“The most human rights violations of SWs in Ukraine occur in medicine”. Interview with Natalia Shestak, Rivne City

WE CONTINUE OUR SERIES OF INTERVIEWS ‘ABOUT WAR AND SEX WORK IN UKRAINE’ with our leaders and paralegals in 2026. Almost a year has passed since our last public conversation with our regional representatives, when we talked about the lives of Ukrainians, the fate of sex workers and the sphere of sex services in Ukraine during the war. This year, we return to this conversation to recall the events of four years of this war and analyse their impact on our community and society.

Natalia Shestak (Наталія Шестак) — leader of the sex workers’ community of the CO "LEGALIFE-UKRAINE" in Rivne.

Natalia Dorofeeva, CO “Legalife-Ukraine” (ND): Hello, Natalia! It’s been a long time since our last meeting. What has changed in your life during this period — both professionally and personally?

Natalia Shestak: It’s actually difficult to answer unequivocally: it seems like a lot of things and nothing have changed at the same time. Speaking of professional development, I attended a seminar on working in the media. This helped me to understand the specifics of social networks and the nuances of PR. Now I am much more attentive to details that I had not noticed before.

Along with professional growth, there were also difficult periods when I had to balance between many roles: taking care of children, wards, and not forgetting about myself.

In my personal life, everything is stable: I don’t have a husband and I’m not looking for one right now. The main thing for me is that I remain psychologically stable and effective in my work.

Of course, there are difficulties. Prices are rising, but my income is not. This makes me think about additional earnings, although I’m still at a crossroads in terms of direction.

ND: Four years of this war are a huge distance, tell us about the changes within your initiative group, how has the life and activities of community activists transformed during this time?

Natalia: The number of activists has decreased during this time: some have moved, for some the issues of sex work have receded into the background. If at the beginning of the war there were about 5–6 girls in the initiative group, now there are 3–4. This is also not a constant number, girls come, leave, some return, and some do not.

This year a tragic incident occurred - a woman from our group died. She was looking for her happiness and started a relationship with a former client. That evening we met, and after the conversation she left with this man. Unfortunately, due to a fatal coincidence and the husband’s failure to provide timely assistance, the woman was found dead only in the morning. Nine children were left orphans. This is a great loss for us, because she was an important member of the group — active and legally aware.

Separately, I would like to note that during the war our girls became stronger, more active, their self-esteem increased. They are much better organized, trust each other more and sincerely care about their colleagues. Those who live and work within the same neighborhood become friends — they try to help each other, support each other, and advise on safety at work.

The composition of the initiative group has also changed today. Due to the war, the demand for sex services fell, so the girls began to work in legal areas: in trade or abroad. They engage in sex work only when there is a request from regular clients.

Social services became our partner this year. We established cooperation, because this body has many levers of influence, in particular in matters of combating violence.

Initiative group of CO “Legalife-Ukraine” in Rivne

ND: And how, in your opinion, has Ukrainian society and the general atmosphere in the country changed during the years of the Great War? In particular, how has this affected the attitude towards vulnerable groups, such as sex workers? What is your personal experience as a leader and human rights activist: do you feel more pressure now and how do you react to it?

Natalia: Sometimes it seems that there are almost no men left in civilian life - there are only women around, and even they may soon go to service. In my opinion, the attitude of society towards representatives of mobilization bodies, in particular the Territorial Center for Recruitment and Social Support,  has noticeably deteriorated. In general, the military are now treated with some caution. People do not know what experience a person has had at the front, whether he has injuries, contusions or PTSD. Therefore, civilians choose a more restrained distance in communication and try not to ask unnecessary or painful questions.

Interaction between people in society remains different, and war is not a determining factor here. If a person is naturally inclined to aggression, then war will not change this. And vice versa - a kind-hearted person will remain so under any conditions. I am leading to the fact that conflicting personalities have always existed.

However, the general tension has objectively increased over the years: human losses, economic instability and uncertainty put pressure on everyone. Cases of burnout and nervous breakdowns have become more frequent, which, of course, provokes new conflicts in society.

The attitude towards vulnerable groups has also changed. Now there are almost no families left that have not been affected by the loss of loved ones. Because of this personal pain, people often close themselves off: "Why should I help someone or volunteer if I myself am in unbearable pain and need help?"

