Correspondence
financial constraints, making the allocation of limited public health resources a challenge. It is essential that Greece sustains and scales up funding for outreach, needle and syringe exchange programmes, and opiate substitution therapy to try to reduce HIV transmission in IDUs.
120 000
110 000
100 000
We declare that we have no competing interests.
90 000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
2011 2012
*Anastasia Pharris, Andrew Amato, Johan Giesecke [email protected] European Centre for Disease Prevention and Control, 17176 Stockholm, Sweden
Figure: Livebirths in Greece, 1999–2012
1
40–44 years went up by 11·7% and 8·7%, respectively, and in those older than 45 years by a hefty 36·1% and 34·8%. There are no available data to assess selective migration of women of childbearing age, but we estimate that foreign women contributed more than a third to the birth decline for 2008–12. Greece’s dramatic downward trend in livebirth rates is a component effect of the ongoing economic crisis, amplifying the problem of demographic ageing. The recession, like in other European countries, has primarily affected younger women and immigrants most probably because of the proportionally larger increase in unemployment in these groups.2 We declare that we have no competing interests.
Nikolaos Vrachnis, *Nikolaos Vlachadis, Zoe Iliodromiti, Maria Vlachadi, George Creatsas [email protected] National and Kapodistrian University of Athens, Medical School Aretaieio Hospital, 11528 Athens, Greece (NVr, NVl, ZI, GC); and Department of Political Sciences, University of Crete, Rethymnon, Crete, Greece (MV) 1
2
Hellenic Statistical Authority. Vital statistics 2012. http://www.statistics.gr/portal/page/ portal/ESYE/BUCKET/A1605/PressReleases/ A1605_SPO03_DT_AN_00_2012_01_F_EN. pdf (accessed Sept 22, 2013). Lanzieri G. Towards a “baby recession” in Europe? Differential fertility trends during the economic crisis. Eurostat 2013. http://epp. eurostat.ec.europa.eu/cache/ITY_OFFPUB/KSSF-13-013/EN/KS-SF-13-013-EN.PDF (accessed Sept 21, 2013).
www.thelancet.com Vol 383 February 22, 2014
HIV surveillance and injecting drug users in Greece Evangelos Alexopoulos (Sept 28, p 1095)1 questioned the validity of HIV surveillance data in an outbreak of HIV in injecting drug users (IDUs) in Athens, Greece. This outbreak, first reported in 2011,2 has continued in 2013 with nearly 1000 new HIV cases reported during this period in IDUs. In an in-depth assessment of the situation of HIV in Greece, the European Centre for Disease Prevention and Control found the HIV surveillance system of the Hellenic Center for Disease Control and Prevention to be functioning well, with adequate mechanisms in place to identify unique new cases and to exclude duplicates from surveillance reports.3 Molecular phylogenetic analysis of the new HIV cases further supports that the cases reported are unique and likely to have been infected from mid-2010. Once the outbreak was identified, efforts were intensified to test and scale up prevention in IDUs in Athens.4 Since 2012, the ARISTOTLE programme has contributed to surveillance and case finding.5 This shift to more active surveillance has increased the sensitivity of the system, with data providing a more accurate representation of the situation. This outbreak is occurring at a time when Greece is experiencing severe
2
3
4
5
Alexopoulos EC. HIV infections and injecting drug users in Greece. Lancet 2013; 382: 1095. Paraskevis D, Nikolopoulos G, Tsiara C, et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill 2011; 16: 19962. European Centre for Disease Prevention and Control. Risk assessment on HIV in Greece. 2012. http://ecdc.europa.eu/en/publications/ Publications/20121130-Risk-Assessment-HIVin-Greece.pdf (accessed Oct 30, 2013). Malliori M, Golna C, Souliotis K, Hatzakis A. Financial crisis, austerity and health in Europe. Lancet 2013; 382: 392. Sypsa V, Paraskevis D, Malliori M, et al. Homelessness and other risk factors for HIV infection in the current outbreak among injecting drug users in Athens, Greece. Am J Public Health (in press).
Evangelos Alexopoulos1 questioned the performance of the surveillance in Greece with regard to the HIV outbreak in injecting drug users (IDUs).2 It is important to mention that, although duplicates are unavoidable in reporting systems worldwide, the Hellenic Centre for Disease Control and Prevention provides surveillance of the highest standards. Recently, the European Centre for Disease Control and Prevention verified the credibility of the Greek reporting system regarding HIV surveillance.3 Athens has experienced a huge HIV epidemic in IDUs. About 1000 unique HIV cases have been diagnosed between 2011 and the first 8 months of 2013. HIV prevalence in people who had contact with drug-treatment facilities in Athens increased from less than 2% before 2011 to almost 8% in 2012.4 In 2012, roughly one fifth 693
financial constraints, making the allocation of limited public health resources a challenge. It is essential that Greece sustains and scales up funding for outreach, needle and syringe exchange programmes, and opiate substitution therapy to try to reduce HIV transmission in IDUs.
