@article {10865,
	title = {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.},
	journal = {PLoS One},
	volume = {10},
	year = {2015},
	month = {2015},
	pages = {e0122367},
	abstract = {BACKGROUND: There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA).

METHODS: We used panel data (2003-2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated.

FINDINGS: In multivariable analyses, using two-year lagged values, we found that a 1\% increase of GDP was associated with approximately 30\% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95\% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested.

INTERPRETATION: Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.},
	keywords = {Economic Development, Europe, Gross Domestic Product, HIV Infections, Humans, Injections, Logistic Models, Poverty, Substance-Related Disorders},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0122367},
	author = {Nikolopoulos, Georgios K and Fotiou, Anastasios and Kanavou, Eleftheria and Richardson, Clive and Detsis, Marios and Pharris, Anastasia and Suk, Jonathan E and Semenza, Jan C and Costa-Storti, Claudia and Paraskevis, Dimitrios and Sypsa, Vana and Malliori, Melpomeni-Minerva and Friedman, Samuel R and Hatzakis, Angelos}
}
