AIDS: A Turning Point
10:13 pm
Thu July 26, 2012

Greece's Latest Crisis: Rising HIV Cases

Originally published on Fri July 27, 2012 8:58 am

One of the alarming consequences of the financial crisis in Greece appears to be a sharp rise in the rate of HIV infection.

The country, which is struggling through a historic debt crisis and a deep recession, still has one of the lowest HIV infection rates in Europe. But budget cuts to health and social services seem to be driving a recent and dramatic increase, especially among injecting drug users.

About 20 recovering drug users gather daily at the Off Club, an outpatient community center in central Athens. On a recent day, one is making lunch wearing a surgical mask and gloves.

"We assume that everyone here either has AIDS or hepatitis C, so we have to be careful," says center director Panagiotis Saivanides.

A 60-year-old recovering heroin addict who gives his name as Yiannis explains how he contracted hepatitis.

"I caught it because the pharmacies refused to give me clean needles," he says. "I tried to buy a syringe but the pharmacist didn't even want to look at me, let alone give me anything."

There had been a program for injecting drug users to exchange dirty needles for clean ones.

But the government canceled this needle exchange program in 2011 because of budget cuts.

Dirty needles are now responsible for a big increase in HIV infections.

Sex, Drugs And The Spread Of HIV

The country still has one of the lowest HIV rates in Europe. Only about 12,000 people have the virus in a country of 11 million.

But the rate has gone up 60 percent since 2010. And among injecting drug users it's increased nearly 1,500 percent, according to the Hellenic Center for Disease Control and Prevention.

A 35-year-old recovering heroin user who gives her name as Marilena says she knows HIV-infected injecting drug users who have sex for money.

"I know what they were doing on the streets," she says. "I know what kind of people they had sex with, and that they never used condoms."

Prostitution is only legal in licensed brothels, where sex workers are required to get regular health checks. Most of the 15,000 prostitutes in Greece work here illegally, mainly on the streets of central Athens, says Eleni Kakalou, a doctor who specializes in infectious diseases and treats people with HIV.

"And prices for commercial sex work have gone dramatically down," especially when addicts are using sex to pay for a fix, Kakalou says. "They say they would have sex for 5 euros ($6). I've even heard 2."

Earlier this spring, ostensibly as a pre-election crackdown on crime, police arrested 17 women with HIV who allegedly worked illegally as prostitutes. The names and photos of some of the women were posted on the police website.

Kakalou says Greek authorities received more than 4,000 calls — mostly from middle-aged men with families who said they had unprotected sex with the women.

"I think that just the fact that people are buying in these conditions commercial sex and they demand the non-use of condom as many of them have families — women, children that are completely unaware — shows the fact that there is a huge gap of knowledge and perception," she says.

Need For Better Strategy, And On A Budget

Yet others in Greece believe they can contract HIV simply by shaking the hand of an HIV-positive person, says a man who gives his name as Marco. He's gay and got the virus 13 year ago through unprotected sex. He says HIV is still a very stigmatized disease.

People "are scared of touching you" and "of the air, of the water, of everything" around you, he says.

Most people living with HIV in Greece are gay men. Marco says that the most people in the gay community are careful about condom use, though he acknowledges that he still knows of risky behavior.

Apostolos Veizis, head of the medical support team for Doctors Without Borders, wants Greece to set up a strategy for educating more people about HIV to stop its spread, especially among injecting drug users.

"All of us saw a situation going out of control," Veizis says. "It's something that did not come from one day to another. Authorities were seeing the situation, and I think they did not do anything, essentially, responding to the problem."

At the very least, the government does plan to restore the needle exchange program. But what else can be done, since the country is broke?

Veizis says Greece should consider Uganda, a developing nation that successfully managed the spread of HIV on a limited budget, using methods like an extensive public education campaign emphasizing condoms, monogamy and abstinence.

