Expert update on drug-related infectious diseases

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) gathered the Drug-related infectious diseases (DRID) expert network to share the latest developments on drug-related infectious diseases in Europe and to identify steps needed to improve the production, availability and use of public health-oriented information at the European level.

The DRID network brings together national experts nominated by national focal points of the EU Member States, Norway and Turkey, as well as institutional partners (ECDC, WHO, Correlation). The meeting also welcomed experts from the Western Balkans (IPA7 project), the European Neighbourhood Policy countries (EU4MD project), Georgia, the United Kingdom, Australia and the United States. Participating experts come from ministries of health, public health institutes, drugs agencies, health services, universities, research institutes and civil society.

The group held an online meeting on 26-27 October 2021, focusing on:

  • The direct impact of COVID-19 on people who use drugs and the COVID‑19 vaccination campaign among this group;
  • A review of recent HIV trends and outbreaks, as well as infectious endocarditis linked to injecting drug use with a focus on risk factors and control measures in place;
  • Country experiences in the elimination of viral hepatitis as a public health threat among people who inject drugs (PWID) and related EMCDDA projects, with a focus on harm reduction and the continuum of care.

The report section on Outbreaks includes some interesting information from South East Europe.

In 2011, an HIV outbreak among PWID was detected in Athens, Greece (Paraskevis et al., 2011). After a combination of prevention and ‘seek-test-treat’ interventions were implemented (including scaled-up NSP, testing, linkage to AOT and antiretroviral treatment (ART), HIV incidence declined (Sypsa et al., 2017) from 7.8/100 person-years in 2012 to 1.7/100 person-years in 2013. However, preliminary data from the latest round of the ARISTOTLE study, conducted in 2018-20 (Roussos et al., 2021) among 681 PWID who were included in previous rounds, suggest that HIV prevalence increased from 14.2 % (2012-13) to 22 % (2018-20). While incidence estimates never returned to their 2011-12 levels, they ranged from 1.52 to 2.04/100 person-years, indicating ongoing transmission. The prevalence of homelessness (25.6 %) and cocaine injecting (28.1 %) had increased over the period. Predictors of seroconversion included lower education, larger network size and daily drug use. The authors concluded that the current level of prevention and treatment services was below levels that would be required to bring transmission down to pre-outbreak levels. They also noted that the COVID‑19 pandemic has severely impacted HIV prevention services for PWID, which could increase the risk of HIV transmission in this population. The study team conducted a similar study in Thessaloniki, the second-largest city in the country, where 1 101 PWID were recruited during 2019-20. They found high HIV incidence among the study population, suggesting that an outbreak was occurring at a time when COVID‑19 controls measures were in place. The authors highlighted that immediate interventions were required to control transmission.

Following the DRID meeting, national experts from three additional EU countries have reported signals of increased HIV transmission among people who use drugs. In Sofia, Bulgaria, reports indicate that the pandemic seems to have worsened a situation that was already deteriorating with respect to harm reduction funding. According to data from the laboratory at the State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism in Sofia, reported by the national expert, the positivity rate for HIV infection among PWID in the capital of Bulgaria was significantly higher in 2019-20 (12.8-14.5 %) than in the previous years (when positivity rates were between 3-6 %). A parallel increase in HBV positivity (HBsAg) was also noted from 2019 (5.9 %) to 2020 (7.6 %). This comes after the Global Fund ended its financial support to harm reduction services in 2017. It consequently led to a disruption in needle and syringe programmes, and a reduction by more than half in the number of PWID being tested annually. The National Centre of Public Health and Analysis is organising a meeting with stakeholders and decision-makers to initiate legal changes in order to ensure sustainable financial support for harm reduction services.

The national expert from Slovenia reported that, by November 2021, four new HIV diagnoses among PWID were reported to the National Institute of Public Health among a total number of 28 reported new HIV diagnoses during 2021. This raised concerns that HIV infections might have started to spread more during the COVID‑19 pandemic among PWID in the country. Since 1986, when HIV reporting became mandatory in Slovenia, a total of 29 HIV infections among PWID have been reported, and such a high number of cases (four) were reported only once before, in 1996. The importance of reaching a good coverage of harm reduction services for PWID was re-emphasised.

