Joint technical mission : HIV in Greece : 22 – 26 October 2012 : mission report

Greece has experienced a fairly stable, low-level HIV epidemic for a number of years. Men who have sex with men have been the most affected population. Since the beginning of 2011, Greece has been facing a significant outbreak of HIV among people who inject drugs in Athens. In the first four months of 2012, for the first time the number of new HIV cases reported among people who inject drugs exceeded the number of new HIV cases among men who have sex with men. This outbreak is driven by unsafe injecting practices among people who inject drugs, for example sharing injecting equipment, and mainly affects Greek nationals. Although foreign nationals who inject drugs are also at risk of acquiring HIV infection, there is no evidence that immigration is driving the current HIV outbreak. This outbreak is occurring at a time when Greece is experiencing an unprecedented and severe financial crisis. It is unclear to which extent the financial crisis has contributed to the outbreak, but it is evident that the crisis has a significant social and health impact on the population of Greece in general, and Athens in particular. In addition, the response of public authorities and civil society to the HIV outbreak is planned and implemented in a context of social and political uncertainty, with extremely scarce financial resources. Without decisive action the outbreak will not only continue but there is also the risk that it could spread beyond Athens. The necessary steps were outlined in an EMCDDA/ECDC rapid risk assessment at the end of 2011 and are restated in this report: measures to break the transmission cycle, namely the provision of sterile injecting equipment, and intensified opioid substitution treatment. These measures will require the coordination of public authorities and civil society at the strategic and operational levels. Encouragingly, significant steps in response to the outbreak have already been taken by the Greek authorities. The outbreak was quickly recognised and reported to national and international stakeholders. The Greek organisation against drugs (OKANA) has quickly expanded the provision of opiate substitution treatment and increased the provision of harm reduction services to prevent further transmission of HIV. However, given the magnitude of the ongoing outbreak of HIV, a significant scale-up of services and additional efforts will be required to significantly reduce the long waiting lists for drug treatment and to improve the supply of sterile injecting equipment to people who inject drugs and thus curb the number of new infections. There is a strong need to establish AIDS coordination bodies, with strong mandates and sufficient resources at strategic and operational levels in order to maximise the response to the HIV outbreak. These bodies need to involve a number of ministries, local authorities, police, civil society, and other key stakeholders. They need to coordinate the response to the current HIV outbreak among people who inject drugs in Athens as well as the overall response to HIV nationally. Given the current epidemic situation and the potential for further spread, it is highly recommended that access to HIV testing is increased. HIV tests should be provided free of charge in