Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study
Open Access
- 12 November 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (11), e78941
- https://doi.org/10.1371/journal.pone.0078941
Abstract
During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012). IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period. Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.Keywords
This publication has 27 references indexed in Scilit:
- HIV Treatment as Prevention: Natural Experiments Highlight Limits of Antiretroviral Treatment as HIV PreventionPLoS Medicine, 2012
- The Impact of Economic Crises on Communicable Disease Transmission and Control: A Systematic Review of the EvidencePLOS ONE, 2011
- A Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject DrugsThe Journal of Infectious Diseases, 2011
- HIV and risk environment for injecting drug users: the past, present, and futureThe Lancet, 2010
- Can hepatitis C virus prevalence be used as a measure of injection‐related human immunodeficiency virus risk in populations of injecting drug users? An ecological analysisAddiction, 2010
- Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drugInternational Journal of Drug Policy, 2008
- Increasing Prevalence of HIV‐1 Subtype A in Greece: Estimating Epidemic History and OriginThe Journal of Infectious Diseases, 2007
- A Nascent HIV Type 1 Epidemic among Injecting Drug Users in Kabul, Afghanistan Is Dominated by Complex AD Recombinant Strain, CRF35_ADAIDS Research and Human Retroviruses, 2007
- Behavioral science at the crossroads in public health: Extending horizons, envisioning the futureSocial Science & Medicine (1982), 2006
- Migration and HIV epidemic in GreeceEuropean Journal of Public Health, 2005