Post on 03-Feb-2018
HIV Risk
assessment: Greece
Anastasios Fotiou
for the Greek Reitox focal point of the EMCDDA at the University Mental Health Research Institute, Athens, Greece
DR
ID m
eeti
ng
Comment: Data from the first 8 months into 2013 project a levelling-off or a decrease in
the number of HIV cases involving PWID compared to 2012
Number of
HIV cases604 962
59%a
1180
23%a
615
-27%a
784
Number of
HIV+ PWID15 260
1600%a
522
100%a
188
-81%a
341
%PWID 2.5 27.0 44.2 30.6 43.5
a Percentage change compared to previous year
Source: HIV Office-Hellenic CDCP (KEELPNO)
Jan-Aug.
'12
Jan-Aug.
'132010 2011 2012
Epidemiological
updatePWID in HIV+ notifications National surveillance system (KEELPNO)
Epidemiological
updateHIV+ in PWID accessing treatment routine testing; national samples
Comment: Sharp increases in HIV prevalence among PWID in ‘11 and ‘12―high prevalence
continued through ’13 but shows signs of levelling-off or even decrease. Figures may
overestimate prevalence as they include PWID tested positive and linked to treatment.
Epidemiological
updateHIV+ in PWID samples routine testing; community samples
Comment: HIV prevalence among PWID accessing treatment varies between settings.
Higher prevalence observed in hard-to-reach populations (community samples) suggesting
the need for implementing indicated interventions.
Comment: The epidemic
is restricted in Athens, it
affects mainly ‘mature’
male opiate users, and it
is associated with high-
risk injecting behaviour
2012: All HIV+ (n=187) n %
Male 148 79.1
<25 9 4.8
25-34 112 59.9
>34 66 35.3
Athens 175 93.6
Past treatments 101 65.2
≥2 years inj. history 171 91.9
Opioids 178 95.2
Cocaine (also) 11 7.2
Shared inj. equip. 133 88.1
Anti-HCV+ 145 96.7
Epidemiological
updateCharacteristics of HIV+ PWID routine testing
Comment:
Significant
increases
between 2011
and 2012 only
among ‘new’
injectors.
Observed
trends should
be treated with
caution due to
small sample
sizes.
Epidemiological
update
HIV+ in young (<25) and in ‘new’
(<2y inj.) PWID | National1 source; routine testing
Epidemiological
update
HIV+ in young (<25) and
‘new’ (<2y inj.) PWID | Athens1 source; routine testing
Comment:
Significant
increases
between ‘10
and ‘12 but not
between ’11
and ‘12.
High HIV
prevalence
among young
users should be
treated with
caution due to
small sample
sizes.
Interventions Self-assessing preventive
intervention situation (I)
Key Intervention STRENGTHS WEAKNESSES
INJECTION EQUIPMENT?
Provision and legal access
YES Sharp increases in the number
of syringes distributed; a newly
set up safe injecting facility in
Athens; expansion of sites
Limited coverage; restricted in
Athens; resource dependent; no
involvment of pharmacies
VACCINATION?
HBV, HAV, tetanus etc.
YES
(HBV)
Low levels of vacination among
PWID (~25% of those entering
treatment, with increasing trend)
DRUG DEPENDENCE
TREATMENT?
OST; drug free; detox
YES Sharp scaling up of OST;
availability of slots in drug-free
settings
Long and waiting lists for entering
OST in Athens; limited resources
TESTING?
HIV,HCV,HBV, TB etc
YES ~100% coverage among those
entering treatment
No consistent testing among those
already in treatment; low coverage
for hard-to-reach PWID
INFECTIOUS DISEASE
TREATMENT?
HIV, HCV, HBV, TB etc
YES free of charge (?) Lack of capacity; resource
dependent; cases of discriminatory
practicies against PWID; no easy
access for undocumented patients
Comment: Almost 3.5 times more syringes were distributed in 2012 compared to 2011,
resulting to a notable increase in NSP coverage. However, the average number of syringes
(n=53) available to every IDU in the country (n=7651 in 2012) is below international standards.
N=132 in Athens given that all interventions are implemented in the capital city.
Interventions NSP coverage
29782 3480964958 55109 68579 61516
119397
404124
3 4 7 7 6 715
53
0
20
40
60
80
100
120
140
160
180
200
0
60,000
120,000
180,000
240,000
300,000
360,000
420,000
2005 (9416)
2006 (9729)
2007 (9916)
2008 (8148)
2009 (10658)
2010 (61516)
2011 (7847)
2012 (7651)
Syri
ng
es p
er
cu
rre
nt in
jecto
r, N
Syri
ng
es d
istr
ibu
ted
/exch
an
ge
d, N
Number of syringes exchanged/distributed
NSP coverage (syringes per current injector per year)
Source: REITOX Focal Point of the EMCDDA - Greece.
Interventions Self-assessing preventive
intervention situation (I)
Key Intervention STRENGTHS WEAKNESSES
INJECTION EQUIPMENT?
