By Zoe Mavroudi Firstly, let us recap what happened. This past September, the World Health Organization published a report (pdf) which included a reference to a case study on the public health effects of the economic crisis in Greece. Buried on page 11 …
By Zoe Mavroudi
Firstly, let us recap what happened.
This past September, the World Health Organization published a report (pdf) which included a reference to a case study on the public health effects of the economic crisis in Greece.
Buried on page 112 of the report the reference offered – without citation – a typically bleak view of a rise in prostitution, suicide and HIV rates and might have gone unnoticed had it not been for this stunning sentence:
“HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug-substitution programmes.”
Given the stark rise in new HIV infections since the crisis hit Greece, what the report was in essence alleging was that hundreds of intravenous drug users had deliberately injected themselves with blood they knew was tainted with HIV in order to infect themselves with the virus and become eligible for a monthly benefit entitlement and an entry into opioid substitution programmes, which in Greece grant priority to drug users with chronic conditions.
The reference was stunning not only because of its content but chiefly because it had made an official report of the United Nations’ public health agency in spite of being utter bogus.
As with many exaggerated stories about Greece in the past few years however, the claim soon became fodder for international media coverage. The New Scientist first picked it up in an October 30 article, which gained traction first on twitter and then in mainstream media. The progressive US blog Media Matters was the first outlet to put matters in their place by explaining that WHO had exaggerated a statement from a 2011 study published in the medical journal The Lancet, which cited “accounts” of “a few” self-inflicted infections. The study had misrepresented another quote, this time from an ad-hoc report authored by Greek scientists that same year, which stated a “well-founded suspicion” of self-infection among Greek users.
The claim of self-infections had apparently self-inflated: “suspicions” had become “accounts,” which then turned into “half of new HIV infections.”
Frustratingly, WHO addressed the fiasco by displaying a curious stubbornness at maintaining the existence of self-infecting drug users in Greece in spite of admitting a complete lack of any evidence to confirm a single such case.
In its first public response the organization claimed the report was “the consequence of an error” in editing, and recognized “no evidence suggesting that ‘deliberate self-infection with HIV’ goes beyond few, anecdotal cases.” Shortly after, in an official correction on its website, WHO insisted on the existence of deliberate infections saying “half of the new HIV cases are self-injecting and out of them few are deliberately inflicting the virus.” An unannounced edit to that text later removed the claim of a few deliberate cases and replaced it once again with “few anecdotal cases.” A third and final edit added the inaccurate statement that “slightly more than half of Greece’s new HIV cases are among those who inject drugs.” (Injecting Drug Users were a significant percentage but still less than half of the 965 and 1,180 recorded new infections in 2011 and 2012 respectively.)
In spite of three edits, WHO ultimately failed to call the claim what it really was: an urban myth.
A system that rewards sickness
Lost in all the international coverage were the realities on the ground for HIV-positive Greeks. According to Positive Voice, a non-governmental organization advocating the rights of Greece’s HIV community, anecdotal evidence suggests that about half of the more than 11,000 Greeks diagnosed with the virus are currently receiving the benefit.
But access to the benefit isn’t reflective of the community’s tangible access to healthcare and social services. Moreover, HIV is a severely stigmatized condition, which presents additional challenges.
“The benefit is a substitute to a defective healthcare and welfare system,” said Positive Voice empowerment and research consultant Apostolos Kalogiannis. “The unemployment level for the people living with HIV in Greece is disproportionally high, even in a country where unemployment has hit 27.4% of the general population. And that doesn’t even take into account severely affected subgroups”, he added. “About 30% of HIV-positive injecting drug users are homeless, which is a nightmare recipe for an explosive epidemic. Most homeless shelters do not accept HIV-positive people.”
He added that even before the crisis hit, HIV-positive Greeks often refrained from seeking benefits due to stigma and confidentiality concerns. Since 2011, revised eligibility guidelines and increased bureaucratic obstacles have made the benefit application process even more frustrating. An HIV-positive person must currently undergo a health evaluation by special committee at newly-established Disability Certification Centres. Benefits are granted to those who are judged with a 50% disability percentage. The number – recently down again after being raised to 67% – is contingent primarily on a patient’s CD4 count, a medical measurement of immune system functionality. A CD4 count is essential but insufficient in determining whether an HIV-positive person has good overall health or is capable of full-time employment. An antiquated evaluation system further complicates things. According to Positive Voice, committees often base their decisions on a list of criteria drafted in the early 1990s, before anti-retroviral treatment even became available. This can lead to rejections that make no medical sense, such as in cases when applicants are rejected for having a good CD4 count even though they suffer from cancer and lymphomas.
More frustratingly, committee hearings have long waiting lists, sometimes reaching a year-long wait; that’s for a benefit that can only be given for up to 2 years. Additionally, some HIV-positive Greeks who were receiving the benefit before the new system was set up have now been disqualified. In a country that is experiencing a constant drop in living standards, these sudden restrictions and cuts to a vulnerable group are evidence of an intolerant and dangerous public health policy.
