex tourism before the war. The industry was extensive, with an estimated 53,000 sex workers, according to the government-run Ukraine Public Health Center.
The war has significantly cut workers’ incomes and badly disrupted aid programs for drug addiction and H.I.V. treatment. Before the invasion, Ukraine had a high number of people living with H.I.V., and it had been a priority of the country’s health services.
The State of the War
- In the East: Russian forces are wrestling for control of villages near the beleaguered city of Bakhmut, which has become a flashpoint in a battle that Moscow views as crucial for its push to seize the Donbas region.
- In Kharkiv: Residents have slowly trickled back into Ukraine’s second-largest city after Ukrainian forces expelled the Russian military. But signs of the war — and the chance that it might return — are everywhere.
- Military Aid: After weeks of tense negotiations, Germany and the United States announced they would send battle tanks to Ukraine. But the tanks won’t be the silver bullet that allows Kyiv to win the war.
- Corruption Scandal: Amid allegations of government corruption, several top Ukrainian officials were fired. The ouster has renewed questions about how Ukraine’s leaders are addressing concerns over aid.
About a third of people who qualified for help with H.I.V. infections or drug addictions before the war were no longer getting it by late summer, according to the health center. The war has undone years of progress toward safer practices, social workers said.
But several sex workers, interviewed on condition of using their first name out of concern for their families and fear of the police, said they needed the work to survive.
“On the first day of war, I didn’t come here at all,” Olena said at a roadside near Kamianske, in central Ukraine. “But on the second, I did.”
Another woman, Liudmyla, said she now charged about $6 per hour, half the prewar rate. “Even my regular clients couldn’t come to me because they had no money,” she said.
Several workers said Ukraine’s mobilization of hundreds of thousands of men had changed the business: Soldiers poured into towns, guns became commonplace.
Liudmyla said some soldiers had been especially kind, bringing both tips and flowers, but other women expressed fear. Olena said she would not get into a car if it had more than one man.
Tetyana said some men refuse to pay full price. “Sometimes a man promises $12, I do my job, but he pays me only $7,” she said. “He says, ‘Hey, I earn less now,’ and I say, ‘So do not come to me.’”
The war has significantly reduced the number of foreign clients, said a worker named Rita, who supports two small children. Vlada, who works in the same brothel and said she helps care for her mother and siblings, said she went from 18 clients a day to about seven.
“The clients used to give us such good tips that we would forget to pick up our salaries,” she said. “Now, $40 is all we have after giving half to the owner of the business.”
Denys, who lives in the capital, Kyiv, and works mainly with gay men, said he lived in the subway for the war’s early weeks, avoiding the bombings but earning nothing.
Even after that, business was slow. “People are mentally exhausted,” he said. “They are tired of living with these air raid sirens. They have different priorities rather than meeting me.”
He now tries to make up lost income by helping social workers, whose scant resources have been deeply strained by the war.
In the city of Dnipro, the charity Virtus has registered 2,300 sex workers, but far more have moved to the city to escape fighting, according to Iryna Tkachenko, a Virtus social worker.
“It takes time to build up the trust,” she said.
With supply chains disrupted, the social workers have fewer condoms to distribute, and fewer clean needles to prevent sharing among drug users.
The spread of H.I.V. is among social workers’ greatest concerns.
Treatment with antiretroviral medications helps reduce the transmission from workers to clients, and thus within the broader society. But over the last year, about 40 of Ukraine’s H.I.V. treatment centers have stopped working, about half because of shelling damage, the health center said.
Another woman named Tetyana, a social worker who has been helping sex workers in Kamianske for 15 years, doles out what she can and reminds them to take medicines.
“We try so hard to teach them to look after themselves,” she said. “I know them all like a mom, but they often do not listen.”
She added, “I stay here and I try to protect them.”
Andrew E. Kramer contributed reporting from Odesa, Ukraine.