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.

Notes:

Nikolopoulos, Georgios KFotiou, AnastasiosKanavou, EleftheriaRichardson, CliveDetsis, MariosPharris, AnastasiaSuk, Jonathan ESemenza, Jan CCosta-Storti, ClaudiaParaskevis, DimitriosSypsa, VanaMalliori, Melpomeni-MinervaFriedman, Samuel RHatzakis, AngelosengDP1 DA034989/DA/NIDA NIH HHS/P30 DA011041/DA/NIDA NIH HHS/P30 DA11041/DA/NIDA NIH HHS/T32 DA007233/DA/NIDA NIH HHS/Research Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov't2015/04/16 06:00PLoS One. 2015 Apr 15;10(4):e0122367. doi: 10.1371/journal.pone.0122367. eCollection 2015.