Health officials tell Greece to act fast to control HIV

LONDON (Reuters) – A spiraling outbreak of HIV in debt-stricken Greece could run out of control if urgent action is not taken, European health officials said on Friday.

The European Centre for Disease Prevention and Control (ECDC) said infections with the AIDS-causing virus among drug users and other high-risk groups were rising fast, and that a failure to act would mean far higher costs in future.

ECDC director Marc Sprenger will meet Greek officials this week to say that free needles, syringes and opioid substitution projects must be stepped up, and testing and treatment for the human immunodeficiency virus made available to all.

“Immediate concerted action is needed in order to curb and eventually stop the current outbreak,” he told Reuters as the ECDC published a report on Greece’s HIV problem.

Since 2009, recession in Greece has reduced economic output by a fifth and sent unemployment to a record high.

The healthcare system is under extreme pressure, making it harder for the poor, unemployed or homeless to get treatment.

While Greece has only 7.4 HIV infections per 100,000 people, compared to 10 per 100,000 in Britain or 27.3 in Estonia, rates have soared since 2011 in high-risk groups such as drug users.

From 2007 to 2010, there were only 10 to 15 cases a year of HIV infection in injecting drug users.

But during 2011, there were 256 such cases – or 27 percent of the total. Another 314 were reported between January and August 2012, most of them in the capital.

Combination drugs can give patients with HIV near-normal life expectancy, but the drugs must be taken for life, and cost 10,000 to 22,000 euros ($ 13,000 to $ 28,500) a year. Sprenger said Greece’s costs were at risk of running out of control.

“If a scale-up (in prevention and testing) is not achieved, it’s likely that HIV transmission among people who inject drugs in Athens will continue and even accelerate – and could eventually spread,” he said.

“The cost of prevention … will be significantly less than the provision of treatment to those who become infected.”

The ECDC said it was unclear how much Greece’s debt crisis has contributed to HIV outbreak.

Rates of other health problems such as depression and suicide have been rising in Greece, which is also battling the re-emergence of mosquito-borne diseases such West Nile Virus and malaria.

(Reporting by Kate Kelland; Editing by Kevin Liffey)

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The Needless Tragedy of Student Loan Defaults

For the first time on record, the delinquency rate on student loans has jumped above the rate for credit cards, car loans, or any other kind of consumer loan. The tragedy? Many of those loans will default, with stunningly harsh consequences, even though there are many good options for debt relief—deferment, forebearance, or reductions in monthly payments.

“There is actually no rational reason for a borrower to be delinquent or default on their loans,” says Mark Kantrowitz, president of MK Consulting in Cranberry Township, Pa., and operator of the FinAid.org website.

Borrowers who are unemployed, in the military, or back in school can ask for up to three years or full or partial deferment on repayment of a federal loan. For those who have a job but don’t earn enough to cover the monthly payment, there are six options: graduated repayment, extended repayment, income-based repayment, income-contingent repayment, income-sensitive repayment, and pay-as-you-earn repayment. In other words, the federal government will do just about anything to keep borrowers from giving up and walking away completely.

If that’s the carrot, here’s the stick: Defaulting is “like a trip through hell with no light at the end of tunnel,” says Kantrowitz. The federal government can garnish up to 15 percent of a borrower’s wages, Social Security disability, and Social Security retirement income without a court order. Unlike other debt, student loans can’t be discharged in bankruptcy. Collection charges of up to 20 percent can be skimmed off the top of payments—enough to turn a 10-year loan into a 19-year loan. To say nothing of the lasting damage to a borrower’s credit score, which will make it hard or impossible to get a credit card, auto loan, or mortgage.

And, oh, by the way, if you win the lottery, the first winner from your windfall is the Education Department.

With that kind of downside, why do so many people default on their student loans? Some may not understand their options, or put off dealing with the problem. Also, research shows that many borrowers consider their student loans illegitimate and don’t feel they should have to pay them back. In fact, default rates are four times as high for dropouts, who presumably feel they didn’t get their money’s worth.

There’s a cyclical factor, too. The Federal Reserve Bank of New York reported on Nov. 27 that the percentage of student loan balances that were 90 or more days delinquent rose to 11 percent in the July-September quarter, higher than the delinquency rate on credit cards since the survey began in 2003. The spike comes at a time when youth unemployment remains historically high. Even for those with jobs, people are paying ever more money for educations that don’t equip them for jobs that pay them enough to cover their debts, as I wrote earlier this year in “Debt for Life.”

At the same time, delinquency rates on credit cards, auto loans, and mortgages have been falling because bad credit has been washed out of the system. There’s no such cleansing mechanism for student debt, which now totals $ 956 billion in outstanding loans, according to the New York Fed. The federal Consumer Financial Protection Bureau, using different methodologies, says student loan debt passed the $ 1 trillion mark sometime last winter.

Then there’s the fact that some of these student borrowers were probably lousy bets for repayment in the first place. The federal government, which holds 85 percent of outstanding student debt, doesn’t make loans to students based on their ability to repay them. That may sound crazy, but it is designed to ensure that students of all backgrounds and income levels get a shot at a college degree.

That willful blindness also sets up the government for huge losses. The purpose of the draconian punishment for defaulters is to make up for the lack of sound underwriting on the original lending. Clearly, though, the threats aren’t working—and neither are the multiple repayment options the government offers.

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Wii U Sells 400,000 Units in First Week

Nintendo‘s Wii U sold 400,000 units during its first week of sales, and Nintendo’s president has said the console is “virtually sold out” at retailers.

[More from Mashable: YouTube-Exclusive ‘Halo’ Miniseries Nets 26 Million Views]

The Wii U, Nintendo’s next-generation console that features a touch screen as a controller centerpiece, was released on Nov. 18 across the United States. Despite large crowds at Nintendo’s flagship store in New York, users on Twitter reported there were few lines if they wanted to get their console on launch day.

The Wii U’s sales on made up only of a portion of Nintendo’s sales last week. Nintendo sold 300,000 Wii units last week; the console was released in 2006, but many retailers had Black Friday deals that dropped it under the $ 100 price point. Nintendo’s 3DS and DS handheld consoles also sold well, with 275,000 and 250,000 units respectively.

[More from Mashable: Double Fine Opens Top Secret Game Brainstorm to Fans]

For context, the Wii sold 475,000 units during its first eight days in the U.S. marketplace in 2006.

CNET reports that Nintendo of America President Reggie Fils-Amie said significant Black Friday discounts lead to the 8-year-old Nintendo DS to outsell the newer model. According to VGChartz, the 3DS has sold about 6 million units in America since being released last year.

BONUS: First Look at the Wii U

GamePad

The Wii U GamePad has a 6.2-inch touchscreen.

Click here to view this gallery.

This story originally published on Mashable here.

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Former boxing champ Mike Tyson to take one-man show on the road

LOS ANGELES (Reuters) – Former heavyweight boxing champion Mike Tyson plans to take his one-man theater show on the road across the United States early next year.

Tyson, 45, made the announcement on ABC’s late-night show “Jimmy Kimmel Live!” on Tuesday.

“Mike Tyson: Undisputed Truth” is an autobiographical monologue performed by Tyson in which he reflects upon his tough childhood in Brooklyn, the absence of his father and his self-described “reckless and destructive” behavior. It premiered in Las Vegas in April and had a run on Broadway.

Tyson, whose reputation was boosted by a cameo in the 2009 hit comedy “The Hangover,” told Kimmel that his inspiration for the show came from a one-man performance of “A Bronx Tale” in Las Vegas.

The 23-date tour, which features the Broadway show directed by Spike Lee, is scheduled to begin on February 12 in Indianapolis, Indiana, the city where Tyson was convicted in 1992 of raping then 18-year-old beauty queen Desiree Washington.

Tyson, who at the age of 20 became the youngest world heavyweight champion, served three years in prison before restarting his boxing career in 1995.

He later became better known for his erratic behavior than for his prowess in the ring. Tyson notoriously bit off portions of opponent Evander Holyfield’s ears in a 1997 bout and publicly said he wanted to eat British champion Lennox Lewis’ children.

Tyson retired from boxing in 2006.

(Reporting By Eric Kelsey; Editing by Patrica Reaney)

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Where You Work Matters When It Comes to Breast Cancer Risk

Regulations to protect workers from on-the-job hazards—and to compensate them for occupational harms—have a strong and storied history in the United States and Canada. But those protections are lacking for women who are at increased risk of breast cancer due to their occupation, says the author of a new study on breast cancer risk.

Previous research has hinted that some types of occupational exposures can raise the risk of breast cancer. Chemicals used in plastics manufacturing jobs, like polybrominated diphenyl esters—or PBDEs—are known carcinogens, as is secondhand tobacco smoke. Yet too little attention has been paid to women’s exposures to these chemicals and cancer risk, says Dr. James Brophy, adjunct faculty at the University of Windsor in Ontario, and a co-author of the new research.

The study, published in the journal Environmental Health, looked at women who were diagnosed with breast cancer in Essex or Kent Counties in Southern Ontario. Researchers  surveyed 1,006 women with breast cancer and a control group of 1,147 women without the disease regarding factors known to influence breast cancer risk—such as family history, use of hormone therapy, smoking, number of children and other factors. The women also described where they worked and their job activities.

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The study showed that women who worked for 10 years in jobs that involved exposure to chemicals had a 42 percent increased risk of breast cancer compared to women who worked in occupations without chemical exposures.

The findings should help shine a light on the link between breast cancer and occupational exposures, Brophy told TakePart.

“In cancer causality, there has been a real turning away from involuntary exposures since the late 1970s,” he says. “Cancer causality has been considered lifestyle choices, such as smoking, drinking, diet. Attention to other causes of cancer has been considered marginal. But the majority of women who get the disease don’t have the known or suspected risk factors. The disease is occurring among many healthy women. That’s opening up a major public health question about why. “

Breast cancer likely arises due to a combination of factors, such as genetics and outside influences, like chemical exposures or diet. But in the study, researchers found a clear link to some occupations even when controlling for many of the other risk factors for the disease.

MORE: Exercise May  Lower Breast Cancer Risk

Women who work in farming had a 36 percent increased risk of breast cancer, Brophy says. In Canada, he notes, employment in farming often begins early in a woman’s life. Early exposure to pesticides may account for the excessive risk.

The study also showed that the breast cancer type was linked to some occupations. For example, women in agricultural occupations with breast cancer were more likely to have a type known as estrogen receptor negative.

“That is the most difficult breast cancer to treat,” Brophy notes. “What we showed was these different occupational exposures were influencing the predominant type of tumor status in these women. That is a significant thing. It added weight that occupation was influencing the disease and the development of the disease.”

Breast cancer risk was almost double for women working in the Canadian car industry’s plastics manufacturing sector. The study showed that breast cancer risk was nearly five times higher in premenopausal women working in plastics and food canning. Breast cancer typically occurs after menopause.

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“The elevated risk for premenopausal women in auto plastics and canning was really very shocking,” he says. “These diseases are occurring among young women, which is normally a low-risk group.”

Overall, breast cancer risk was doubled for women working in food canning or tinning. Women in metalworking had a 73 percent increased risk of breast cancer.

Perhaps not as surprising, women employed in bars, casinos and at race tracks had double the risk of developing breast cancer, most likely due to secondhand tobacco smoke exposure.

More attention has been paid to the health effects of chemical exposures to males in particular industries, Brophy notes, such as the risk of lung cancer linked to mining. However, the theory that certain chemicals, called endocrine disruptors, can cause cellular changes during critical periods of breast development is well known in the medical world.

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“In occupational health, in general, there has been an ongoing tension about the lack of focus and concern about issues for women,” he says. There is a lack of attention to blue-collar occupations, but even less attention paid to the working conditions of women.”

Even in occupations where men and women hold the same position, women are affected differently and may require a different set of workplace protections, he says.

“A woman janitor in a hospital is assumed to have the same exposure as a male janitor in a hospital ,” he says. “The accepted idea is that their exposures are the same as men. But what we discovered in our study is often in these workplaces there is a division of labor in which men have certain tasks and women certain tasks and their exposures can be entirely different…Women have a different vulnerability. On the whole issue of hormonal disruption, what that means for a woman would differ than for a man.”

MORE: Produce Industry Says Quit Complaining About Pesticides

The concept that workers should be protected from occupational harm has been expanding in recent years in some areas. For example, some countries now recognize that working irregular shifts or night shifts can increase the risk of obesity and obesity-related diseases, like diabetes.

But there is still no workplace standard that accounts for exposure to chemicals that are known endocrine disruptors, Brophy says.

“There is very little being done to protect women from these exposures,” he says. “I think there is an awareness among workers. The problem has been what you can do about it.”

Emerging scientific evidence may give workers  an avenue to seek compensation for harms through the courts, Brophy adds.

“It’s only after you establish compensation that there is a real incentive for employers to do something about it,” he says.

Question: Should employers act now to protect female workers from an increased risk of breast cancer linked to particular occupations? Tell us what you think in the comments.

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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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U.S. declines to name China currency manipulator

WASHINGTON (Reuters) – The Obama administration on Tuesday said China‘s currency remained “significantly undervalued” but stopped short of labeling the world’s second-biggest economy a currency manipulator.

In a congressionally mandated semi-annual report, the U.S. Treasury noted that yuan had risen 12.6 percent against the U.S. dollar in inflation-adjusted terms since June 2010. An official said it was up 9.7 percent on a nominal basis through Tuesday, when it closed at a record high.

Although Beijing keeps the yuan, also known as the renminbi, in a tight trading band, the Treasury said China did not meet the legal requirements to be deemed a currency manipulator. The label is largely symbolic but would require Washington to open discussions with Beijing on adjusting the yuan’s value.

The Chinese government had “substantially” reduced its intervention in foreign exchange markets since the third quarter of 2011 and loosened capital controls, the Treasury said in the report, which examines the currency practices of major U.S. trading partners.

“In light of these developments, Treasury has concluded that the standards … have not been met with respect to China,” it said. “Nonetheless, the available evidence suggests the renminbi remains significantly undervalued.”

During the U.S. presidential campaign, Republican candidate Mitt Romney pledged to label China a manipulator on his first day in office to show he would be tougher on the United States’ chief economic competitor than President Barack Obama.

Many U.S. businesses and lawmakers complain that China keeps the value of its currency artificially low to gain an advantage in trade.

But an international consensus is growing that the yuan is closing in on its fair value after about a decade at an artificially weak level. The International Monetary Fund softened its language on the yuan in July.

YUAN AT RECORD HIGH

The yuan closed at a record high on Tuesday as the central bank’s reluctance to let the currency rise more quickly limited trading activity.

The People’s Bank of China limits currency moves by allowing the yuan to rise or fall by only 1 percent from whatever rate the central bank sets that day.

It has been 18 years since the U.S. Treasury has designated any country a currency manipulator. China was so labeled five times from May 1992 to July 1994.

Charles Schumer, the No. 3 Democrat in the Senate and a longtime critic of China’s yuan policy, said the Treasury should label China a manipulator to be able to impose penalties on it.

“It’s time for the Obama administration to rip off the band-aid, and force China to play by the same rules as all other countries,” the New York senator said in a statement.

But the U.S.-China Business Council, which represents about 240 American companies that do business with China, applauded the latest decision.

“The exchange rate has little to do with the U.S. trade balance or employment,” council President John Frisbie said. “We need to move on to more important issues with China, such as removing market access barriers and improving intellectual property protection.”

The Treasury said further appreciation of the yuan would help China balance its economy toward consumption by giving households greater purchasing power.

The report also called on China to reduce its “exceptionally high” foreign exchange reserves and to publish data about its intervention in currency markets.

The Obama administration also used the report to keep pressure on South Korea to limit its intervention in foreign exchange markets.

South Korea says it intervenes to smooth the volatility of its won currency, but it has gone into the market throughout 2012, the Treasury report said. In July, the IMF said the won was undervalued by up to 10 percent.

“We will continue to press the Korean authorities to limit their foreign exchange interventions to the exceptional circumstances of disorderly market conditions,” the report said.

(Reporting by Anna Yukhananov, additional reporting by Doug Palmer; Editing by James Dalgleish and Dan Grebler)

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The Wii U sells out in its first week: Evidence of a Nintendo comeback?

The latest console from the videogame pioneer is flying off the shelves. But are the kids really still into Mario and Zelda?

Earlier this year, Nintendo posted its first annual loss in three decades, a grim omen for the pathbreaking videogame maker that introduced the world to classic characters like Mario, Donkey Kong, and Link. The Japanese company has struggled amidst an industry-wide decline in the sales of consoles and games, a trend partly attributed to the ever-growing popularity of tablets and smartphones. Nintendo’s last breakout success was the Wii, released in 2006, and there have been serious doubts that its successor, the Wii U, could sell as many units. However, since the Wii U went on sale in North America on Nov. 18, Nintendo has completely sold out of all 400,000 consoles shipped to retailers. “As soon as the Wii U hits the shelf, it’s selling out,” said Reggie Fils-Aime, the head of Nintendo’s U.S. operations.

The Wii U’s early success is a surprising indication of “strong demand for the company’s next generation of videogame devices,” says Ian Sherr at The Wall Street Journal. And during the week of Nov. 18, Nintendo also sold 300,000 units of the original Wii, as well as more than 500,000 units of its portable DS and 3DS systems, which could reflect a rebound in consumer demand as the economy continues its long slog of a recovery from the Great Recession. Nintendo says it expects to sell 5.5 million Wii U systems by the end of March 2013, the end of its fiscal year.

However, it’s important to remember that “Nintendo has a very dedicated audience that craves almost anything new the company has to offer, not unlike Apple’s fans,” says Nick Wingfield at The New York Times. “The real test of the Wii U’s durability will come when the product is in better supply and more casual gamers, who don’t dream about Mario and Zelda in their sleep, can more easily buy it.” In addition, rivals Sony and Microsoft are expected to unveil their new consoles sometime in 2013, putting extra pressure on Nintendo. 

And perhaps most importantly, Nintendo has to sell games. The Wii U — which retails for $ 299.99, and $ 349.99 for a more powerful model — is being sold at a loss. Nintendo hopes that users will continue to buy games in the years to come, particularly those that aren’t sold on other systems, such as the latest installments in the “Super Mario Bros.” and “Legend of Zelda” franchises. That’s among the keys to Nintendo’s future profitability.

Sources: The Los Angeles Times, The New York Times, USA Today, The Wall Street Journal

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Turkish PM fumes over steamy Ottoman soap opera

ISTANBUL (Reuters) – A hit TV show about the Ottoman Empire‘s longest-reigning Sultan has raised a political storm in Turkey, with Prime Minister Tayyip Erdogan urging legal action over historical inaccuracies and the opposition accusing him of artistic tyranny.

Erdogan tore into the weekly soap opera “Magnificent Century”, which attracts an audience of up to 150 million people in Turkey as well as parts of the Balkans and Middle East, in response to criticism of his government’s foreign policy.

The lavish television production, which grips audiences with tales of power struggles and palace intrigue, is set during the 16th century reign of Suleiman the Magnificent, when Ottoman rulers held sway over an empire straddling three continents.

Bristling at suggestions that Turkey was meddling too much in its neighbors’ affairs, Erdogan recalled Turkey’s heritage, and said Suleiman had been a proud conqueror rather than the indulgent harem-lover portrayed in the show.

“(Critics) ask why are we dealing with the affairs of Iraq, Syria and Gaza,” Erdogan said at the opening of an airport in western Turkey on Sunday.

“They know our fathers and ancestors through ‘Magnificent Century’, but we don’t know such a Suleiman. He spent 30 years on horseback, not in the palace, not what you see in that series.”

Scenes that showed Suleiman with women in the harem have prompted calls from viewers in the mostly Muslim and largely conservative country for the broadcasting regulator (RTUK) to ban the series. But it tops the viewing charts each week.

Erdogan said the director of the series, which has been on air since January 2011, and the owner of the channel that broadcasts it had been warned, but also said he expected the judiciary to act, without elaborating.

Erdogan’s opponents accused him of authoritarianism.

“The prime minister must be jealous of the series’ popularity. He thinks there’s no need for another sultan when he’s in power,” said Muharrem Ince, the deputy chairman of the main opposition Republican People’s Party (CHP).

“Erdogan wants to be the only sultan.”

Elected a decade ago with the strongest majority seen in years, Erdogan has overseen a period of unprecedented prosperity in Turkey. But concerns are growing about his increasingly authoritarian rule.