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Transcript

RENEE MONTAGNE, HOST:

The International AIDS Conference wraps up today in Washington, D.C. The week was packed with panels and high-profile guests discussing the global pandemic and how to combat it. One country, seeing a shift in HIV infection rates is Greece. It still has one of the lowest rates in Europe, but the country has seen a sharp rise recently, and it appears to be an alarming consequence of the financial crisis.

Budget cuts to health and social services seem to be driving the dramatic increase, especially among addicts who inject drugs. Reporter Joanna Kakissis has our story from Athens.

UNIDENTIFIED MAN #1: (Speaking foreign language)

UNIDENTIFIED MAN #2: (Speaking foreign language)

JOANNA KAKISSIS, BYLINE: About 20 people are gathering in an outpatient center for drug users. One of the recovering addicts is making lunch wearing a surgical mask and gloves. The center's director, Panagiotis Saivanides, explains why.

PANAGIOTIS SAIVANIDES: (Speaking foreign language)

KAKISSIS: We assume that everyone here has AIDS or Hepatitis C, he says. So we have to be careful. A 60-year-old recovering heroin addict who gives his name as Yiannis explains how he contracted hepatitis.

YIANNIS: (Through Translator) I caught it because the pharmacies refused to give me clean needles. I tried to by a syringe, but the pharmacist didn't even want to look at me, let alone give me anything.

KAKISSIS: There was a program where injecting drug users could exchange dirty needles for clean ones. But the government canceled this needle exchange program because of budget cuts. Dirty needles are now responsible for a big increase in HIV infections. The country still has one of the lowest HIV rates in Europe. Only about 12,000 people have the virus in a country of 11 million. But the rate has gone up almost 60 percent since 2010, and among injecting drug users, it's increased an astonishing 1500 percent says the Hellenic Center for Disease Control and Prevention.

A 35-year-old recovering heroin user who gives her name as Marilena says she knows HIV-infected injecting drug users who have sex for money.

MARILENA: (Through Translator) I know what they were doing on the streets. I know what kind of people they had sex with, and that they never used condoms.

KAKISSIS: Prostitution is only legal in licensed brothels, but most of the 15,000 prostitutes who work here illegally on the streets and without health checks, says Eleni Kakalou, a doctor who treats HIV patients.

DR. ELENI KAKALOU: And prices for commercial sex work have gone dramatically down. They say they would have sex for five euros. I've even heard 2 euros.

KAKISSIS: This spring ostensibly as a pre-election crackdown on crime, police arrested 17 women with HIV who allegedly worked illegally as prostitutes. The names and photos of some of the women were posted on the police website. Kakalou says Greek authorities received more than 4,000 calls, most from middle-aged men with families saying they had unprotected sex with the women.

KAKALOU: I think that just the fact that people are buying in these conditions commercial sex and they demand the non-use of condom as many of them have families, women, children that are completely unaware, shows the fact that there is a huge gap of knowledge and perception.

KAKISSIS: Other people think they can contract HIV simply by shaking the hand of an HIV-positive person, says a man who gives his name as Marco. He's gay and got the virus 13 years ago through unprotected sex.

Do they think that they can just get it by touching you sometimes?

MARCO: Yes. Scared of the air, of the water, of everything. Scared of touching you.

KAKISSIS: Most people living with HIV are Greece are gay men, though Marco says the gay community is now more careful about using condoms. But Greece needs a strategy as soon as possible to educate more people here about HIV and prevent its spread, especially among injecting drug users, says Apostolos Veizis of Doctors Without Borders in Greece.

DR. APOSTOLOS VEIZIS: All of us saw a situation going out of control. It's something that did not come from one day to another. Authorities, they were seeing the situation, and I think they did not do anything, essentially, responding to the problem.

KAKISSIS: At the very least, the government does plan to restore the needle exchange program. But what else can be done since Greece is broke? Veizis says that the country should consider Uganda, a developing nation which successfully manages the spread and treatment of HIV on a limited budget. For NPR News, I'm Joanna Kakissis in Athens.

MONTAGNE: And to see our complete coverage on this week's International AIDS Conference, go to npr.org. Transcript provided by NPR, Copyright NPR.

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