20th International AIDS Conference - Melbourne, Australia


MOAD0104 - Oral Abstract Session

Recession and income inequality are associated with large increases in rates of reported HIV infections among people who inject drugs in Europe

Presented by Georgios Nikolopoulos (Greece).

A. Fotiou1,2, G. Nikolopoulos3, E. Kanavou1, C. Richardson4, A. Pharris5, J. Suk5, J. Semenza5, C. Costa-Storti6, D. Paraskevis7, M.-M. Malliori2, S.R. Friedman8, A. Hatzakis7

1University Mental Health Research Institute, Greek REITOX Focal Point of the EMCDDA, Athens, Greece, 2Athens University, Medical School, Athens, Greece, 3IAS/NIDA Fellow, Hellenic Centre for Disease Control and Prevention, HIV and STDs Office, Athens, Greece, 4Panteion University of Social & Political Sciences, Athens, Greece, 5European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, 6European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal, 7National Retrovirus Reference Centre, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece, 8National Development and Research Institutes, Institute of Infectious Disease Research, New York, United States

Background: Despite mounting discussion about possible links between economic recession and adverse health outcomes, there is still sparse evidence that explicitly demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic recession, associated socio-economic, policy and structural indicators, and increases in rates of reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA).
Methods: We used panel data (2003-2012) for 30 EEA countries. The statistical analysis included random-effects logistic regression models.The dependent variable was the annual national number of newly diagnosed HIV cases attributed to injecting drug use (treated as a dichotomous variable taking the value “1” if there was a significant increase in the national rate of HIV diagnoses in PWID). Explanatory variables (lagged values, 1 to 3 years before the current observation) included: growth rate of Gross Domestic Product (GDP), people at risk of poverty rate, unemployment rate, income quintile share (S80/S20) ratio, Gini coefficient, per capita government expenditure on health and social protection, and relevant drug control policy and drug population level variables.
Results: Bivariate analyses showed that the occurrence of large increases in the annual national rate of HIV diagnoses in PWID was negatively associated with GDP growth and positively related to poverty, the S80/S20 ratio, and the Gini coefficient. In multivariate analyses, using 3-year lagged values and adjusting for GDP growth, the only significant variables were the S80/S20 ratio (Odds Ratio [OR] = 3.89; 95% Confidence Interval [CI]: 1.15-13.13) and the Gini coefficient (OR = 1.43; 95% CI: 1.00-2.03). The multivariate analyses produced similar results across the three lag-time lengths.
Conclusions: Considering the ecological study design with its inherent limitations, we found that changing inequality of income distribution was associated with large increases in the number of HIV diagnoses among PWID in the EEA in the economic recession of the last decade. HIV prevention and control interventions may enhance their effectiveness if developed in national and EU level policy contexts that foster income equality, especially among vulnerable groups.

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