120 000
110 000
100 000
We declare that we have no competing interests.
90 000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
2011 2012
*Anastasia Pharris, Andrew Amato, Johan Giesecke [email protected] European Centre for Disease Prevention and Control, 17176 Stockholm, Sweden
Figure: Livebirths in Greece, 1999–2012
1
40–44 years went up by 11·7% and 8·7%, respectively, and in those older than 45 years by a hefty 36·1% and 34·8%. There are no available data to assess selective migration of women of childbearing age, but we estimate that foreign women contributed more than a third to the birth decline for 2008–12. Greece’s dramatic downward trend in livebirth rates is a component effect of the ongoing economic crisis, amplifying the problem of demographic ageing. The recession, like in other European countries, has primarily affected younger women and immigrants most probably because of the proportionally larger increase in unemployment in these groups.2 We declare that we have no competing interests.
Nikolaos Vrachnis, *Nikolaos Vlachadis, Zoe Iliodromiti, Maria Vlachadi, George Creatsas [email protected] National and Kapodistrian University of Athens, Medical School Aretaieio Hospital, 11528 Athens, Greece (NVr, NVl, ZI, GC); and Department of Political Sciences, University of Crete, Rethymnon, Crete, Greece (MV) 1
2
Hellenic Statistical Authority. Vital statistics 2012. http://www.statistics.gr/portal/page/ portal/ESYE/BUCKET/A1605/PressReleases/ A1605_SPO03_DT_AN_00_2012_01_F_EN. pdf (accessed Sept 22, 2013). Lanzieri G. Towards a “baby recession” in Europe? Differential fertility trends during the economic crisis. Eurostat 2013. http://epp. eurostat.ec.europa.eu/cache/ITY_OFFPUB/KSSF-13-013/EN/KS-SF-13-013-EN.PDF (accessed Sept 21, 2013).
www.thelancet.com Vol 383 February 22, 2014
HIV surveillance and injecting drug users in Greece Evangelos Alexopoulos (Sept 28, p 1095)1 questioned the validity of HIV surveillance data in an outbreak of HIV in injecting drug users (IDUs) in Athens, Greece. This outbreak, first reported in 2011,2 has continued in 2013 with nearly 1000 new HIV cases reported during this period in IDUs. In an in-depth assessment of the situation of HIV in Greece, the European Centre for Disease Prevention and Control found the HIV surveillance system of the Hellenic Center for Disease Control and Prevention to be functioning well, with adequate mechanisms in place to identify unique new cases and to exclude duplicates from surveillance reports.3 Molecular phylogenetic analysis of the new HIV cases further supports that the cases reported are unique and likely to have been infected from mid-2010. Once the outbreak was identified, efforts were intensified to test and scale up prevention in IDUs in Athens.4 Since 2012, the ARISTOTLE programme has contributed to surveillance and case finding.5 This shift to more active surveillance has increased the sensitivity of the system, with data providing a more accurate representation of the situation. This outbreak is occurring at a time when Greece is experiencing severe
2
3
4
5
Alexopoulos EC. HIV infections and injecting drug users in Greece. Lancet 2013; 382: 1095. Paraskevis D, Nikolopoulos G, Tsiara C, et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill 2011; 16: 19962. European Centre for Disease Prevention and Control. Risk assessment on HIV in Greece. 2012. http://ecdc.europa.eu/en/publications/ Publications/20121130-Risk-Assessment-HIVin-Greece.pdf (accessed Oct 30, 2013). Malliori M, Golna C, Souliotis K, Hatzakis A. Financial crisis, austerity and health in Europe. Lancet 2013; 382: 392. Sypsa V, Paraskevis D, Malliori M, et al. Homelessness and other risk factors for HIV infection in the current outbreak among injecting drug users in Athens, Greece. Am J Public Health (in press).
Evangelos Alexopoulos1 questioned the performance of the surveillance in Greece with regard to the HIV outbreak in injecting drug users (IDUs).2 It is important to mention that, although duplicates are unavoidable in reporting systems worldwide, the Hellenic Centre for Disease Control and Prevention provides surveillance of the highest standards. Recently, the European Centre for Disease Control and Prevention verified the credibility of the Greek reporting system regarding HIV surveillance.3 Athens has experienced a huge HIV epidemic in IDUs. About 1000 unique HIV cases have been diagnosed between 2011 and the first 8 months of 2013. HIV prevalence in people who had contact with drug-treatment facilities in Athens increased from less than 2% before 2011 to almost 8% in 2012.4 In 2012, roughly one fifth 693
