HIV testing and HIV risk perceptions (n = 1874).

<p>*Significant difference between women and men at p<.05.</p><p>#The denominator for HIV tested in past is 1818 (total sample minus 39 non-responses and 17 persons who were unsure whether they might have tested for HIV).</p

Socio-demographic characteristics (n = 1874).

<p><u>Note:</u> Totals for each variable are in some cases less than 1874. Economic status missing for 20 individuals; information on place of residence and long-term migration missing for 1 of the total sample.</p

National Income Inequality and Declining GDP Growth Rates Are Associated with Increases in HIV Diagnoses among People Who Inject Drugs in Europe: A Panel Data Analysis

<div><p>Background</p><p>There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA).</p><p>Methods</p><p>We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated.</p><p>Findings</p><p>In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested.</p><p>Interpretation</p><p>Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.</p></div

Summary statistics for explanatory variables (years: 2002–2011).

<p><i>Notes</i>.</p><p>^† The number of injectors for each primary substance use (opioid and cocaine) was calculated from each annual Table TDI-17 part-ii and part-iv, respectively, by multiplying the relevant percentage by the number of clients whose usual route of administration was known;</p><p>^†† The total number of injectors was obtained by adding the numbers of injectors of each substance (opioid, cocaine, stimulants, and cannabis), calculated from the percentages in the tables;</p><p>^†††All per population estimates were obtained by dividing the actual variable values (derived from EUROSTAT or EMCDDA) by population estimates derived from Eurostat.</p><p>Summary statistics for explanatory variables (years: 2002–2011).</p

Univariable logistic regression models.

<p>The dependent variable was dichotomous taking value 1 for years in which a European Economic Area (EEA) country was experiencing an HIV outbreak, 0 otherwise. The results include Odds Ratios (OR), Lower (L) and Upper (U) limits of the confidence interval (CI), P-values, the number of Observations (Obs) in each model, and the number of countries (C) from which data were obtained for at least one year.</p><p>^†Per capita or per population</p><p>^††PWI: Public Wealth Index = GDP per capita divided by S80/S20 ratio.</p><p>Univariable logistic regression models.</p

The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review.

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings