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.

Georgios K Nikolopoulos,Claudia Costa-Storti,Samuel R Friedman,Anastasios Fotiou,Jonathan E Suk,Melpomeni-Minerva Malliori,Angelos Hatzakis,Clive Richardson,Marios Detsis,Eleftheria Kanavou,Anastasia Pharris,Vana Sypsa,Dimitrios Paraskevis,Jan C Semenza,Spencer Moore

doi:10.1371/journal.pone.0122367

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.

Highlights

The annual numbers of newly diagnosed HIV cases among people who inject drugs (PWID) varied across European countries during the ten-year period between 2003 and 2012
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)
Greece reported the largest increase in new HIV diagnoses among PWID in 2011–2012, followed by Romania, while in Bulgaria the change was less abrupt and started earlier (2006–2012)

Summary

Introduction

The annual numbers of newly diagnosed HIV cases among people who inject drugs (PWID) varied across European countries during the ten-year period between 2003 and 2012. Two European Union (EU) countries, Greece and Romania, experienced large HIV outbreaks in 2011 and 2012, [3,4] while rising numbers have been observed in Bulgaria since 2006.[5]. High levels of HIV transmission coincided with or followed severe social, political, and economic disruption in Russia and other former Soviet Union states in the early 1990s.[7,8] It should be noted that the coverage of opioid substitution treatment (OST) and needle and syringe programs (NSP) had been constantly low in Greece before the outbreak. 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)

Methods

Results

Conclusion