In Greek crisis, HIV gains ground

ATHENS Thu Nov 10, 2011 11:19am EST

Nurse Maria Vatista examines an immigrant inside a mobile HIV testing van in Omonia square in Athens October 31, 2011. REUTERS/Yannis Behrakis

Nurse Maria Vatista examines an immigrant inside a mobile HIV testing van in Omonia square in Athens October 31, 2011.

Credit: Reuters/Yannis Behrakis

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ATHENS (Reuters) - 'Contagion' is the label financial markets use for the economic spread of the Greek crisis. For hundreds of people in an increasingly chaotic society, the word has a deadlier meaning.

Take the mother of four introduced to Reuters by her social worker at the bright offices of an Athens non-governmental organization called Kentro Zois, or The Center for Life. A Ukrainian, she said she immigrated to Greece 12 years ago and married a Greek man.

Bleached blonde hair tightly pulled back in a bun, the 34-year old spoke on condition of anonymity. When her two-year-old daughter was wheezy last October, she brought the child to a state-run hospital. The doctors could not explain the baby's persistent fever. One suggested an HIV test. The diagnosis for both mother and child was positive. "I was devastated," she said.

She isn't the only one to be shocked. In 2009, the year the baby was born, Greece had detected not a single case of a mother transmitting the AIDS virus to her child, according to the Hellenic Center for Diseases Control and Prevention, a public health agency funded by the Health Ministry. The mother's infection was apparently missed by a nationwide screening program for pregnant women.

"How was it possible for an HIV-positive child to be born in Greece? That is my question," asked the woman's social worker, Anna Kavouri, head of social services at The Center for Life, which helps people living with HIV/AIDS. Kavouri is working with the woman to try to find out what happened and what options she may have for legal redress.

The health ministry did not respond to phone calls seeking comment, and Reuters was unable to verify all the elements of the woman's story. But others in the Greek capital say the country's social safety net is fraying, nowhere more so than in the health system. Spending by Greeks on health is falling 36 percent this year, according to the National School of Public Health. Including both the government and private individuals, the country spent around 25 billion euros, or roughly 10 percent of GDP, on both public and private health in 2010; in 2011 that will be 16 billion. Just 10 billion or so is government spending on the public health sector.

The effect of that is most visible on the edges of society. Heroin use and prostitution are up. Drug addicts and illegal immigrants with HIV say clean needles, heroin substitutes and antiretroviral treatments are harder to come by. The pace of HIV infection is surging.

The latest available United Nations figures, from 2009, show that 11,000 people, or 0.1 percent of the Greek population, had HIV/AIDS, a third the rate in the United States. But that may be changing. In the first five months of 2010, Greece had 255 new HIV cases. Over the same period this year, there were 384 new cases -- an increase of more than 50 percent. The Hellenic Center predicts the rate of increase will rise to 60 percent by the end of 2011. By comparison in the United States, cases are increasing by around 7 percent annually.

The problem in Greece has been aggravated by increased drug use. Historically, only about a quarter of people newly infected with HIV in Greece were injecting drug users. But 174 drug users have tested positive to mid October this year. The Hellenic Center says that will be around 200 by the end of the year. Nikos Dedes, an adviser to the HIV Committee at the World Health Organization (WHO), says that while most HIV in Greece is still transmitted through unprotected homosexual sex, the risks through heterosexual sex are rising.

"The HIV situation in Greece is like a dry forest in summer which has just been hit with a gust of wind," says Dedes, who is also head of Positive Voice, a Greek NGO set up to combat the spread of HIV. "It could go up in flames any minute.

HOLES IN THE SYSTEM

The Ukrainian mother said she is not an injecting drug user and believes she got HIV through an operation several years ago, though this was impossible to verify.

People in any society can have HIV and not know it -- the United Nations believes around 250,000 in the United States do. That's why many countries, including Greece, routinely screen pregnant women. But the mother said she was not offered an HIV test when she was pregnant with her youngest.

"It didn't even occur to me that I would need one," said the mother, dressed in black sweatpants and a camel-colored leather jacket. When and how she became infected is not clear, but doctors say she probably passed the virus to her daughter through breastfeeding. Women with HIV are told not to breastfeed as it significantly increases the chance of passing on the virus.

The baby has a twin, a boy, who along with the rest of the family has tested negative for HIV. Unlike his sister, he did not take to breastfeeding.

The mother has separated from her Greek husband in the last year, and now lives with her children in a government-run shelter.

