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A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011

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Abstract

Although many studies have found an association between harm reduction interventions and reductions in incidence rates of Human Immunodeficiency Virus (HIV) infection, scant research explores the effects of harm reduction cross-nationally. This study used a year- and country-level fixed effects model to estimate the potential effects of needle-and-syringe programs (NSPs) and methadone maintenance therapy (MMT) on incidence rates of HIV in the general population and among people who inject drugs (PWID), in a sample of 28 European nations. After adjusting for Gross Domestic Product (GDP) and total expenditures on healthcare, we identified significant associations between years of MMT and NSP implementation and lower incidence rates of HIV among PWID and the general population. In addition to years of implementation of NSP and MMT, the greater proportion of GDP spent on healthcare was associated with a decrease in logged incidence rates of HIV. The findings of this study suggest that MMT and NSP may reduce incidence rates of HIV among PWID cross-nationally. The current study opens a new avenue of exploration, which allows for a focus on countrywide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of the adoption of harm reduction programs as empirically-based health policy as well as the direct benefits that are accrued from public spending on healthcare on incidence rates of HIV within the general population and among subpopulations of PWID.

Section snippets

Background

The high prevalence of HIV among people who inject drugs (PWID) contributes substantially to global mortality rates (Degenhardt & Hall, 2012). Worldwide, 30% of HIV infections outside of sub-Saharan Africa are caused by injection drug use (International Harm Reduction Association [IHRA], 2012). It is estimated that between 11 and 21.2 million people inject drugs of which between .8 and 6.6 million are infected with HIV (Mathers et al., 2008). Numerous scientific studies—including reports by The

Data and measures

Data for this study were extracted from several publically available sources. The World Health Organization (WHO) Regional Office for Europe, and the European Center for Disease Control (ECDC) jointly compile HIV/AIDS surveillance data on the number of new cases of HIV infection in the general population for all 53 nations in the WHO European Region from 1985 to the present (World Health Organization [WHO], 2015). Annual numbers of new HIV cases for the 28 countries included in this study were

Results

Table 1 presents descriptive statistics and means for each country and the overall sample. The mean overall incidence rate of HIV was 5.70 (.40–30) (per 100,000 of the population) from 1995 to 2011. The numbers within parentheticals in Table 1 for both the overall population and PWID embody the minimum and maximum incidence rates of HIV for each country and the entire sample of countries over the time period from 1995 to 2011. Among PWID, the mean overall incidence rate of HIV was 123.04

Discussion

The central aim of this exploratory study was to examine the association between harm reduction programs and incidence rates of HIV in both the general population and PWID in Europe.

Conclusion

Given the absence of cross-national analyses of correlates of HIV incidence rates, this study opens the door to a new approach to studying the effects of harm reduction policies globally. Our findings reinforce extant literature suggesting that MMT and NSP implementation not only protects the basic human rights and health of PWID, but also promotes the health and wellbeing of societies at large by virtue of reducing overall rates of HIV.

Acknowledgements

Phillip L. Marotta was supported by a T-32 Training Grant from the National Institute on Drug Abuse (NIDA) Grant #: 1T32DA037801-01 during the writing and analysis of this research report. The authors gratefully acknowledge the support provided by Irwin Garfinkel, Neeraj Kaushal, Elwin Wu and Nabila El-Bassel.

Conflict of interest statement

The authors of this manuscript have no conflicts of interest to declare.

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