HIV organizations and doctors in Greece have been ringing alarm bells that patients may resort to desperate measures – albeit not the kind WHO alleged. These could include halting their medication in order to provoke a short-term drop in their CD4 count and qualify for state support.
And that’s not all. Repeated reports of anti-retroviral drug shortages in major Greek public hospitals have added to widespread insecurity about whether the state will even be able to guarantee access to medication. You didn’t hear it in the lengthy coverage of the WHO, blunder but the Greek state’s policy doesn’t invite voluntary self-infection but instead, it provokes and rewards actual sickness of those already diagnosed. The claim of self-infection in the WHO report did nothing more than add insult to injury for HIV-positive Greeks.
Still there are signs of hope. Kalogiannis said that advocacy from Positive Voice and the Hellenic Association for the Study and Control of AIDS among other groups, may soon ensure that an HIV-positive person starting his or her medication, can be counted as a sufficient index of qualification for the benefit.
He said however, the times are critical: “The spike in diagnoses in the past few years is an indication that the ideologico-political individualism that drives the so-called reforms in our health care system has a detrimental effect. Infectious diseases such as HIV are a litmus test for the community and solidarity bonds that are currently under attack.”
The ideological rhetoric of personal choice
The “ideologico-political individualism” Kalogiannis referred to strikes at the heart of the matter. The self-infection myth that the World Health Organization drew from obscure scientific reports has been publicly trumpeted by prominent members of the Greek medical community and government. At a 2011 press conference, the year of the first significant rise in new infections, it was the President of the Hellenic Association for the Study and control of AIDS Marios Lazanas, who reported an existence of self-infecting drug users only to later redact the statement. Lazanas was in the presence of then Greek Health Minister Andreas Loverdos, who made another unfounded statement a few months earlier, this time at the United Nations High Level meeting on AIDS, saying many new HIV infections in Greece were among female trafficking victims from Sub-Saharan Africa.
The persistent resurgence of urban myths and inaccuracies that put vulnerable people on the public spot bears additional significance for Greece. The country’s crisis has been consistently framed in ideological terms that attribute it to individual choices presumably shared by large numbers of people. As a nation, Greeks have been compared to feral cats looking for handouts and called dishonest, lazy Southerners, who brought their crisis on to themselves by choice.
The WHO report gave this narrative a more sinister and absurd turn. The idea that hundreds of people would deliberately get a serious infection in order to stave off poverty or gain access to free opioids imagines a world where individual intent can precede the very deliberate politics that give birth to public health crises in the first place. What drove the spike in HIV infections in Greece in the past three years was not individuals living on the street but individuals dictating policy at the top, both among the Greek political class and the Troika of lenders, who can and should be blamed for austerity policies that have proven detrimental to public health. As highlighted in the Lancet study cited in the WHO report, there is ample evidence that HIV became a problem in Greece due to insufficient harm reduction programmes and brutal cuts across the health sector.
The rhetoric of personal choice amidst the kind of political engineering Greece has witnessed, isn’t aimed at placing any kind of healthy individualism at the centre of social reform but at diverting public attention from the failures of policy makers and demonizing vulnerable groups – the biggest victims of the crisis.
After all, what would political failure be without discrimination and stigma?
This is also why the American far-right shock jock Rush Limbaugh coloured his rant on the WHO report and the effects of the Greek welfare state with a dash of homophobia. “The [Greek] people, blissfully ignorant though they are, are always victims, always innocent … they never have one iota of responsibility in any aspect of their lives,” he told listeners on his daily show, adding: “Greece is like the gay capital of the world?”
Limbaugh’s words carried echoes of the rhetoric that accompanied the AIDS epidemic during its first years, also an era of brutal austerity. It was during the early 1980s that proponents of Reaganism in the United States persistently neglected to take urgent measures in the face of an obvious spread of the disease among the gay population and intravenous drug users, two highly stigmatized groups. To many, the victims were simply paying for their supposed sins. The criminal neglect of the powerful during those days is well documented.
Today’s austerity dogmatists similarly invoke irresponsible individual behaviour in order to abandon their institutional responsibility to avert disaster. When they do decide to take measures, they are invariably extreme. The Greek State’s scapegoating of its most vulnerable citizens reached a new low a few days before the 2012 national elections, when police and health authorities targeted a group of female injecting users later charged with the intent of infecting men through alleged illegal prostitution. The witch-hunt was based on flimsy evidence and was followed by the women’s public exposure. Similar state and police abuses against drug users and migrants under the pretext of protecting public health have become routine in Greece.
But these actions serve no public health purpose. Instead, they expose a state in a panic reminiscent of the first AIDS outbreak. The difference between those days and today is that HIV is now a treatable condition and those newly diagnosed don’t have to endure the humiliations of previous decades. And yet, urban myths coupled with ideology help cement policies that have caused much unnecessary humiliation and suffering already.
With its erroneous report, WHO has unintentionally shed light on some very deliberate policies. They are implemented by irresponsible individuals and must be addressed with organized, collective action.
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