To read full report from this meeting and get the information from expert update, follow this link>>>.

 

Greek organisations started street work with vulnerable groups

The Positive Voice announces the suspension of the operation of the prevention and examination centres “Checkpoint” in Athens and Thessaloniki, from 16 March 2020.

In the context of our contribution to the suspension of the spread of the pandemic, but also to the protection of the health of their visitors, volunteers and employees, the Association took all appropriate measures and has already stopped the operation of Red Umbrella Athens in Omonia and the examinations at the “Syn Athena” Home of the Municipality of Athens.

But, the same day, in the framework of the emergency plan for the care of homeless and psychoactive substance users, the Municipality of Athens held a meeting with organizations active in the field of prevention and harm reduction of vulnerable groups. The Association of HIV-positive people of Greece “Positive Voice”, the Association of Liver Patients “Prometheus“, OKANA, KETHEA, Praksis, STEPS and Doctors of the World were invited and attended.

The agreements that were unanimously accepted are oriented to the following actions:

  • Minimize the transmission of the virus to the vulnerable population, through continuous information, wide distribution of sanitary and pure injectable material and access to personal hygiene, nutrition and hospitality services.
  • Adoption of measures aimed at reducing the consequences of the transmission of the virus

Since then, the street work of the associations “Positive Voice” and “Prometheus” has been carrying out actions to support vulnerable groups through the provision of food, safe use synergies and protective equipment (such as gloves and condoms).

In particular, to date they have reached 434 people and have distributed more than:

  • 200 kit of sanitary material for injectable use
  • 2,882 condoms
  • 110 servings of food
  • 464 snacks (toast / sandwich / croissant)
  • 208 juices and water

The Anti-Narcotics Agency (OKANA) has contributed to this effort by distributing sanitary material, safe use synergies and information leaflets.

On Tuesday, April 7, 2020, the Association of HIV-positive people of Greece “Positive Voice” and the Association of Patients of Liver of Greece “Prometheus” were hosted on the ANT1 show “Special Report”.

Journalists conducted extensive research discussing the people who live on the streets and the organizations that implement their support programs. Following the appearance of the first case of COVID-19 in a homeless day centre in Piraeus, the show is investigating the safety net of vulnerable groups from the spread of the virus.

As part of the emergency plan of the Municipality of Athens for the care of homeless and users of psychoactive substances, the two associations have undertaken an extraordinary initiative through street work, in order to support vulnerable groups. Users of psychoactive substances, homeless people, sex workers, immigrants and refugees are the target groups of the initiative and their support is provided through the provision of safe use and protective materials (such as gloves, injectable material and condoms).

In his interview, the President of the Association “Prometheus”, George Kalamitsis, among other things, noted that things have not changed enough today. “What has changed is that some of our fellow citizens are more afraid. There is fear either for the pandemic, or because there are too many police in central Athens at the moment. The reasons are obvious, but they are scary. As for the hospitality structures and the supervision of the people who live in them, we need services that can be adapted to the needs of the people.

At the same time, Nikos Fitsialos, head of the street work team, added that “general attention needs to be paid to the people who are outside, especially now that citizens who are in solidarity are not circulating and will share a portion of food or a conversation. People lack communication. We notice that people want to talk to us, they ask us and they need it. Not necessarily to learn information about the coronary artery, but to have a human contact.

In the interview, the Municipality of Athens highlighted the need to minimize the transmission of the pandemic to vulnerable populations, through continuous information, wide distribution of medical supplies and access to personal hygiene, nutrition and hospitality services. In addition, Nikitas Kanakis from Doctors of the World added that “the homeless today are under the radar of epidemiological surveillance and are people who do not have the ability, not only to protect themselves but also do not have the right to individual responsibility.

The action of the street work team takes place three times a week, every Wednesday, Thursday and Friday and is implemented mainly in Omonia, Exarchia, Syggrou Avenue in Metaxourgeio and on Panepistimiou (Nomiki), Kavala, Iasonos, and Patision (ASOE) streets. . After careful consideration of the growing needs, it is necessary to expand working hours and days, something that will happen very soon.

