In 2011, the EMCDDA and ECDC reported that new outbreaks of HIV were occurring in Greece and Romania despite an overall long-term declining trend in newly diagnosed HIV cases among injecting drug users (IDUs) in Europe. Reports received in 2012 continue to suggest increases in HIV prevalence and in rates of newly diagnosed cases among IDUs in these two countries. While in Greece prevention measures are being scaled up, in Romania coverage has declined.

A joint ECDC/EMCDDA risk assessment conducted in 2011 concluded that the data available for Greece and Romania were likely to reflect true increases in the incidence of HIV among IDUs. To follow up on the results of the risk assessment exercise, updated country reports were commissioned from both countries.

Data from these reports suggest there is no evidence of the outbreaks slowing down. Both in Greece (country report) and Romania (country report), increases in HIV prevalence (until 2012 and 2011 respectively) as well as in the rate of newly diagnosed cases (in 2012) are reported. In Romania, HIV prevalence increased from 4% in 2010 to around 12% in 2011 among IDUs in contact with services. In Greece (Athens), the increase in users in contact with services was from 1% to 4-5%, with preliminary data for 2012 suggesting prevalence of around 9%. In a study in a specific setting of users the prevalence was 23%. Numbers of newly diagnosed cases have also increased markedly in both countries, with the number reported during the January to August period almost doubling in Greece (from 161 in 2011 to 314 cases in 2012) while in Romania the number of cases reported in the first six months of 2012 (102 cases) is not far from the number of cases reported for the whole of 2011 (129 cases).

In Greece, a rapid scaling up of interventions is taking place despite the difficult economic situation, including a large increase in the coverage of opioid substitution treatment (OST) and an increase in the number of syringes distributed by needle and syringe programmes (NSPs). In Romania, the syringe coverage level achieved with external funding since 2007 dropped significantly from mid 2010 onwards due to lack of national funding. Although the legal conditions for implementing OST by GPs have been created, its actual implementation has faced obstacles and provision has remained limited.

Summary of key findings

Greece

• 314 new cases of HIV in IDUs were reported in the first 8 months of 2012, as compared to 161 in the first 8 months of 2011.
• HIV prevalence among IDUs contacting services in Greece was under 1% among 2028 IDUs tested in 2010 but had reached levels of between 3.7% and 5.6% among 2269 IDUs tested in 2011. In Athens in 2012, it was 8.5% among 2573 IDUs tested in drug treatment centres while it reached 23% in a specific study that included out-of-treatment populations (1000 IDUs recruited in Athens through respondent driven sampling).
• Current injecting decreased among IDUs in treatment, but increased in the population accessing low-threshold services.
• Needle/syringe sharing increased in both new IDUs (injecting less than 2 years: from 14% in 2008 to 32% in 2011) and in young IDUs (under age 25: from 31% to 47%).
• The use of stimulants increased while the use of opioids (heroin) declined.
• Despite a substantial scaling up of responses since the beginning of 2011, OST and NSP coverage of prevention services for IDUs still remain low in comparison to international standards.

Romania

• 102 new IDU-related HIV cases had been reported in 2012 by the end of June as compared to 30 in the same period in 2011 (129 in the whole of 2011) and 12 in 2010.
• Self-reported HIV prevalence among IDUs in contact with services and tested in the last 6 months increased from 4.2% in 2010 (12 out of 288 IDUs) to 11.6% (25 out of 216 IDUs) in 2011.
• The injecting and non-injecting use of stimulants has increased among IDUs.
• Evidence exists of high levels of risk behaviour: 8 out of 10 IDUs in a 2011 study reported recent sharing of used needles/syringes.
• Responses to the HIV outbreak among IDUs have been limited due to lack of finances and lack of an approved national HIV prevention strategy.