As for the stigmatization of sex workers, its level has remained approximately the same as before. Some support it, some are indifferent, and some feel irritated - it’s all very individual. The only thing I can state: our society is still not ready for an open discussion of the topic of sex and there is a lack of education on this issue. Perhaps the reason is the position of the media, which often maintains a condescending tone towards sex work. If the media presented this topic without prejudice, condemnation or aggression, then the attitude of citizens would be more loyal.

Personally, I almost never encounter hate. My group on social networks is currently closed, so there are no negative comments there. In real life, people usually don’t say anything offensive to my face either - on the contrary, most people support my work. Although I remember a case when they asked: "Why do you help prostitutes, and not "ordinary" people? For what merits do they receive support?" In such situations, you have to stop and patiently explain to your opponents the principles of equality and human rights.

ND: And if we look inside the sex work sphere, how did the war and the crisis affect the sex services market? Have there been any fundamental changes in its structure and what new risks have appeared compared to peacetime? How have approaches to security within the community changed?

Natalia: The market has definitely changed - both in terms of the clients themselves and in terms of sex workers. Some left trying to escape the war, some - because of illness, and some - to try to earn money legally or illegally abroad. We have a woman who left the country because she needs a joint replacement, but she plans to return in time.

Based on the conversations, I can say with confidence: the number of IDP women involved in the sex business has increased, although the overall influx of IDPs to the city has begun to decrease. However, it has not yet been possible to contact them, nor to track their exact number in the city. They have not yet gotten used to the circumstances in their new place and are therefore “hiding”.

The number of clients has clearly decreased. However, even among those men who use the services of community girls, there has been an increase in military personnel - they have better solvency, better attitudes. Because of this, even the cost of services has increased. However, the girls are wary of military personnel who have returned directly from the combat zone. It is believed that they can be dangerous due to their own psychological traumas and can pose a danger to others. Of course, it depends on the person, but at the same time, girls are forced to be more careful about what and how they say.

Despite the fact that the cost of services has increased, women’s incomes have fallen. Most often, it is precisely because of the lack of clients: before the war, each woman could find up to 5-7 clients during the day, and as of today, if there is one - good, if there is two - it is already luck. At the beginning of the war, earnings were higher, but now they have nothing to brag about in terms of salary for their work.

Working meeting with infectious disease specialist Olena Bilyk on expanding access to medical support for women from groups vulnerable to HIV

ND: Nataliya, how does the war and general tension in society affect the safety of sex workers? What new threats have emerged and what "survival protocols" do women within the community use to protect their health and lives?

Natalia: The issue of violence is still extremely acute. The war has made its adjustments: the general stress of society greatly affects people, making them more aggressive.

The level of dangers to health and life is growing, so most of our wards categorically do not agree to risky sexual practices. This is a separate type of service that can lead to such trauma or diseases that treatment will be too expensive. And there is practically no income anyway. So safety and health are now a matter of survival.

As for protection from clients, first of all, girls need a safe place to work. As for security measures, now girls have become much more "savvy" and literate: they protect each other and try not to work alone. They are sure to inform colleagues where and with whom they are going, turn on the real-time geolocation tracking function, opening access to their location. They share the license plates of the cars they drive away in so that in case of an emergency, the offender can be found. Since most clients are now available by phone, it is possible to ask about them in advance. Our girls have also come up with a system of code words: if you say such a word, it means that the client is dangerous and the woman needs immediate rescue. Despite these measures, critical situations do occur. Recently, there was a case when a client took our girl to an unknown place and kept her locked up for several days, and also brought his friends. She barely escaped. But still, this is a rare, extreme case. Much more often, the "danger" is limited to simply quarrels or misunderstandings with clients that do not end in physical violence or beatings. Such terrible stories as I have told are now extremely rare, although we still have to be prepared for them.

But it is not only clients who can be dangerous. Now, social and domestic problems are no less acute and important for women. Today, girls more often suffer from being left homeless due to debts, sinking into credit holes, or becoming addicted to alcohol or drugs. This destroys their lives no less than isolated conflicts with clients at work.

Recently, we had a woman who ended up on the street, all dirty and in terrible shape. When we started to figure out how she got to this point, it turned out that she met a man, fell in love, and moved in with him. And then there was the classic trap: he beat her, abused her, took her money, and even her pension card. When the man was gone, his mother (mother-in-law, so to speak) simply kicked the woman out onto the street. And her own mother refused to take her back—she was ashamed.

We were able to find a connection with her daughter, who lives abroad. She was the one who helped: she rented an apartment for her mother, helped her normalize her life. Thanks to this, the woman even stopped drinking alcohol. This story shows that it is much more terrible to find herself in a social vacuum without the support of her family than to face an inadequate client.

