Before 2011, when HIV infections among people who injected drugs in Athens, Greece rose suddenly and steeply, the epidemic of the virus in that country was classified as a low-level one; affecting less than 1 percent of the general population, and less than 5 percent of any of the populations at greatest risk. In the midst of a steep economic downturn, availability of measures to minimize harm and prevent HIV infection from drug use -- including opioid substitution therapy and sterile needle/syringe distribution -- was limited.
Nonetheless, government and non-governmental responses were swift and wide in scope, encompassing exponentially increased needle and syringe access, as well as an organized effort to identify people injecting drugs and offer them HIV testing, counseling, treatment, and condoms. Perhaps most importantly, the authors of a report on the response write in a recent article in Journal of Infectious Diseases, the rapid response of care and prevention measures, dubbed ARISTOTLE, drew on the population it sought to reach by enlisting the help of people who injected drugs to refer people they knew, who in turn referred people they knew, to services. In that way, note the authors, led by Vana Sypsa of the University of Athens, services reached an estimated 88 percent of people injecting drugs in the city within the year that followed. Rates of new infections dropped nearly as steeply as they had risen, from 7.8 per 100 people in 2012, to 1.7 per 100 in the year that followed.
Degrees of success of each intervention, and their impacts on risks varied, and so, authors note, ARISTOTLE's impact on the drop in incidence is hard to gauge. But they note, the drop in new infections indicates that the combination of proven measures, delivered swiftly, with the engagement of those most affected, is likely to have helped. An accompanying commentary in the journal notes that this conclusion is important to responders in the United States, where, as authors Philip A. Chan and Timothy P. Flanigan of Brown University put it, "micro-level outbreaks continue to fuel the larger HIV epidemic. The authors of the commentary point to the surge of HIV infections in a rural Indiana community where the 12 months between November 2014 and November 2015 saw 181 diagnoses associated with shared syringe use.