Big Events in Greece and HIV Infection Among People Who Inject Drugs

Abstract

Big Events are processes like macroeconomic transitions that have lowered social well-being in various settings in the past. Greece has been hit by the global crisis and experienced an HIV outbreak among people who inject drugs. Since the crisis began (2008), Greece has seen population displacement, inter-communal violence, cuts in governmental expenditures, and social movements. These may have affected normative regulation, networks, and behaviors. However, most pathways to risk remain unknown or unmeasured. We use what is known and unknown about the Greek HIV outbreak to suggest modifications in Big Events models and the need for additional research.

Keywords :

• Big Events
• economic crisis
• HIV
• Greece
• drugs
• injectors
• epidemics
• epidemiology
• drug use networks
• risk environments

THE AUTHORS

Georgios K. Nikolopoulos, Ph.D., has received a post-doctoral research fellowship from the International AIDS Society and the National Institute on Drug Abuse and is now leading the Transmission Reduction Intervention Project (Principal Investigator: Dr. Samuel Friedman) in Athens, Greece. He earned a PhD in the epidemiology of infectious diseases at the School of Medicine of the Athens University in Greece and has served at the Greek public health agency for almost one decade, focusing on HIV surveillance. Dr. Nikolopoulos also has expertise in the conduct of systematic reviews and meta-analyses with useful contributions to the evolving domain of genetic epidemiology.

Vana Sypsa, Ph.D., is Assistant Professor of Epidemiology and Preventive Medicine in the Department of Hygiene, Epidemiology and Medical Statistics of Athens University Medical School in Greece. She obtained her first Degree in Mathematics, an M.Sc. in Biometry, and a Doctoral Degree in Epidemiology. She has been involved in several projects on infectious diseases and was co-investigator in a large RDS program in injecting drug users during an HIV outbreak in Athens. She is the Secretary of the Executive Committee of the International Society for Clinical Biostatistics. She is the author or coauthor of 68 papers published in peer-reviewed international journals.

Stefanos Bonovas, MD, M.Sc., Ph.D., graduated from the Medical School, University of Athens, and completed a medical residency in General Practice. He earned his M.Sc. in Biostatistics and his Ph.D. in Pharmacoepidemiology from the Medical School, University of Athens, Greece. His research focuses in the areas of pharmacoepidemiology, drug safety, public health, infectious disease surveillance, outbreak investigation, and meta-analysis of clinical research.

Dimitrios Paraskevis, Ph.D., is Assistant Professor of Epidemiology and Preventive Medicine in the Department of Hygiene, Epidemiology and Medical Statistics at Athens University Medical School in Greece. Dr. Paraskevis has a master of science in Molecular Biology and a doctoral degree in Molecular Epidemiology of viruses. His research interests cover the epidemiology, molecular epidemiology, and evolution of viral infectious diseases, molecular diagnostics, as well as the resistance to antivirals. He is a panel member of the European HIV Drug Resistance and Tropism Guidelines.

Melpomeni Malliori-Minerva, DDS, MD, Ph.D., is Associate Professor of Psychiatry at Athens University Medical School in Greece. She is Member of the Management Board of the European Monitoring Centre for Drugs and Drug Addiction. Dr. Malliori-Minerva was President of the Greek Organization against Drugs and vice President of the Hellenic Centre for Disease Control and Prevention. She was Member of the European Parliament and has served as its representative to the European Centre for Disease Prevention and Control. She has 35 publications in international medical journals and books, and 70 publications in national medical journals and books.

Angelos Hatzakis, MD, M.Sc., Ph.D., is Professor of Epidemiology and Preventive Medicine, and former Director of the Department of Hygiene, Epidemiology and Medical Statistics at Athens University Medical School in Greece. He is founder and Head of the National Retrovirus Reference Center, and founder and Chair of the “Hepatitis B & C Public Policy Association.” Prof. Hatzakis has participated in many Executive Committees and was President of the Hellenic Center for Disease Control and Prevention. His research interests cover epidemiology and preventive medicine including virology, pathogenesis, prevention, and treatment of viral diseases and oncogenic viruses (human retroviruses, hepatitis viruses, herpes viruses).

Samuel R. Friedman, Ph.D., is Director of Infectious Disease Research at National Development and Research Institutes, Inc. and the Director of the Interdisciplinary Theoretical Synthesis Core in the Center for Drug Use and HIV Research, New York City. Dr. Friedman is an author of about 450 publications on HIV/hepatitis C/STIs, and drug use epidemiology and prevention. Honors include an NIDA Avant Garde Award (2012), the International Rolleston Award of the International Harm Reduction Association (2009), the first Sociology AIDS Network Award for Career Contributions to the Sociology of HIV/AIDS (2007), and a Lifetime Contribution Award, Association of Black Sociologists (2005).

GLOSSARY

• Big Events: Transitions, Serious Economic Crises, Wars, and Ecological Disasters. The term refers to major events, natural, as well as man-made, which effect adaptation, functioning, and quality-of-life of individuals as well as social relationships and systems. Existential threat, instability, and chaos are major dimensions and loss of control over one's life is experienced.

Notes

¹ The reader is referred to Hills's criteria for causation, which were developed in order to assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58:295–300.).

² The reader is asked to consider that concepts and processes such as “risk,” “vulnerability,” and “protective” factors are often noted in the literature, without adequately delineating their dimensions (linear, non-linear, rates of development, sustainability, cessation, etc.), their “demands,” the critical necessary conditions (endogenously as well as exogenously; micro to macro levels) which are necessary for them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to operate and whether their underpinnings are theory-driven, empirically based, individual and/or systemic stake holder-bound, historically bound, based upon “principles of faith” or what. This is necessary to clarify, if possible, if these terms are not to remain as yet additional shibboleths in a field of many stereotypes. Editor's note.