Self-help group for sex workers in Rivne, 2025

ND: It is this understanding that girls can be left without any support that makes us work even more actively. Nataliya, please tell us how the community’s needs for our services have changed over the past four years? What requests from sex workers are relevant now and what services do you provide in response?

Natalia: The needs of female sex workers have hardly changed over the past four years. I would say they have rather gained momentum. As before, so now there is a need to cover basic needs - pay for housing, feed the child, buy medicines, get substitution therapy, antiretroviral therapy (for those who need it). Now everything is the same, only more, because earnings have fallen, salaries are not growing, there is a great lack of funds. And those who are IDPs - they have already lost everything, and they need to organize their lives from scratch.

As the leader of the initiative group, I help girls in several areas. This includes counseling, direct support in restoring or processing documents, and humanitarian support: medicines, food and hygiene kits, as well as basic necessities - blankets, power banks, dishes, etc. As for consultations, we cover a huge range of topics. First of all, it is health: we explain the changes from the Ministry of Health, how the Medical Guarantees Program works, how to use e-prescriptions and receive e-medicines under the National Health Insurance Fund packages. We talk about the rights and obligations of patients, prevention and treatment of HIV/AIDS, combating discrimination, and finding specialized medical institutions. There is also a great demand for legal support and professional psychological assistance.

ND: You mentioned psychological help. How has the internal state of women in the community changed in recent years? What phobias and anxieties do girls come to you with most often?

Natalia: Over the past few years, the nature of requests for psychological help has changed dramatically. What started as isolated concerns about safety or the future has gradually grown into deep chronic stress that permeates absolutely all areas of their lives.

For example, I will mention the story of one of the girls: when she went abroad, she was so paralyzed by the fear of the unknown that she was seriously afraid of finding herself in a stadium under the open sky. This stress had a physical manifestation - her hands were constantly shaking until the situation was resolved and she was settled in normal conditions.

In general, sex workers have adapted to the realities to a certain extent, even got used to living in the circumstances we have now. However, the sharp loss of income has had a strong impact on their psycho-emotional state. It is because of this financial and life insecurity that girls today need professional psychological counseling much more than before.

Humanitarian aid to sex workers from the CO “Legalife Ukraine”, Rivne, 2025

ND: Natalia, you help girls not only with products or counseling, but also act as a paralegal. In which areas do you most often record violations of rights and could you tell us about specific cases that best illustrate the situation?

Natalia: In my experience, the most violations of sex workers’ rights occur in medicine. There, confidentiality is violated by disclosing the status, and they are treated in a completely intolerant manner. There are cases when they demand money for services that should actually be free of charge.

This is especially acute in gynecology: if they find out about a positive HIV status, the negative attitude begins instantly. There are still a lot of shortcomings in the medical field, and there are only a few real improvements there, perhaps by one or two percent. In general, medical workers are not very willing to do anything for our girls; usually help can only be achieved when you start to fiercely defend your rights.

There was a case with a narcologist who prescribes substitution therapy. The girls complained that she treated them with contempt and did not listen to the needs of the patients at all - for example, when it came to dosage adjustment or other important requests. In the end, some of the girls simply switched to other specialists who know what tolerance is and respect their patients.

I tried to talk to this doctor in person, but in vain: she simply refused to have a dialogue, without even explaining the reasons. I heard a lot of negative feedback about her work. Perhaps this is due to a lack of experience - she is still young and, most likely, simply incompetent in the specific issues of our community.

At the beginning of the year, another very difficult story happened. One of the girls lived with a man who told her that he had tuberculosis. She even went to get his medicine herself, although for some reason he never took it. The scariest thing about this is that the girl was completely inexperienced in such matters: she didn’t even suspect anything wrong with the fact that she had to get medicine for "tuberculosis" at the AIDS center. After his death, the terrible truth was revealed: he had HIV. This was hidden by both the husband himself and his entire family. Accordingly, this woman is now also infected. For me, as a paralegal, this case is an example of a gross violation of human rights. No one warned her about the danger. A woman should have a choice - to be with this person or not. And she was simply deprived of the opportunity to protect herself. I helped her undergo a full examination and start treatment - she is now receiving ART therapy. She refused to go to court or any attempts to punish the guilty. But the diagnosis was a huge emotional shock for her. In addition to legal support, I had to provide her with psychological support, because in such a state it is critically important for a person to have someone by her side. She was not afraid to turn to me so as not to be left alone with her misfortune.

