Source: politico.eu<\/p>\n
Greece was never known for the quality of its health system. But in 2009, at least among drug users, HIV was not a major threat \u2014 just 15 were diagnosed with the virus that year.<\/p>\n
Then came the financial crisis and the harsh austerity that followed. In 2011,\u00a0another 256\u00a0drug users learned they had HIV. In 2012, the\u00a0number was 484. The\u00a0reason\u00a0for the explosion: the Greek financial crisis and the harsh austerity measures that followed.<\/p>\n
The ballooning epidemic illustrates the importance that politics and policy plays in the fight against AIDS. Though there\u2019s still no cure, experts say we already have the tools to eliminate HIV as a threat to human health.<\/p>\n
The problem is not the science. It\u2019s the political will \u2014 and the fact that the most vulnerable tend to live on the margins of society. Lingering homophobia in some countries holds back men who have sex with men from getting care. Where they\u2019re accepted, sex workers and migrants are still at risk \u2014\u00a0and blamed for the spread of the epidemic.<\/p>\n
\u201cThese groups are generally discriminated [against] and stigmatized,\u201d making them less likely to seek help with prevention and treatment, said Nedret Emiroglu, the chief for communicable diseases in the World Health Organization\u2019s European Region. HIV isn\u2019t just a medical condition; it\u2019s “a social disease,” she added.<\/p>\n
Marios Atzemis was one of the Greek drug users diagnosed with HIV in 2011. He had been addicted to heroin and a regular in Athens\u2019 open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe\u00a0lost a third of their funding. Atzemis stopped seeing the vans that used to distribute fresh syringes, even as new users were entering the scene, shooting newer, cheaper drugs.<\/p>\n
\u201cAs a community of drug users, we didn\u2019t have an effective means of defense,\u201d said Atzemis, now a harm-reduction coordinator with the\u00a0Association of People Living with HIV Greece\u00a0(Positive Voice). \u201cIt was very easy for us to be targeted and to be scapegoats.\u201d<\/p>\n
The doctor refused to put him on anti-AIDS antiretrovirals medication until he got clean at a rehab clinic \u2014 even though the clinic was on the brink of being shut down for lack of funding.<\/p>\n
For Atzemis, now 44, this was enough motivation to wean himself off the drugs. \u201cIt didn\u2019t work the same for other people,\u201d he said.<\/p>\n
Whether it\u2019s inconsistent funding for programs that are working or social stigma blocking help from getting to the people who need it most, activists and public health professionals say even relatively wealthy countries are struggling to close the remaining gaps in the fight against the epidemic.\u00a0Worldwide, just four countries \u2014 Burundi, the Dominican Republic, the Democratic Republic of Congo and Portugal \u2014 are on track to meet the global goal to reduce AIDS deaths by 75 percent between 2010 and 2020, according to UNAIDS.<\/p>\n
AIDS is in many ways a 21st century success story. The\u00a0epidemic tore communities apart in the 1980s and 1990s. In 2000, only 680,000 people were on antiretroviral therapies. Today, 62 percent of people with HIV \u2014 some 23.3 million people \u2014 have access to the life-saving drugs. New infections are down 40 percent since their peak in 1997,\u00a0according to UNAIDS.<\/p>\n
Early diagnosis and speedy treatment create their own virtuous side effect. The drugs that prevent HIV from exploding into full-blown AIDS also\u00a0prevent HIV-positive people from transmitting it to others.<\/p>\n
London\u00a0serves as an example of what is possible. An\u00a0estimated 95 percent of people with HIV in the British capital have been diagnosed with the virus. And of those, 97 percent of them have such low levels of the virus that it’s undetectable (and therefore not contagious).<\/p>\n
On top of that, some antiretrovirals taken in advance of exposure, a treatment known as PrEP, can actually drastically reduce people’s chances of getting infected in the first place. Lower-tech methods like condom campaigns and needle-exchange programs help prevent HIV\u2019s spread further. There’s justified optimism that London can end HIV transmission in the coming years.<\/p>\n
Then there’s what happened among drug users in Greece. Backsliding threatens progress worldwide. Complacency is another major threat.<\/p>\n
Funding to fight HIV dropped in 2018 compared with the previous year, the NGO Doctors Without Borders warned in a\u00a0report\u00a0published this month. This dip in donations, the first since the turn of the century, could trigger an \u201cepidemic rebound\u201d in some poor African countries that can\u2019t afford to pick up the slack left by the loss of international aid.<\/p>\n
HIV diagnoses are down in the EU as a whole; however, in a third of the bloc’s countries, the trend is moving the wrong way. Ireland, for example, saw a record high number of diagnoses in 2018. Public health officials\u00a0pointed the finger\u00a0at migrants, but\u00a0activists argue\u00a0the country needs better access to PrEP and self-testing kits.<\/p>\n
Indeed, late diagnosis is a problem around the EU, where\u00a0about half of patients\u00a0don\u2019t find out they\u2019re HIV positive until several years after infection, according the the European Centre for Disease Prevention and Control.<\/p>\n
Sex between men is still the top mode of transmission in the EU, but it\u2019s also a bright spot: Diagnoses among this population are down 20 percent between 2015 and 2017. PrEP has the potential to drive further improvements, but it\u2019s not reimbursed in many countries, and the principal developer, Gilead, has found itself in some\u00a0bitter pricing disputes.<\/p>\n
Russia represents a horrifying story of complacency, denial and discrimination. The epidemic there didn\u2019t take off until the mid-1990s, and then mainly among people who inject drugs. But the country refused to fund harm-reduction measures, and in 2013, it outlawed targeting information to gay men. More recently, its rate of infections has been increasing by\u00a010 to 15 percent annually, with\u00a0100,000 infected in 2017 alone, and most transmissions are between heterosexual couples.<\/p>\n
In Greece, government officials, civil society and activists were relatively quick to acknowledge the problem. While the government faced heavy criticism from human rights advocates when it\u00a0posted photos\u00a0of alleged HIV-positive prostitutes, the public health community also rallied, doubling the number of needle exchanges in 2011 and cutting wait times for addiction treatment. Greece also introduced a\u00a0novel system\u00a0of paying drug users \u20ac5 to get tested and \u20ac3 for referring others, while connecting them with treatment and other services. That approach is now considered a\u00a0model\u00a0for responding quickly to outbreaks.<\/p>\n
For better or worse, Greece shows that a country doesn’t need to fix its entire health system to deal with HIV. As a case in point, its progress on AIDS hasn’t translated into progress on correlated problems like hepatitis C. Those rates rose during the debt crisis and haven’t ebbed much; based on 2017 data,\u00a0around 62 percent of drug users in Greece\u00a0have tested positive for hepatitis C.<\/p>\n
The crisis-era HIV outbreak marked “the first time that all the stakeholders \u2014 NGOs, state structures, every single one \u2014 worked together to face this epidemic,\u201d said Atzemis. “And probably the last time.”<\/p>\n\n\n\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":2400,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[785,62,2192,2178,1865,620],"class_list":["post-2399","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aids-hiv","tag-who-2","tag-aids","tag-drug-pricing","tag-global-health","tag-infectious-diseases","tag-public-health"],"yoast_head":"\n