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Greek Tragedy: Austerity and Addiction

Slashing the safety net is causing a perfect storm of unemployment, prostitution, addiction and HIV. Can the new government stop a catastrophe for a generation of Greek youth?

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A dragnet of street people by Athens police photo via

By Kevin Gray

06/21/12

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Polina Patsi is bracing for a summer of overdoses.

The 33-year-old outreach worker in Athens, Greece, told The Fix that the country’s austerity measures, which have eviscerated social welfare programs and curbed access to drug treatment, will lead to more deaths this season, as it has each year since the country’s economic crisis began in 2007. “It’s hot here, the addicts are dehydrated, and they pass out in the direct sun, which is dangerous,” Patsi said. “We end up calling the ambulance two or three times a month. But with the cutbacks, they don’t always make it in time. The safety nets are tearing apart.”

Greece’s financial crisis has led to an alarming surge in intravenous drug use, overdoses, prostitution and HIV infections, according to experts in the field as well as academics studying the problem. Prior to the crisis, Greece had a historically low prevalence of HIV. But last year, the number of new infections spiked 57% over 2010, according to the Hellenic Center for Disease Control and Prevention, spreading most rapidly among a growing population of dirty needle users, among whom the rate was 15 times higher than in 2010. Little wonder, since the country saw a 20% rise in heroin use in 2010—to an estimated 24,100 users from about 20,200 the previous year, according to a report last fall in the British medical journal The Lancet.

Cases of HIV in Athens where addicts congregate soared last year by 1,450%, after needle-swaps were closed.

“Drug use in Greece was already on the rise before the crisis,” said Alexander Kentikelenis, a public health policy expert at Cambridge University and the lead author of the Lancet report. “What changed after the crisis were cuts to money for needle exchange programs, condom distribution and drug rehabilitation,” he told The Fix. “So you have more people injecting drugs at the same time that you have less money available to cater to the needs of this group, and that creates a dangerous situation.” 

And it is likely to get worse. The new coalition government, which took office on June 20, has very few options in stemming the country’s death spiral of addiction and HIV, thanks to the brutal austerity measures imposed by creditors, who have already given Greece multibillion-dollar bailouts. Led by Prime Minister Antonis Samaris, the government is faced with trying to either renegotiate those crippling terms or further cut social programs and salaries for a population already “injured” and in need of “healing,” as Samaris has put it. Greece has been reluctant to pass major reforms, like reducing its pubic sector, improving tax collection and privatizing certain industries, in hopes of raising some $62 billion.

Wary of Greece’s chronic foot-dragging on these targets, its creditors, such as EU nations like Germany, are far from eager to accept a loosening of demands. But it could prove an omen for other EU countries threatened with economic collapse, and even the US. So far, the makings of an austerity-driven perfect storm of health emergencies in other EU crisis countries—Ireland, Portugal, Spain and even Italy—have not been borne out. In fact, the EU’s drug agency announced in its annual report last year that the use of at least one drug, cocaine, had fallen since the economic crisis hit, in part because of its affluent identity and high cost compared to other street drugs.

However, the head of the European Monitoring Center for Drugs and Drug Addiction, Wolfgang Götz, noted darkly, “Policymakers must not take their eyes off the ball. Conditions for future drug-related outbreaks [of HIV] may now again exist in some member states.” He warned that budget cuts could jeopardize successful prevention programs especially among drug injectors, who continue to pose “major health problems.”

Kentikelenis, who said he will monitor health issues in other EU countries as the data appears, predicts that the other shoe will drop across the rest of the crisis zone. “Studies show economic crises are associated with a rise in health problems,” he said. “People don’t have money to pay for private medical care at the same time that there is less money to take care of them publicly. So their illnesses go untreated and become more severe. That’s why social policies should be counter to economic cycles.”

Last February, Greek joblessness hit a record 27.1%, with nearly 1.1 million people out of work, mostly in Athens and other cities. Hardest hit are the young—the ones most likely to turn to drugs and prostitution. A record 54% of Greeks between the ages of 14 and 25 are out of work. With a national debt that is 142% of GDP [gross domestic product], Greece had to borrow $170 billion from the International Monetary Fund under crippling austerity measures, slashing government spending by 30%. “When you have a radical drop in GDP, you need labor-market programs to help these people re-renter the job market and not become the long-term ill and unemployed,” Kentikelenis said.

In Greece, budget cuts in 2009 and 2010 killed a third of the country’s outreach programs to counsel and treat prostitutes, addicts and the homeless. An October 2010 survey of 275 drug users in Athens found that 85% were not in a drug-rehabilitation program. Reveka Papadopoulou, the general director of Medecins sans Frontieres’ Greek branch, said cases of HIV in the city center had gone up last year by 1,450%, according to The Guardian. The medical charity attributed the rise largely to the suspension of the capital’s needle exchanges.

For outreach workers like Polina Patsi who works for Kathea, the nation’s largest affiliation of drug outreach and rehab facilities, one of the biggest challenges is trying to encourage addicts to get treatment or enter rehab. She and her team of five do harm reduction in the center of Athens, where addicts and prostitutes congregate in groups of 60 or more, on Omonoia Square, across from the nation’s parliament. Her team counsels some 350 addicts and homeless people per month, handing out condoms and pamphlets on HIV prevention and directing addicts to a shrinking number of syringe swaps.

“When we try to motivate them, they say, ‘It’s not worth doing because when we get out, society is against us. With the financial crisis, we cannot find jobs, so why should we?’” Patsi said. “There’s a sense of despair.” Patsi and her team have seen their own pay cut by a third.

Junkie desperation, coupled with financial panic, has led to a doubling in new HIV infections in Greece. Traditionally, women, men and transgender people who do sex work, which is legal in Greece, sometimes supplemented their incomes through odd menial jobs at, say, sidewalk cafes or through money received—or stolen—from their family. But “under the crisis, there’s a lot less money available to them,” Kentikelenis said.

Frantic for cash, and facing a shrinking client base, prostitutes—and addicts who might not have previously turned tricks—are taking greater risks during sex with johns who will pay more for unprotected sex. Prostitutes are also more likely to have unprotected sex “when withdrawal symptoms from drugs are particularly acute,” Kentikeleni said. “They are much more willing to compromise and do it.”

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