Positive Voice also published advice for Greek citizens that have been stranded abroad and those that are not a Greek citizen and have been stranded in Greece on the procedure for accessing antiretroviral treatment.

For more information about activities in Greece, you can contact Positive Voice.

Too bad politics and prejudice keep getting in the way

Photo: Aris Messinis/AFP via Getty Images

DPNSEE Board member Marios Atzemis contributed to the article

“We know how to end AIDS”, published by Politico

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 – just 15 were diagnosed with the virus that year.

Then came the financial crisis and the harsh austerity that followed. In 2011, another 256 drug users learned they had HIV. In 2012, the number was 484. The reason for the explosion: the Greek financial crisis and the harsh austerity measures that followed.

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’ open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe lost 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.

As a community of drug users, we didn’t have an effective means of defense,” said Atzemis, now a harm-reduction coordinator with the Association of People Living with HIV Greece Positive Voice) “It was very easy for us to be targeted and to be scapegoats.”

The doctor refused to put him on anti-AIDS antiretroviral medication until he got clean at a rehab clinic – even though the clinic was on the brink of being shut down for lack of funding.

For Atzemis, now 44, this was enough motivation to wean himself off the drugs. “It didn’t work the same for other people,” he said.

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, around 62 percent of drug users in Greece have tested positive for hepatitis C.

The crisis-era HIV outbreak marked “the first time that all the stakeholders – NGOs, state structures, every single one – worked together to face this epidemic,” said Atzemis. “And probably the last time.”

To read full article, follow this link>>>

Women in Drug Use: Deafening silence

In Greece, the Support. Don’t Punish campaign was this year dedicated to women who use psychoactive substances, the silent group that has no voice or face in the country, but suffers from stigmatization and marginalization and is hard-pressed by serious problems in addition to its usual usage.

On the occasion of Global Day of Action of the campaign, the member organizations of the NGO Platform for Psychoactive Substances (Peer-to-Peer Users Network of Psychoactive Substances, Diogenis Policy Dialogue on Drugs, Positive Voice, Centre for Life, Prometheus, Steps and PRAKSIS) organised an event dedicated to women using psychoactive substances. They invited guests to talk about them, name them and open the road together to find realistic solutions, listening to the stories of the women themselves as well as the experiences of professionals in the field. The event was held on 27 June at the Beatniks Road Bar in Athens.

Women have the right to enjoy rights and fundamental freedoms, without discrimination, in all areas of life. These rights also apply to women who use psychoactive substances.

The multiple identities that women using drugs experience – pregnant, mothers, workers, migrant, refugees, sex workers, trafficked persons, victims of physical violence, prisoners – reflect the particular needs associated with the experience of social stigma, financial situation, insufficient social support, family relationships, a substance-mate partner, children and treatment. Services for women using psychoactive substances should take into account these particular needs of this vulnerable population and be hospitable, non-critical, supportive and, of course, provide emotional safety.

A “Rights Guide” for women using psychoactive substances which highlights the above was presented at the event.

HIV/AIDS situation in Greece

The National Public Health Organisation (Εθνικό Οργανισμό Δημόσιας Υγείας) publishes annually the HIV/AIDS Surveillance Report in Greece. This annual edition includes data that have been reported by 31 December 2018. Data were reported by Infectious Disease Units, Outpatients clinics for HIV infected patients, HIV/AIDS Reference and Control Centres and Hospitals.

In 2018, 687 new HIV cases were diagnosed and reported. Totally, 90 cases (13.1%), who were diagnosed with HIV in 2018, had already developed AIDS or progressed to AIDS during that year. Sex between men accounted for 40.0% of HIV diagnoses in 2018 followed by heterosexual transmissions (22.4%) and infections attributed to injecting drug use (15.4%). The predominant age group in both males (34.0%) and females (44.4%) was that of 30-39 years old.

The cumulative number of HIV diagnoses since the outbreak of the epidemics (including AIDS cases) reported in Greece by 31/12/2018 was 17,389. Of these, 14,397 (82.79%) were males and 2,951 (16.97%) were females. Sex was not reported for 41 (0.24%) HIV diagnoses.

