Greece’s efforts to control its debt crisis threaten to hobble the fight against an outbreak of HIV that has become the largest among drug users in the European Union.

The nation’s Organization Against Drugs, or Okana, may close treatment centers after its budget was cut almost in half to 20 million euros in 2012 from 35 million euros in 2010, said Meni Malliori, Okana’s president. That’s jeopardizing progress the group has made in almost tripling the number of centers it operates in Athens to help arrest new infections.

“We have to face this very difficult problem under the worst circumstances,” Malliori said in a telephone interview. “If we don’t get more money, we can’t even maintain what we did during the last year.”

New infections among drug users have exploded 35-fold in two years, adding pressure on a strained medical system that’s been battling simultaneous outbreaks of malaria and West Nile virus with shrinking resources amid the financial crisis. A government hiring freeze and spending cuts aimed at curbing the nation’s spiraling debt threaten to stall the response and extend the almost four-year wait for methadone, a prescription drug used to ease withdrawal symptoms so that addicts can quit and avoid HIV.

The Greek outbreak contributed to the first increase in cases since at least 2004 in the European Economic Area. Greece had more cases in that group than any of the region’s other members in 2011, according to a report published in November by the European Centre for Disease Prevention and Control.

Infections double
 
Infections among injecting drug users more than doubled to 487 as of the end of October, from 206 in the same period in 2011 and 14 in 2010, according to data on the Hellenic Center for Disease Control and Prevention’s website. Injecting drug use accounted for almost half of all new infections, overtaking sex between men for the first time as the main means of transmission, the data show.

“It’s going to get worse and worse,” said Nikos Dedes, the chairman of Positive Voice, an Athens-based AIDS charity. “You have to respond to a galloping problem, and at the same time the entities that are responsible to do it are losing money.”

The country’s HIV epidemic grew from conditions that had been developing for years. A lack of programs to provide addicts with clean needles or those trying to quit with methadone proved fertile ground for the virus, the Stockholm-based ECDC said.

Right circumstances
 
“All the circumstances were right,” said Marita van de Laar, the ECDC’s head of sexually transmitted infections. “When HIV got introduced into that network, it just exploded.”

On the streets of Athens, drug users are switching from smoking cocaine, which can cost as much as 20 euros a hit, to injecting methamphetamine that sells for as little as 2 euros, said Okana’s Malliori. Combined with needle sharing, the riskier drug-taking practices have fanned the epidemic, she said.

With less money to buy drugs, users are making what they can get go further by injecting, which gives a bigger high more quickly than snorting or smoking, Malliori said.

“People just want to fill their heads with anything,” said Efi, an HIV-positive former heroin addict in Athens who declined to give her last name because she hasn’t told her family about her HIV status. “People feel very desperate right now, and helpless. You reach out for help, and there’s no help anywhere.”

Cheap sex
 
Prostitution is adding fuel to the fire. Among prostitutes who tested positive for HIV last year, almost all were selling sex to support a drug habit, the ECDC said. A majority of male, street-based prostitutes are under 18, migrants and charge as little as 3 euros for sex, the report said.

“This group of people have less pocket money, they are out in the streets more hours,” Malliori said. “They are doing whatever they can to live.”

In response to the increase in cases, Okana expanded its number of treatment centers to 56 from 20 since the outbreak began in early 2011, cutting waiting lists for methadone programs to less than four years, compared with more than seven years in 2010, according to the ECDC.

Instead of requiring drug users to hand in used needles in exchange for new ones, Okana is distributing free kits of 20 clean syringes to reduce the risks of transmission, Malliori said. The organization also paid drug users 3 euros to have an HIV test, and a further 3 euros if they brought a fellow user with them, she said.

Hiring freeze
 
Those advances were made without increasing staff because of a public sector hiring freeze implemented by former Prime Minister George Papandreou as part of austerity measures. Okana is also about 5 million euros behind on payments for substitution therapies such as methadone, Malliori said. Without an increase in its budget, the gains may not be sustainable.

For Efi and other former drug users, the biggest fear is that government spending cuts will leave them unable to get the methadone they rely on to stay off heroin.

Okana’s methadone program enabled her to get back in touch with her family and regain custody of her teenage son, she said.

“We’re all worried about whether there will be money to maintain the program,” she said, sitting in a suburban Athens apartment her parents bought her after she quit using heroin.

“It’s all the lost years,” Efi said. “I’m trying to catch up.”

The long-term costs of a worsening HIV epidemic may be far greater than the costs of trying to contain it, said the ECDC’s van de Laar.

“I’m afraid,” she said. “It’s not easy to turn this tide. They need to invest now, right now.”

[Bloomberg]