Will HIV Be Greece's Next Crisis?

Photo above: December 1, 2014. People light red candles during an event for World AIDS Day, in Aristotelous Square at the northern Greek city of Thessaloniki.

According to the Hellenic Center for Disease Control and Prevention (HCDCP) [Greece is officially known as The Hellenic Republic], "the majority of HIV infections in Greece are among gay, bisexual, and other men who have sex with men (MSM). Between January and October 2017, MSM accounted for  45.9 percent (226 cases) of all new infections. Another 17.9 percent (88 cases) were not placed in a specific transmission category although it is likely that the majority of these are also among heterosexual identified MSM. These rates are on par to match or surpass to 2016 figures in which 246 cases (47.0) percent were among MSM, and another 77 cases (14.7 percent) were unidentified. In the absence of identified cases, MSM accounts for some 60 percent of new infections."

In 2015, HCDCP noted MSM as one of the priority populations for HIV prevention efforts, noting the goal “To raise awareness on issues such as prevention of HIV/AIDS, systematic use of condom and adoption of safer sexual behaviors, among others. The aim of integrating information, concerning prevention and sexuality as an essential part of life, is to strengthen the sense of responsibility in the subsequent behavior of the general population.” However, a robust body of biopsychosocial research among MSM does not inform these approaches. 

Dr. Maria Kantzanou of the Univerity of Athens in Greece along with Dr. Perry Halkitis and Pamela Valera of the Rutgers School of Public Health, and Gregory Vallianatos, Greece's leading LGBT activist, have come together to stem the tide. Dr. Halkitis and his colleagues have recently issued a  call-to-action to address the health of gay men in the Era of Troika.

Dr. Maria Kantzanou and Dr. Perry Halkitis at the University of Athens earlier this year. 

To date, the work on HIV prevention and LGBT health in Greece has been limited. Research on HIV has focused on the epidemiology and treatment of the disease with little attention to the drivers of HIV infection in sexual minority men. "Our collaboration with the School of Medicine at the University of Athens coupled with our two-decades of experiences conducting biopsychosocial research on HIV infection in gay men at our research site, the Center for Health, Identity, Behavior & Prevention Studies (CHIBPS.org), situate us perfectly to undertake a pilot investigation on the drivers of HIV infection in the Athenian MSM population. Our overriding goal is to develop the knowledge needed to inform data-driven decision making about HIV prevention programming for sexual minority men," says Halkitis.

They note that, despite what some Western press have called a recovery, the economic devestation wrought by the Troika (i.e., the European Commission, the European Central Bank, and the International Monetary Fund) is far from over. In actuality, the economic crisis — now in its tenth year in The Hellenic Republic — is actually worse.

Unemployment is at its height (20 percent) and the youth unemployment rate is even higher at 43.6 percent. "Because unemployment rates are high and steady, poverty rates have increased from 8.9 percent in 2011 to 15 percent of the total population in 2015. Compounding unemployment and extreme poverty are the conditions created by thousands of refugees from the Middle East, Africa and Asia, who, because of war or persecution in their countries, are seeking entry into Europe via Turkey through Greece," adds Halkitis.

The financial crisis has impacted the universal healthcare system of Greece as well. "Services such as cancer-screening programs, treatment for mental health and substance use, human immunodeficiency virus (HIV) prevention programs, and municipal public health services have suffered severe cuts." In turn, these adverse economic developments have negatively affected the physical, psychological and social health of the Greek population, including displaced migrants. The proportion of people reporting poor health has steadily increased since 2009, while unmet medical and dental health needs also have been recorded. "Importantly, a 45 percent increase in suicides between 2007 and 2011 and a nearly 5 percent rise in the one-month prevalence of major depression has been documented."

Greek economic turmoil has also been marked by a disproportionately high morbidity and mortality burden comprised of different large-scale epidemics such as the A(H1N1), malaria and Western Nile Virus outbreaks during the period 2009-2012.

Kantzanou continues, "Between 2011-2103 there was a striking rise in the incidence of HIV infections, particularly among intravenous drug users. Restrictions on funding of preventive measures (e.g., syringes, condoms) to this vulnerable population were shown to be the leading cause of the new HIV cases in the region. Moreover, some refugee migrants have access only to emergency care and only until a condition has been stabilized." That being said, little is known whether HIV-positive migrants in Greece have access to antiretroviral therapy. This situation is of heightened concern because many migrant boys and men turn to sex work with Greek men as a means of survival, creating a potential vector into migrants camps for HIV and the spread of sexually transmitted infections. "It is within this context that that the health of Greek gay men must be considered (Hellenic Centers for Disease Control & Prevention [HCDCP], 2015)."

Nikos Dedes is the head chair of the Association of PLHIV of Greece and also the Chair of the foremost European HIV/AIDS Group, the European AIDS Treatment Group. Their recent call-to-action supports Halkitis and Katzanou's suggestions, "The HIV Outcomes initiative complements the work of other initiatives focusing on HIV prevention, diagnosis, and access to high quality treatment and care."

Do all these factors suggest that Greece is on the precipice of a major health catastrophe? Halkitis responds, "Anytime a group is marginalized health disparities emerge. This can be in the form of drug and alcohol use, mental health issues, violence, or STIs. So unless we work to ameliorate the discrimination experienced by the LGBTQ population in Greece we will continue to see health disparities much like in the United States." 

What Greece needs is dramatic shift in cultural attitudes that don't seem to be forthcoming in the midst of what looks to be a multi-generational economic depression that has led to the rise of right wing parties and strengthened the vice-grip the Greek Orthodox church holds over the government and much of the populace.

Halkitis says,  "Many things can help: this includes widespread sex and same sex education starting at a young age and training of health professionals to work with compassion and understanding with LGBT people. Challenging the traditional hypermasculine hegemonic conceptions of masculinity will help to alleviate stigma."

This is challenging for not only Greek but all Mediterranean and Latino culture where machismo is revered. 

"Moreover, the Greek Orthodox Church must enter the modern era and realize that all God’s children are loved. Fortunately, leaders like Metropolitan Nikita of the Dardanelles are among the enlightened leaders moving the church forward. Finally laws and policies that protect the rights of LGBTQ people will function to normalize conditions, which in turn will reduce stigma."