Clive Richardson Panteion University of Social & Political Sciences, Athens & Greek Reitox Focal Point

Transcription

1 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 Clive Richardson Panteion University of Social & Political Sciences, Athens & Greek Reitox Focal Point

2 Author list of submitted paper G. Nikolopoulos, A. Fotiou, E. Kanavou, C. Richardson, M. Detsis, A. Pharris, J.E. Suk, J.C. Semenza, C. Costa-Storti, D. Paraskevis, M.-M. Malliori, S.R. Friedman, A. Hatzakis Athens University / Greek Focal Point / ECDC / EMCDDA / NDRI

3 Introduction Economic downturn started in Some European countries have been hit severely by the crisis (e.g. Greece) Interest in the impact of financial crisis on health (Stuckler, 2011). including communicable diseases (Bonovas & Nikolopoulos, J Prev Med Hyg 2012; Suhrcke, PLoS One 2011)

4 Big events (such as wars, crises, transitions) have unleashed HIV epidemics in the past (e.g. Russia in the 1990s) (Friedman, Int J Drug Policy 2009) Stable or declining trends in HIV cases among drug injectors in Europe (ECDC/WHO. HIV/AIDS Surveillance in Europe 2012) but large increases in Greece and Romania (Paraskevis, Euro Surveill 2011; Pharris, Euro Surveill 2011)

5 Annual new HIV diagnoses in PWID

6 Annual new HIV diagnoses in PWID Greece Romania Bulgaria

7 Objective To explore the relationship between economic recession, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EU, Iceland, Norway)

8 Data sources ECDC (TESSy) Eurostat EMCDDA

9 Methods

10 Dependent variable Newly diagnosed HIV cases among PWID Dichotomized = 1 if there was a significant increase in diagnosis rate that year, and for years following = 0 otherwise i.e. indicator of an outbreak

11 Dependent variable Country with an outbreak Country with no outbreak

12 Independent variables macro level GDP pre capita % change in GDP from previous year S80/S20 measure of income inequality Gini index of income inequality Public wealth index = GDP p.c./ (S80/S20) Population at risk of poverty Unemployment

13 Independent variables policy level Government expenditure on health Government expenditure on social protection Recorded drug trafficking crimes Syringes distributed or exchanged OST clients

14 Independent variables drug user level Problem drug users /1000* Problem injecting drug users /1000* New clients entering treatment Opioid treatment entries who inject (%) Cocaine treatment entries who inject (%) Opioid treatment entries who use daily (%) * Too many missing values not used

15 Univariate results (2-year lag; results similar for other lags) Variable OR 95% Conf. Interval GDP growth rate Poverty S80/S Gini index Public wealth index

16 Multivariable results Lag Variable OR 95% Conf. Int. 1 year GDP growth rate Gini index years GDP growth rate Gini index years GDP growth rate Gini index

17 Main finding Increased risk of an HIV outbreak among drug injectors in this set of countries is associated with declining rate of GDP growth the unequal distribution of national income

18 These results agree with several previous studies: GDP and Gini were associated with TB mortality rates in Latin America (Biggs, Soc Sci Med 2010) Gini was associated with HIV prevalence in 90 countries (Holmqvist 2009 working paper) Gini was associated with HIV prevalence in African countries (Tsafack-Temah 2008 PhD thesis)

19 Gini was correlated with HIV prevalence in 77 large US metropolitan areas among PWID.. and with AIDS mortality rates in heterosexuals in US metropolitan areas (Friedman, Ann Epidemiol 2014) Homelessness in drug injectors was associated with both GDP and HIV prevalence in Athens (Sypsa, Am J Public Health 2014; Paraskevis, PLoS One 2013)

20 Limitations Ecological correlations Unable to study pathways from large-scale processes to HIV risk Lack of HIV incidence estimates in PWID HIV prevalence estimates in PWID available at regional level only Limited availability of data on other key determinants of HIV risk in PWID

21 Recommendations Despite their inherent limitations, analyses of this kind could inform policy makers Maintaining equality could help avert HIV epidemics in PWID while GDP is falling Need to study the pathways from Big Events to HIV risk

22 Acknowledgments The study was funded by the European Centre for Disease Prevention and Control, ECDC grant ECD.4167 Georgios Nikolopoulos was supported by the IAS/NIDA fellowship during the conduct of this analysis

23 Clive Richardson Anastasios Fotiou