However, prejudiced attitudes towards women are also found among social service workers. For example, in a village near Rivne, where a woman from our community was settled. She, the victim of violence, was given a house in terrible condition – the roof was in terrible condition, it was collapsing on ​​her head. The woman had five children in her arms, but she never saw the promised support. True, once the village council did allocate a truckload of firewood, but that was all. Moreover, a local social service worker came to her in a drunken state: she behaved inappropriately, shouted. I consider this a direct violation of rights and blatant disrespect.

Another problem is that girls often forget to contact me for legal help immediately. Over time, emotions subside, the situation "blurs" and is somehow forgotten. I am sure: if they had sought protection immediately, the number of recorded cases of human rights violations would have been many times higher.

Organization of examination of female sex workers at the Regional Tuberculosis Dispensary in cooperation with CO "Positive Women"

ND: From your experience, has the state apparatus become more sensitive to the requests of our community over the past four years of war? How has the nature of interaction with the police and social services changed - towards partnership or greater isolation?

Natalia: As of the end of 2025, we can firmly say that interaction with the police has become neutral - we have no appeals to them, and they have nothing, accordingly, to us. I think this situation arose because with the beginning of the war, the police were reorganized for military tasks. Against the background of the general situation in the country, the problems of our girls ceased to be perceived by the authorities as something significant. Complaints and appeals were considered, as they say, "half-heartedly".

Because of this, girls who previously did not really want to go to the police (they did it extremely rarely, only in the most pressing circumstances), now began to be afraid to contact the police at all. They are convinced that either they will not receive any help at all, or that it will be provided poorly. Therefore, girls try to solve all their issues on their own. As a result, trust in the police has been completely lost.

Although there was one interesting case regarding cooperation with the police - if you can call it that. Once, law enforcement officers contacted me about a woman from our community. She was "caught" by surveillance cameras in various stores in Rivne and other cities stealing. This woman had been homeless for some time, so I sheltered her at my place. The police came, talked to her, saw her conditions. She also has a seriously ill child - although she is in a specialized institution, her mother helps her as best she can. In fact, law enforcement officials showed leniency: they, so to speak, “forgave” these offenses and only obliged the woman to reimburse the cost of the goods to the stores.

The situation with hospitals is not good either - we have encountered cases of outright refusal to provide medical services or extremely biased attitude. This usually happens when medical workers find out about the diagnoses of patients and, accordingly, guess about their profession. After that, the attitude instantly changes not for the better.

The situation with administrative services is a little better. Since I help girls, including displaced women, with restoration or registration of documents, I have to constantly cooperate with the local social service. And there they really go to our aid: they suggest the correct algorithm of actions, and in general they completely take on the solution of some issues.

Working meeting with the Chairman of the Board of CO "Network of 100 Percent of Life Rivne" Yuriy Lazarevich on involving sex workers in HIV prevention and treatment programs

ND: Since interaction with state structures is difficult, the main burden probably falls on partnerships with other non-governmental organizations. Who in the city have you managed to build cooperation with?

Natalia: As of the end of autumn 2025, our organization has built a powerful partnership network. We work closely with the CO "Network of 100 Percent of Life Rivne" and the NGO "Positive Women" - these are our key partners in supporting women with HIV status and protecting their rights.

If a girl has experienced violence or is in an acute crisis, we connect the "Mobile Brigade of Social and Psychological Assistance" ("Мобільна Бригада Соціально-Психологічної Допомоги") - they help to stabilize the emotional state and provide shelter. The cooperation with NGO "Future Without Limits" (ГО "Майбутнє без меж") is very valuable: they took on an unusual task - dental treatment for people on substitution therapy. You know how difficult it is to find a dentist who understands the specifics of patients on OST, so this is a huge support for us.

And, of course, we are constantly in touch with the AIDS Center, where our wards can receive medical support and necessary medications without unnecessary bureaucracy.

ND: Natalia, I am sincerely grateful to you for such a frank conversation. Finally, I ask you to give some advice to those girls and boys who have just felt the power to change the world, but perhaps are still hesitant?

Natalia: My advice to beginners: always, under any conditions, maintain a tolerant attitude and remember the principle of "equal to equal"! Get to know each woman individually and delve into their lives, be interested in them, because everyone in this world needs attention and support. Love yourself, love people and give your love to the world - it is love that drives us!

Interview by Natalia Dorofeeva, CO “Legalife-Ukraine”