During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012). IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period. Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.

Objectives. We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods. We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results. Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions. Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.

International studies show a rise in drunkenness among young people in recent years. In this study the number of drunkenness occasions among 15-year old students in 22 countries is reported. The cross-national association between drunkenness, on the one hand, and the frequency of alcohol intake and the preference for distilled spirits, on the other, is described. Variation between countries is examined on the basis of national characteristics, including national prevention policies. Data on alcohol use were taken from the 1998 World Health Organization (WHO) collaborative, cross-national survey on Health Behaviour of School-Aged Children. The multinational representative sample consisted of 10,951 male and 11,451 female (drinking) students. County characteristics were derived from the WHO Global Alcohol Database. Hierarchical Generalized Linear Model was used to analyze the effects of country characteristics on individual drunkenness. The lifetime prevalence of drunkenness was 57.1% for males and 50.4% for females. The number of drunkenness occasions showed a significant variation in the 22 countries. The correlation between drunkenness and preference for distilled spirits was positive in 21 countries and strong (Spearman's p > 0.40) in some eastern countries. Geographic location turned out to be an important country-level association with drunkenness and its predictors. Southern European countries showed moderate associations, whereas strong associations were found in Scandinavia, the Baltic countries and Russia. Cultural differences in alcohol use exist, and frequency of alcohol intake and use of spirits influence drunkenness. Despite the potential influence of preventive policy measures on drunkenness, no preventive effect of the measures included in this study was found.

The aim of this paper is to investigate the association between anabolic steroid (AS) use and intensive physical exercise among adolescents. The 1999 cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD). Data collection by standardized methodology using anonymous self-administered questionnaires completed in the classroom. National probability samples of a total of 18,430 16-year-old high school students from six European countries (Bulgaria, Croatia, Cyprus, Greece, the Slovak Republic, and the U.K.) Besides AS use and physical exercise, questionnaire items selected for this study included tobacco, alcohol, and illicit drug use, indicators of other deviant behavior (self-harming thoughts and behavior, truancy, aggressive behavior), friends' use of AS, and perceived availability. Backward elimination with likelihood ratio tests was used to select the variables to be retained in a mutlifactorial model. Interactions of other independent variables with country were checked. Logistic regression analysis of lifetime AS users compared to nonusers showed that the odds of lifetime AS use are 1.4 times higher for students who exercise almost daily and 1.8 times higher for boys compared to girls. Significant associations of AS use were also found with current frequent alcohol use, lifetime use of tranquilizers/sedatives and cannabis, and with the perceptions of friends' use of AS and of easy availability of the substance. Findings indicate that daily exercising appears to increase the risk of anabolic steroid use in adolescents. However, a more general pattern of closely interlinked deviant types of behavior, such as other drug use and aggressive behavior, is prominent. Preventive interventions are needed targeted towards adolescents involved in intensive exercise and sport. These should take into account both the idiosyncrasy and setting of the sporting culture and the special characteristics of this group.