Unprotected male-to-male sexual contact is the most frequently reported mode of HIV transmission in Greece. In total, 48.2% of HIV diagnoses, that were reported in Greece were Men who have Sex with Men (MSM) (table 9). After excluding cases with undocumented mode of HIV transmission, the aforementioned percentage comes up to 57.6%.

An outbreak of HIV occurred among PWID; 319 infections were diagnosed in 2011 and 525 in 2012. However, HIV diagnoses attributed to injecting drug use have been decreasing since 2013 and increasing by 2018 [2013 (n=270), 2014 (n=120), 2015 (n=95), 2016 (n=100), 2017 (n=93) and 2018 (n=106)].

Of 3,754 cases infected through heterosexual contact, the majority (53.3%) were females (tables 10, 11). After 2010, however, the percentage of males among heterosexually-infected cases increased (2015; males 54.7%), whilst in 2016 we notice the inverse pattern emerging women in higher levels (58.9%). Similar was the trend for 2017 and 2018.

AIDS case reporting started in Greece in 1984 while HIV case reporting started in 1998. Both are anonymous, confidential and mandatory by Ministerial Decisions.

To read the full report, follow this link>>>

Homophobic attack at Checkpoint in Athens

The building that houses checkpoint managed by our member organisation Positive Voice in the centre of Athens was the target of an attack with obvious homophobic motives at dawn on Monday, 11 March. The fire broke out on the first floor of the structure located in Monastiraki quarter and caused extensive material damage. However, the early intervention of the fire brigade prevented its spread to the upper floors, as well as to adjacent buildings in an extremely densely populated area.

Luckily, there were no people in the structure because volunteers of Positive Voice had left the building at 12:30 in the evening to implement the club’s external action and the attack took place about an hour and a half later.

According to the fire service, the attackers came from the balcony on the first floor and caused the fire by throwing gasoline. They threw the rainbow flag from the façade, revealing so the homophobic characteristics of the attack.

The Checkpoint as a Positive Voice initiative and AHF Europe, have conducted over 100,000 free tests and diagnosed about 30% of new HIV cases each year in Greece. The confidence of society and vulnerable groups in this effort and the international recognition of its success is due to the fact that it is as high as the value of health, dignity, equality and respect for human rights.

Through the operation of Checkpoint, Positive Voice are leading the elimination of discrimination, stereotypes and prejudices that push entire social groups into the margins and threaten social cohesion. In this way, they serve health by focusing on human beings, regardless of gender expression, identity, gender, race, age, sexual orientation, social status, religion and financial status.

The attack will not prevent Positive Voice from fulfilling their Mission nor stop its operation for a moment. Recipients of our services will be temporarily admitted to the mobile unit that is parked outside the building.

Positive Voice calls on all social partners, public bodies, institutions, civil society organizations, businesses and every citizen to raise their rainbow flag on their buildings as a symbolic response against such intimidation.

DPNSEE and it members fully support our colleagues and stand with them!

Greek Parliament set to vote on new bill establishing Supervised Drug Consumption Sites

A hearing meeting of the Standing Committee on Social Affairs of the Hellenic Parliament took place on 20 February 2019 to discuss draft law submitted by the Health Ministry. Among others, it includes various amendments of the Law 4139/2013 on drugs as well as a specific provision for the legal establishment of supervised drug consumption sites in Greece. The debate over the recent draft law is entitled “Private Clinics Statutory Framework, Modernization and Reformative recommendations, The National Public Health Organization establishment, the National Institute of Neoplasms and the other provisions establishment”.

Sofia GalinakiSofia Galinaki, Advocacy Officer of Diogenis and representative of the Greek organizations’ Platform for psychoactive substances, participated in the hearing, during which in cooperation with other Platform’s member organizations presented a series of proposals aiming to improve this legislative initiative.

Α relevant proposals’ memorandum was submitted on behalf of the Platform to the Committee and the Minister of Health, Mr A. Xanthos.

The second reading of the draft law by the Committee scheduled for 26 February 2019.

The current Law (in Greek) is available following this link>>>>

Survey of drug users mapping in the centre of Athens

DPNSEE member organisations from Greece Prometheus and Positive Voice have developed a study on the anthropogeography of users of psychoactive substances in the centre of Athens in September 2018 using a sample of 200 people. The survey collected information on demographics and living conditions of users, type of psychoactive substance they use and whether or not they joined the retirement or substitution program.