Provision and legal access
YES Sharp increases in the number
of syringes distributed; a newly
set up safe injecting facility in
Athens; expansion of sites
Limited coverage; restricted in
Athens; resource dependent; no
involvment of pharmacies
VACCINATION?
HBV, HAV, tetanus etc.
YES
(HBV)
Low levels of vacination among
PWID (~25% of those entering
treatment, with increasing trend)
DRUG DEPENDENCE
TREATMENT?
OST; drug free; detox
YES Sharp scaling up of OST;
availability of slots in drug-free
settings
Long and waiting lists for entering
OST in Athens; limited resources
TESTING?
HIV,HCV,HBV, TB etc
YES ~100% coverage among those
entering treatment
No consistent testing among those
already in treatment; low coverage
for hard-to-reach PWID
INFECTIOUS DISEASE
TREATMENT?
HIV, HCV, HBV, TB etc
YES free of charge (?) Lack of capacity; resource
dependent; cases of discriminatory
practicies against PWID; no easy
access for undocumented patients
Comment: OST coverage has increased substantially during the last 2 years-especially
between 2011 and 2012 owing to the massive scaling-up of OST services. Almost one in
every 2 problem users (n=20429 in 2012) would be able to enter OST in Greece in 2012.
Interventions OST coverage
3596 3950
5045 5360
62646783
9821
19 2025 22
2833
48
0
10
20
30
40
50
60
70
80
90
100
0
2,000
4,000
6,000
8,000
10,000
2005 (19151)
2006 (20146)
2007 (20516)
2008 (20181)
2009 (24097)
2010 (22515)
2011 (20473)
2012 (20429)
Co
ve
rag
e, %
Nu
mb
er
of
pe
rso
ns r
ece
ivin
g O
ST
, N
Number of persons receiving OST
OST coverage (% of estimated PDU who receive OST)
Source: REITOX Focal Point of the EMCDDA - Greece.
Interventions Self-assessing preventive
intervention situation (I)
Key Intervention STRENGTHS WEAKNESSES
INJECTION EQUIPMENT?
Provision and legal access
YES Sharp increases in the number
of syringes distributed; a newly
set up safe injecting facility in
Athens; expansion of sites
Limited coverage; restricted in
Athens; resource dependent; no
involvment of pharmacies
VACCINATION?
HBV, HAV, tetanus etc.
YES
(HBV)
Low levels of vacination among
PWID (~25% of those entering
treatment, with increasing trend)
DRUG DEPENDENCE
TREATMENT?
OST; drug free; detox
YES Sharp scaling up of OST;
availability of slots in drug-free
settings
Long and waiting lists for entering
OST in Athens; limited resources
TESTING?
HIV,HCV,HBV, TB etc
YES ~100% coverage among those
entering treatment
No consistent testing among those
already in treatment; low coverage
for hard-to-reach PWID
INFECTIOUS DISEASE
TREATMENT?
HIV, HCV, HBV, TB etc
YES free of charge (?) Lack of capacity; resource
dependent; cases of discriminatory
practicies against PWID; no easy
access for undocumented patients
Interventions Self-assessing preventive
intervention situation (II)
Key Intervention STRENGTHS WEAKNESSES
HEALTH PROMOTION
safer injecting behaviour; sexual
health, etc
YES Relatively easy access
to drug scenes;
mobilisation and active
involvement of NGOs
Only in Athens; no
evaluation
TARGETED DELIVERY OF SERVICES
organised and delivered according
to user needs and local conditions
PARTLY Focus in Athens No needs assessment
IMPLEMENTED IN COMBINATION? YES Small geographical area
for implementation;
small number of
organisations
Resource dependent;
capacity dependent;
limited cooperation
between organisations
ExpenditureOST and harm reduction
expenditure (in million Euros)
ExpenditureOST and harm reduction
expenditure (in million Euros)
…almost 6 times
more clients in
OST than in
drug-free
Similar number
of units, and…
… similar
number of
treatment staff,
but…
Expenditure A case of (dis)proportionality1
About 20million Euros
state funding/year for each one of the these two types of treatment
Expenditure A case of (dis)proportionality2
Headline points
1. HIV case reporting in PWID shows signs of levelling off in 2013
compared to 2012—national prevalence ranges between 5% and
8% (higher in Athens and in community samples)
2. Significant scaling-up in OST and NSP services have resulted in
improved coverage but the latter still falls short of recommended
standards, i.e., >50% OST coverage with no waiting time for entry
and >200 syringes/IDU/year
3. Resources have been disproportionally distributed given the
needs (i.e., demand for OST, ongoing HIV epidemic in Athens)
4. Reductions in public spending threaten the sustainability of the
existing services and austerity measures the morale of the
personnel and thereby the quality of services―interventions
sustained primarily by EU funds
Thank you for your attention
Special thanks to data providers and to Manina Terzidou, Argyro Andaraki, Lia Malettou, Ioanna Siamou, Sonia Papadopoulou,
Clive Richardson and Ioulia Bafi at the Greek REITOX Focal Point for their early work on some of the data presented here.