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Nearly half the new HIV infections in Greece occur in sexual minority men, yet pre-exposure prophylaxis is not currently supported in the national HIV program. We examined factors associated with PrEP persistence among Greek SMM in PrEP for Greece, the first PrEP study in Greece. Participants (n = 100) were recruited from 2016 to 2018 through respondent-driven sampling among SMM in Athens, receiving supplies for daily PrEP at interval visits over 12-months. PrEP persistence, operationalized as Total PrEP Time, was high, 74% of participants achieving perfect persistence. Higher alcohol risk scores (OR 1.27, 95% CI 1.08-1.49) and adherence to HIV testing guidelines (OR 1.23, 95% CI 1.00-1.51) were associated with persistence. Housing impermanence (OR 0.14, 95% CI 0.04-0.48) and serostatus disclosure concerns (OR 0.77, 95% CI 0.60-0.97) were associated with limited PrEP persistence. While PrEP persistence among Greek SMM is high, socioeconomic factors and societal attitudes may challenge prevention efforts.

Background The first case of SARS-CoV-2 in Greece was identified in February 2020. During the COVID-19 pandemic two lockdowns took place (March-May 2020/November 2020-ongoing). People who use drugs (PWUD), as well as the homeless, constitute vulnerable social groups. The main aim of this study is to assess the impact of social distancing measures during the COVID-19 pandemic on these groups. Methods A program was implemented in Athens between December 2020 and January 2021 in a sample of PWUD and homeless recruited both in Substitution Treatment Units and the Homeless Shelters. The interview was conducted with a structured questionnaire. Results The study included 303 participants (215 PWUD and 88 homeless individuals (HI)). The mean (SD) age was 49.2 (9.7) and 61.9 (10.2) years for PWUD and HI respectively. Chronic hepatitis C was reported by 33% of PWUD and 1.1% of HI. HIV infection was reported in 9.3% of PWUD. Testing for SARS-CoV-2 was reported by 55% and 100% of PWUD and HI respectively; 0.8% of PWUD and 5.7% of HI were found positive. Compliance with individual measures against SARS-CoV-2 was reported to be high (98-100%) during lockdowns. 88.8% and 98.9% of PWUD and HI reported change in the quality life. Feelings of isolation were reported by 46.6% and 11.5% on PWUD and HI, respectively. PWID enrollment in OST programmes during the 1st and 2nd lockdown was 67.1% and 92.9% respectively. OST attendees did not report changes in treatment during lockdowns. Access to hygiene materials was 9.8% and 100% in 1st and 2nd lockdown. Access to drugs was high (91.5% and 94.3%) in both lockdowns. The illegal drug use as compared to regular use was increased 12.2%/14.3%, decreased 40.2%/40%, stable 47.6%/45.7% for 1st/2nd lockdown respectively. Conclusions The population studied is well-aware and compliant with the prevention measures against COVID-19 with access to frequent laboratory testing, low levels of SARS-CoV-2 and access to prevention materials. Key messages Among PWUD the OST services provision was stable. Provision of antiseptics was higher during the 2nd lockdown while changes in drug use were similar during the 1st and 2nd lockdown. Limitation: This study does not assess PWUD with limited access to OST and HI living in the streets.

Background and AimsThe HIV outbreak among People Who Inject Drugs (PWID) in Athens, Greece in 2011-2013 was the largest recent epidemic in Europe and North America. We aim to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens, to estimate HIV incidence and identify risk factors and to explore HIV-1 dispersal using molecular methods during 2014-2020.MethodsTwo community-based HIV/hepatitis C programs on PWID were implemented in 2012-2013 (N=3,320) and 2018-2020 (N=1,635) through consecutive Respondent-Driven Sampling (RDS) rounds. PWID were uniquely identified across rounds/programs. We obtained RDS-weighted HIV prevalence estimates per round for 2018-2020 and compared them to 2012-2013. We assessed changes in HIV status, behaviours, and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 persons-years during 2014-2020 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.ResultsHIV prevalence per round ranged between 12.0%-16.2% in 2012-2013 and 10.7%-11.3% in 2018-2020 with overlapping 95% Confidence Intervals (95% CI). Among PWID participating in both programs, HIV prevalence[95% CI] increased from 14.2%[11.7%-17.1%] in 2012-2013 to 22.0%[19.0%-25.3%] in 2018-2020 (pConclusionsThe ongoing HIV transmission among PWID in Athens provides empirical evidence that the current levels of prevention and treatment are inadequate to control the epidemic. Re-evaluation of prevention programs is urgently needed.

Background: Rheumatoid arthritis (RA) is treated successfully with biologic disease-modifying anti-rheumatic drugs (bDMARDs). However, a significant withdrawal rate, due to non-responsiveness or toxicity, remains a major barrier for their long-term use. Objectives: To determine the withdrawal rate of the first bDMARD in a large cohort of RA patients due either, to non-responsiveness or toxicity. Methods: In this study, were included retrospectively 220 patients from our outpatient clinic. The following bDMARDs were evaluated: Etanercept (n=66 patients), Adalimumab (n=61 patients), Infliximab (n=70 patients), Rituximab (n=6 patients) and others, such as Certolizumab pegol, Golimumab, Tocilizumab, Anakinra and Abatacept (n=17 patients). Disease activity was regularly measured by DAS-28 until the end of follow up. Kaplan-Meier plots were performed to examine the withdrawal rate of each biologic agent. Severity of AEs was classified according to the Common Terminology Criteria for Adverse Events (CTCAE, version 4.03). Results: A total of 220 patients (49 men, 171 women) were included in the analysis. The most frequently used first-line bDMARDs were Infliximab (31.8%), Etanercept (30%) and Adalimumab (27.7%). The median of treatment duration with the first bDMARD was 15 months (Q1:8, Q3:40.5). Taking all bDMARDs as a whole, 126 patients (57,27%) discontinued the first bDMARD, either due to AEs(n=66, 52.38%), or loss of efficacy (n=60,47.62%) after a follow-up of 167 months. However the most withdrawals (53.18%) occurred within the first 60 months of follow-up. Mean initial and final DAS-28 were: for those who discontinued treatment due to AEs 4.96±1.33(95%CI 4.64-5.28) and 3.43±1.47(95%CI, 3.08-3.79), respectively, for those who discontinued due to failure of therapy: 5.04±1.37(95%CI, 4.70-5.39) and 4.91±1.27(95%CI, 4.59-5.23) respectively and for those who continue 4.79±1.55(95%CI, 4.47-5.10) and 2.63±1.06(95%CI, 2.41-2.84), respectively. Differences in survival among bDMARDs are attributed to their AEs and not to their efficacy. As far as the AEs are concerned, infections constituted the majority of cases (n=23, 34.8%), from which 34.8% needed hospitalization (CTCAE 3-4). The percentage of 12,1% of AEs is attributed to cancer cases, while allergic reactions counted for 31,8% of them. Survival of Etanercept within our cohort was significantly longer than those of other bDMARDs. Conclusion: Biologic agents are important drugs in our armamentarium to combat RA. However nearly 50% of patients discontinue these agents after 60 months of treatment due either to AEs or inefficacy. Differences in survival of bDMARDs were associated not to their inefficacy, but to their AEs. Choosing the right drug for the right patient is a matter of advanced research involving a better understanding of the plasticity of the pathways of inflammation and specific biomarker selection. References [1] C. Lampropoulos, P. Orfanos, M. Manoussakis, A. Tzioufas, H. Moutsopoulos, P. Vlachoyiannopoulos. Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics:A real-world study.ClinExpRheumatology.2017;35:192-200. [2] C. Lampropoulos, P. Orfanos, V. Bournia, T. Karatsourakis, C. Mavragani, D. Pikazis, M. Manoussakis, A. Tzioufas, H. Moutsopoulos, P. Vlachoyiannopoulos.Adverse events and infections in patients with rheumatoid arthritis treated with conventional drugs or biologic agents: a real world study.ClinExpRheumatology.2015;33:216-224. Disclosure of Interests: Olga Katsouli: None declared, Georgia Liantinioti: None declared, Panagiota Katsouli: None declared, MARY PAPPA Employee of: Bayer, Markos Patsouras: None declared, Theodoros Angelopoulos: None declared, Sotiris Roussos: None declared, PANAYIOTIS VLACHOYIANNOPOULOS: None declared

