A critical political economy of syndemics: HIV in Ukraine amid war, reform, and COVID-19

The spread of complex viral epidemics and pandemics worldwide has become more dangerous, and researchers, policymakers, and health organisations have focused on the biological determinants and sequelae of these conditions. This paper explores the concept of a syndemic from the public health literature, infused with a critical political economy framework, to understand an intractable and dangerous viral emergency: that of human immunodeficiency virus (HIV) in Ukraine during violent conflict. The syndemic paradigm combines a concern with both biological and social factors in understanding disease emergence, progression, and outcomes, but the literature using this framework has so far elided the structuring logics and social relations of multi-scalar political economies that this paper argues are vital to study epidemics. Using HIV in Ukraine during war as a case study, the paper explores how the virus has emerged from being practically unknown in Ukraine during the 1990s to become one of Europe’s worst syndemics. Individualised, biological factors only explain a very small part of the story, this piece argues, and the ongoing HIV emergency in Ukraine is intimately interrelated with state failure, the collapse of social services, healthcare reform, decentralisation, war, mass displacement, COVID-19, and Russia’s formal invasion in 2022.