National Income Inequality and Declining GDP Growth Rates Are Associated with Increases in HIV Diagnoses among People Who Inject Drugs in Europe: A Panel Data Analysis

Abstract

BackgroundThere is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA).MethodsWe used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated.FindingsIn multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested.InterpretationGiven the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.

A network intervention that locates and intervenes with recently HIV-infected persons: The Transmission Reduction Intervention Project (TRIP)

“…TRIP was conducted (6/2013–7/2015) in Athens, Greece, where an HIV epidemic among PWID began in 2011242526.…”

Overview of HIV molecular epidemiology among people who inject drugs in Europe and Asia

“…Despite decreasing trends in HIV-1 diagnoses among PWID in Western Europe after 2000, Greece and Romania, and in particular their capital cities, Athens and Bucharest respectively, experienced recent PWID-related outbreaks (Nikolopoulos et al, 2015a; Paraskevis et al, 2015). The HIV-1 epidemic in Greece was concentrated in MSM (Nikolopoulos et al, 2008) being the product of multiple introductions of subtype B from other Western countries although the prevalence of subtype A has been increasing over time (Paraskevis et al, 2007).…”

“…This geographical area includes countries with past or recent PWID-related outbreaks (Nikolopoulos et al, 2015a), countries with mega-epidemics in PWID such as Ukraine, Russia, China, and Malaysia (Wolfe et al, 2010), and hotspots of ongoing recombination processes (Lau and Wong, 2013). …”

Interpersonal Attacks on the Dignity of Members of HIV Key Populations: A Descriptive and Exploratory Study

“…We thus developed questionnaire items to measure attacks on dignity in the context of a larger research project to develop measures of hypothesized pathways by which major social (or “structural”) interventions such as neighborhood-uprooting urban renewal or reductions in fire service coverage that result in urban “burnouts” (7, 8) or large-scale economic, political, social, and climate-driven “Big Events” might lead some people to become members of Key Populations such as PWID or sex workers; and how they can lead members of Key Populations such as PWID, men who have sex with men (MSM) or other populations such as heterosexuals to engage in high-risk behaviors (6, 9 – 11). Big Events are an important macro-social phenomenon of considerable interest to HIV research since a number of them have been followed by major HIV outbreaks (6, 9 – 11).…”

“…Big Events are an important macro-social phenomenon of considerable interest to HIV research since a number of them have been followed by major HIV outbreaks (6, 9 – 11). We developed a theorization of pathways from macro-social change or Big Events to HIV risk in terms of CHAT (Cultural-Historical Activity Theory); this included an outline of relevant measures that need to be developed (6).…”