In the last decade, Turkey has been perceived, both in Greece and Israel, as assuming a leading role in the Middle East and the Eastern Mediterranean through economic and political as well as ideological influence. Israel, in particular, feels alienated from Adalet ve Kalkinma Partisi (AKP) policy towards political Islam, and isolated in the region. As a result, its political elite is in search of new alliances in the Eastern Mediterranean. Meanwhile, Greece’s strategic concerns are heavily influenced by the inability of the European Union (EU) to build a comprehensive and integrated solution to the economic and social crisis in the European South and the poor results yielded by the Europeanisation of Greek-Turkish relations in terms of resolving bilateral territorial disputes in the Aegean or over the Cyprus issue.

The Greek Orthodox Patriarchate of Jerusalem is arguably the most important single Christian institution in the Holy Land. It has seen itself as a ‘bulwark’ of Hellenic Christianity, and the constitution and make-up of the Patriarchate has been Greek. This has created conflict and tensions between the senior Greek clergy and the predominantly Palestinian Arab Orthodox community. The Patriarchate has operated at times a controversial approach to Church–State relations in Jerusalem. The question of the ownership and sale of land, in a conflict situation where land is one of the principal motives and issues, has led the Patriarchate into conflict with other Christian churches and its own Arab Orthodox community.

Evanthis Hatzivassiliou. NATO and Western Perceptions of the Soviet Bloc: Alliance Analysis and Reporting, 1951-1969. London: Routledge, 2014. xii + 228 pp.

In September 2008 a meeting of the leaders of France, Turkey, Qatar and Syria took place at a time when the USMiddle East strategy was faced with a series of impasses, despite the improved security conditions in Iraq. The isolation policy against Syria, as well as against Hamas and Hezbollah, has not brought the expected results; the Annapolis peace process has reached a stalemate and the Persian Gulf monarchies are terrified at a possible military conflict with Iran; and finally, the traditional US allies, Egypt, Saudi Arabia and Jordan, see their role being played down. We are currently witnessing a tectonic change in the Middle East. In essence, for the first time since 1948, neither of the regional balancing powers (Iran and Israel) in this sub-system are Arab. It is clear that the roles of Egypt and, to a certain extent, Saudi Arabia have been decreasing. At the same time, the Middle East is experiencing for the first time in five centuries an unprecedented revival of Shi’a Islam in Iraq and Lebanon (Hezbollah), among the substantial Shi’a minorities or majorities (Bahrain) in the Gulf region, and certainly under the Alawite (Shi’a-related) Assad regime in Syria. In fact, the Shi’a bloc is succeeding for the first time in influencing Sunni Muslim organisations as well, such as the Palestinian Hamas. For both the US and Europe, the key assumption so far with regards to sustaining their policies on the Middle East has been that it is necessary to deal with a clash between secular – that is, democratic and Western-oriented – political forces and Islamist ones. In the event that the secular forces prevail, then according to the same assumption, security and stability will be consolidated in the region. This assumption has major weaknesses. In numerous countries of the Middle East and North Africa (Turkey, Egypt, Jordan, Saudi Arabia, Algeria, etc.), there are no secular political forces worth mentioning that could claim power through coherent political discourse. The real conflict rages between the authoritarian state and various economic, political and social patronage networks developed by the former, and the Islamists. In Turkey, in fact, the state is vested with a typical mid-war authoritarian ideology along the lines of Salazar, Franco or Reza Sah, which is at