According to the findings of the study, 80% of users are male. The average age is on an upward trend compared to 2010 (33.7) and 2012 (37) – currently it is 38 years. 53% of the sample are primary school graduates, while in terms of nationality there is an increase in the number of foreigners (from 13% in 2012 to 34.5%).

In the residence area in the centre of Athens, the largest concentration of population is located in the areas of Vathis Square, Karaiskakis Square the Theatre Square and the University campus. Regarding the type of psychoactive substance, the highest rate is 63.5% heroin use, while cocaine use accounts for 44.5% of the sample, 14% for Tai, 16% for benzodiazepines and 15% for shisha.

Out of the 200 people, 116 have been included, even once during their lifetime, in a drug rehabilitation or substitution program. However, at the time of the survey, only 49 people were enrolled in a program. The majority of the sample (130 persons) is not in a program or have applied for it.

In conclusion, it is noted that the population of psychoactive drug users in the centre of Athens is “aging“, while the association of the particular population with a high risk of premature death is questioned. Also, high users’ time in the centre of Athens, coupled with the increased rate of homelessness, raises serious issues of personal and public health and user safety. The findings of this study are consistent with the results of the Aristotel’s HCV/HIV study and demonstrate the need for harm reduction policies such as the re-opening of the medically supervised areas and the immediate increase in free distribution of safe use in cooperation with organizations active in the field.

To summarize, the findings of the study highlight the issue by demonstrating that the problems associated with the drug use in the centre of Athens are perpetuated, increased and differentiated at rates that require immediate and effective action.

The study was conducted in collaboration with a working group under the scientific responsibility of Mr. Giorgos Kalamitsis, President of Hellenic Patients’ Association Prometheus, Minerva Melpomeni Malliori, Professor of Psychiatry, First Psychiatric Clinic of Athens University, Eginiteio Hospital and Vana Sypsa, Professor of Epidemiology and Preventive Medicine, Laboratory of Epidemiology and Medical Statistics of the Medical School of the University of Athens and courtesy of the Athens Trade Association and the Union of Hoteliers of Attica and Argos Oasaronic.

To view the original article follow this link>>>>

We are all POSITIVE!

On the occasion of World AIDS Day 2018, the Greek Association of People Living with HIV Positive Voice and the Onassis Foundation organized a series of interpersonal activities “I am Positive” promoting human stories related to HIV/AIDS on 21 and 22 November 2018 at The Onassis Stegi Cultural Centre in Athens.

Children and adolescents had the opportunity to chat with representatives of the seropositive community on sexual health, but also about the challenges and prejudices they face and the stigma that accompanies these groups through their stories, hopes and fears, the reality that HIV-positive people in Greece face and the medical and social dimension of the disease. A serodifferent couple, a mother whose son lives with HIV and a gay claiming his right to prophylactic treatment PrEP shared with the public their thoughts and experiences.

The debate was co-ordinated by journalist Elena Akrita.

To view the original article, including video recordings of personal testimonies, follow this link>>>>

Diogenis is candidate for the Bravo! Sustainable Awards

Diogenis – Drug Policy Dialogue has the honour of being a Bravo! Sustainable Awards 2018 candidate, in the category Bravo Society with the action “SDGs and Drugs: Policies for Development and Harm Reduction” that was implemented in the period 1/12/2016 – 31/5/2017, under the LADDER program.

For the 8th consecutive year, the Bravo Initiative opens up a large social dialogue on sustainable development with a wide range of social partners and active citizens. The initiative is a systematic social dialogue based on the sustainable development goals developed in Greece by businesses, local governments and civil society organizations. Initiatives and programs should promote the improvement of quality of life and the development of standards of responsible behaviour at a collective and individual level in Greece. In order to create a wider culture of Sustainable Development, Responsible Entrepreneurship and Social Responsibility issues, the Bravo Dialogue Institution is developing a platform for dialogue, information and open consultation with the participation of a large group of Social Partners.

You can see the action description, the 7 SDGs associated with it and post your vote following this link>>>