MORE SEEK TESTS

As the economic crisis worsens, society is becoming gloomier. Greeks are swallowing 35 percent more anti-depressants than they did five years ago, according to the National School of Public Health. The health ministry says suicides are up 40 percent so far this year. And if the lines of people at the Hellenic Center's mobile HIV testing vans around Athens' poor quarters are anything to go by, more and more Greeks are also worried about AIDS.

Wearing a stethoscope and long white gown, doctor Evaggelos Liapis conducts tests every night between 6 and 10 pm on the corner of Omonoia Square, which bustles with sesame breadstick vendors, businessmen and drug users hunting for cash. Six months ago, Liapis said, all four vans operating around the city would receive on average two people per night. That's now gone up to 40 tests a night.

"There are no clean syringes around here and we have an increase in poverty and prostitution, especially amongst the drug users," Liapis said as a heavily tattooed Greek man in his twenties sat down in the van for a blood test.

The WHO recommends that 200 clean syringes are provided per drug user per year, to limit HIV infection. Greece has been providing three, the Hellenic Center says.

Adding to the risk is the fact that when times are tough, drug users are more likely to inject heroin rather than snorting or smoking it, because they get a bigger hit for their money by using a needle, according to French researchers. "Between 2007 and 2008, whilst gross salary growth rates were falling significantly, the proportion of injecting drug users rose by 1.70 percent," wrote Christian Ben Lakhdar, of the Catholic University of Lille, and Tanja Bastianic, of the French Monitoring Center for Drugs and Drug Addiction, in the International Journal of Drug Policy.

Yannis, a 34-year old Greek addict, is among them. He said he used to inject heroin, then cleaned up at a state-run rehab center just outside of Athens. But earlier this year he says he became HIV-positive from sharing needles.

"Now they want me on a detox programme to prove my commitment to giving up drugs. Otherwise it can get difficult to get my (HIV) drugs, even though I am Greek and have social security," he said by telephone in Athens.

On paper, all Greeks who make social security contributions should be granted HIV treatment, but Yannis says doctors are becoming choosy over who gets them. And the treatment is expensive.

CAN'T PAY FOR DRUGS

Budget cuts have complicated Athens' relationship with pharmaceutical companies. Athens has imposed some of the most draconian price cuts for medicines of any European country, and some companies have been forced to accept Greek government bonds instead of cash for outstanding debts.

So far, there are no signs that this has disrupted supplies of HIV medicine. But the cuts could have a huge impact on the health system. "It is proven that the more money spent on health, the lower the fatality (rate). Cuts in health will affect lives," said epidemiologist Georgios Nikolopoulos, who tracks HIV rates at the Hellenic Center.

Currently, antiretroviral drugs cost Greece at least 1,000 euros per patient a month. For the state to pay for all those people would cost just over 130 million euros a year. According to Christianna Rizopoulos, who collects data at the Hellenic Center's HIV office, there is talk among health professionals that the government plans to cut its contribution for drugs to 600 euros per treatment per month, so patients would have to foot almost half the bill. The health ministry did not answer calls seeking comment.

"We are very worried," said Rizopoulos. "With the economic crisis, there is no way of knowing what will happen next."

"MAKES NO SENSE"

Josephine, a 50-year old HIV-positive illegal immigrant from Mozambique who also visits the Center for Life, is among those on the edge.

She has been in Athens since 2005, applied for asylum four years ago and says she is still waiting to learn if her status will be approved. She has a limp caused by severe arthritis, which HIV aggravates.

For the past six months, she said, she has received zero antiretroviral medicine because she cannot find work to pay social security contributions.

"This is also due to the economy in Greece now. I used to get plenty of work before," she said, her small black braids tucked under a red and white scarf. Last year she didn't work at all. Since April this year, she has found sporadic cleaning jobs, but hasn't paid her rent for seven months.

And Greece's preventative programs are under heavy pressure. In September the health ministry ordered that the seven mobile clinics that provide heroin replacement treatment around the rundown areas of town be moved to 32 state-run hospitals across Athens.

The move was welcomed by some health professionals, who said it would help improve the distribution of staff and treatment. Others said it was unrealistic.

Staff for the Greek Organization Against Drugs, OKANA, which provides the bulk of drug replacement treatment and reintegration programs, joined an anti-austerity protest on Syntagma Square last month. They said the cuts will make it harder to reach drug-users.

"Countries like Spain have the centers right where the problem is, here we have the opposite," said Emi Koutsopoulou, an OKANA psychiatrist. "We now have rehab and methadone points in really posh hospitals in wealthy suburbs. This makes no sense. A drug user is not going to go out there."

(Additional reporting by Ben Hirschler in London; Edited by Sara Ledwith and Simon Robinson)

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