Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece

Abstract

Objectives We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.

Network Characteristics of People Who Inject Drugs Within a New HIV Epidemic Following Austerity in Athens, Greece

“…This is consistent with other reports suggesting that the emerging HIV epidemic among PWID in Athens is primarily driven by high-risk injecting behaviors 13,15,19 , rather than sex networks which, given our findings, appear to only play a limited role in HIV transmission at this stage of the epidemic. Other emerging epidemics have followed a similar pattern of early injection drug-driven transmission 31,32 .…”

“…Other emerging epidemics have followed a similar pattern of early injection drug-driven transmission 31,32 . In Athens, future interventions to prevent epidemics among other groups are warranted, however, given that 48% of men in Aristotle reported sex with non-PWID 19 . In addition, only 59% of men reported using condoms “always” or “usually” 19 .…”

“…In Athens, future interventions to prevent epidemics among other groups are warranted, however, given that 48% of men in Aristotle reported sex with non-PWID 19 . In addition, only 59% of men reported using condoms “always” or “usually” 19 . Considering the substantial proportion of respondents engaging in risky sex behaviors and reporting sex with non-PWID, the risk of increased future HIV spread via sexual networks will require additional intervention as the epidemic matures.…”

“…Details of the Aristotle cohort have been described previously 19 . In brief, the sample was generated using respondent driven sampling (RDS) 20 .…”

“…In 2012, 547 newly diagnosed cases of HIV in PWID were reported, representing 46% of the newly reported infections for that year 16 . Some studies have linked the outbreak to austerity measures, cuts in public spending, housing instability and unemployment resulting from the political and financial crises 15,17–19 . The goal of this analysis is to determine the potential for network-based interventions in this context by exploring how networks, including more distal networks, are associated with individual HIV seroprevalence and risk behaviors.…”