Despite a decreasing trend of HIV cases among injecting drug users (IDUs) in most of the EU/EEA countries, Greece reported in 2011 a significant increase in the HIV case reports and the HIV prevalence among IDUs, a trend which continued also throughout the first 8 months in 2012.

In 2012, IDUs have become the most affected population, representing 41% of all reported HIV infections (HCDCP data).

HIV prevalence rate in Athens exceeds 5% among IDUs entering treatment (NFP data) and reaches 20% among out‐of‐treatment populations (ARISTOTLE study). The outbreak is ‘concentrated’, and high HIV prevalence is becoming established in this population.

The HIV outbreak among IDUs has a local character, i.e. it is restricted to the capital city, Athens. 80% of the 2011 HIV cases with injecting drug use as a probable route of transmission were men and in a similar proportion they were Greek nationals. The majority (56%) were aged 25 to 34 (HCDCP data).

One in every three people whose probable route of HIV infection was IDU in 2011‐2012 is on antiretroviral therapy (ART), a lower proportion compared to other groups affected (HCDCP data). There is no information available about IDUs’ adherence to ART.

Despite a substantial scaling up of the responses since the beginning of 2011, opioid substitution treatment (OST) and needle and syringe programme (NSP) coverage of prevention services addressed to IDUs remain short and significantly lower compared to international standards (NFP and EMCDDA data).

The emergence of the HIV outbreak coincides with the economic downturn that the country is being currently undergoing, budgetary cuts in the health system (especially the field of drug treatment and harm reduction), the deteriorating socio‐economic environment of the Athens city centre, and changes in injecting behaviours among IDUs.

The intensification of indicated interventions within the existing NSP and OST programmes, the extension of the availability of testing, and the scaling up of ART uptake and adherence remain essential if the emergence of new HIV cases among IDUs in Athens and the expansion of the outbreak beyond the capital city are to be prevented. Pilot implementation of harm reduction services for IDUs in the Greek prisons should also be encouraged and their outcome evaluated.

State financing cutbacks threaten the sustainability of the provision of HIV prevention programmes and potentially increases the risk for establishing high prevalence of HIV in the IDU population. Harm reduction programmes and ART treatment should be provisionally excluded from public spending cuts in order to protect the health of IDUs and public health.

Guidance given by the EMCDDA, ECDC and other experts in the field has contributed substantially in better appraising the situation and setting priorities in planning the responses.

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