Risk Assessment on HIV in Greece

Description

Like many countries in the European Union, Greece has had a fairly stable, low-level human immunodeficiency virus (HIV) epidemic. Men who have sex with men have been the most affected population. Since 2011, Greece has been experiencing a significant outbreak of HIV among people who inject drugs in Athens. In the first eight months of 2012, for the first time the number of new cases reported among people who inject drugs exceeded the number of new cases reported among men who have sex with men. The outbreak among people who inject drugs is likely due to a combination of factors, the most important being low levels of preventive services prior to the outbreak. In response to the outbreak, Greek authorities have immediately prioritised scaling up the most effective interventions to prevent HIV e.g. opioid substitution treatment and needle and syringe programmes. The Greek Organisation Against Drugs (OKANA) has quickly expanded the provision of opioid substitution treatment and, in partnership with non-governmental organisations (NGOs) and the Hellenic Centre for Disease Control and Prevention (KEELPNO), increased the provision of needle and syringe programmes to prevent further transmission of HIV. However, given the magnitude of the ongoing outbreak, further scale-up of these services (in particular needle and syringe programmes) will be required to reduce HIV incidence and prevent high long-term HIV prevalence. These efforts will require improved coordination of public authorities and NGOs at strategic and operational levels. There is a strong need to establish an inter-sectoral acquired immunodeficiency syndrome (AIDS) coordination body with strong mandates and sufficient resources, at both strategic and technical levels to maximise the response to HIV in Greece overall, and specifically among people who inject drugs and men who have sex with men. These coordination bodies need to involve a number of ministries, local authorities, law enforcement, NGOs and other key stakeholders. Given the ongoing high transmission of HIV, it is imperative to develop a comprehensive HIV prevention strategy in partnership with community organisations and relevant actors. At the technical level, task forces with a sufficient mandate for action and access to resources, are needed to coordinate the response to the current HIV outbreak among people who inject drugs in Athens, and to address continued transmission among men who have sex with men. These bodies would include all relevant stakeholders and would meet regularly to review the situation and redirect the response. Without decisive action, the outbreak of HIV among people who inject drugs will not only continue but there is also the risk that it could spread beyond Athens. Immediate suggested actions are based on the best evidence available and include a further scale-up of both needle and syringe programmes and opioid substitution treatment to stop transmission. Examples and best practise are provided in this risk assessment. Given the current epidemic situation and the potential for further spread, access to HIV testing must be increased. This will involve ensuring that HIV testing is provided free of charge in all testing facilities, based on the public health principles of informed consent and medical confidentiality. Due to the increased number of HIV positive people who inject drugs, HIV treatment services have reached a ceiling with respect to resources. In addition, infectious disease clinics in Athens are confronted with new challenges in caring for HIV positive drug users with specific issues like co-morbidity and drug dependency. Integrating health services for HIV positive people who inject drugs, i.e. scaling-up HIV treatment services and providing more comprehensive care tailored to the specific needs of the drug users, in a 'one stop shop' model is suggested. The ongoing HIV outbreak is occurring at a time when Greece is experiencing a severe financial crisis. Although the extent to which the financial crisis has contributed to the outbreak is unclear, it is evident that the crisis has a significant social and health impact on the population of Greece. In addition, the response to the HIV outbreak by public authorities and NGOs is being managed in the context of social uncertainty, with exceedingly scarce financial resources. However, by directing HIV prevention and care resources to those populations where most HIV infections are occurring, people who inject drugs and men who have sex with men, available resources will be maximised. Finally, the current economic turmoil will continue to have adverse effects on HIV prevention not only in Greece, but also in other parts of Europe. A failure to break the chain of HIV transmission will inevitably lead to high long-term HIV prevalence. At the same time, evidence shows that early and decisive concerted action can be effective and reduce future health burden. There is a continuous need to keep public health and preventative services on the agenda even in challenging economic times so that long-term, high-cost burden to the health system can be averted.

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