Hundreds of politicians, academics and journalists are in jail on charges of plotting against the government, while more than 300 army officers were given prison terms in September for conspiring to topple him not long after he swept to power.

Turkey has been increasingly assertive in regional politics, most notably over the crisis in neighboring Syria, where it has led calls for international action and scrambled war planes in a warning to Damascus not to violate its territory.

“I think the prime minister’s aim here is to change the agenda. I can’t think of any other reason to discuss an imaginary television series when there are so many problems in a country,” Nebahat Cehre, who played Suleiman’s mother during the first two seasons, told Turkey’s Birgun newspaper.

(Editing by Nick Tattersall and Jon Hemming)

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Youth HIV Rate High, Testing Low

Americans between the ages of 13 and 24 accounted for more than a quarter of new HIV infections in 2010 — about 12,000 cases — but only a third of that age group had ever been tested for the virus, the CDC reported.

“This is our future generation, and the bottom line is that every month, 1,000 youth are becoming infected with HIV,” said Dr. Thomas Frieden, director of the agency.

The “shocking” data, reported in a Vital Signs article from Morbidity and Mortality Weekly Report, detail the prevalence, incidence, and risk factors of HIV among youths, Frieden said in a teleconference with reporters.

Read this story on www.medpagetoday.com.

One implication of the new incidence data is a growing future healthcare burden, Frieden said.

Noting that the lifetime cost of care for a person with HIV is about $ 400,000, he said: “Every month we are accruing about $ 400 million of healthcare costs — and every year $ 5 billion — from preventable infections in youth.”

“It is just unacceptable that young people are becoming infected at such high rates,” Frieden said.

CDC researchers used surveillance data to analyze 2009 prevalence rates of diagnosed HIV among youths and the number of new infections in the 13 to 24 age group in 2010.

They also assessed the prevalence of risk factors and HIV testing among youths, both those still in high school and those 18 through 24.

They found that in 2009, the prevalence of HIV among youth was 69.5 per 100,000 population, with a state-by-state range from 2.3 to 562.8 per 100,000.

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The rates were higher in southern and northeastern states compared with the West and Midwest.

Also, of the estimated 47,500 new HIV infections in 2010, 12,200 (25.7 percent) were among youths.

More than four-fifths of the new infections in 2010 (82.8 percent) were acquired by males.

Among newly infected youth, 57.4 percent were African American, 19.6 percent were Hispanics, and 19.5 percent were white.

Male-to-male sexual contact accounted for 72.1 percent of infections, while 19.8 percent were because of heterosexual contact. Injection drug use accounted for 4 percent, and 3.7 percent of infections were due to a combination of male-to-male sex and injection drug use.

Among males, 87.1 percent of infections were attributed to male/male sex, while among females, 85.7 percent were attributed to heterosexual contact.

Overall, youths with HIV made up 6.7 percent of the 1.1 million HIV-positive people in the U.S., the agency reported, and 59.5 percent of those did not know they were infected.

“That’s a much higher proportion than the less than the 20 percent we estimate overall don’t know they are HIV-infected,” Frieden said.

The agency used data from 12 states and nine large urban school districts, collected in 2009 and 2011, to analyze risk behaviors among male and female students in grades 9 through 12.

Males who reported sexual contact with other males, the CDC found, reported more risky behavior than other youths.

For instance, they were more likely to report sexual intercourse with four or more persons during their lifetime (39.4 percent versus 26.9 percent) and to have ever injected any illegal drug (20.4 percent versus 2.9 percent).

Importantly, they were also significantly less likely to have used a condom during last their sexual intercourse (44.3 percent versus 70.2 percent), the agency reported.

They were less likely to report having ever been taught in school about AIDS or HIV infection (74.6 percent versus 86.3 percent), the CDC found.

Overall, in 2011, 12.9 percent of all students in grades 9 through 12 reported that they had ever been tested for HIV, but the proportion reached 22.2 percent among those who reported being sexually active (49.2 percent of males and 45.6 percent of females).

In the older group – those 18 through 24 — 34.5 percent reported ever having been tested for HIV.

The CDC has recommended for several years that HIV testing should be part of routine medical care, but Frieden said many doctors still haven’t bought into the idea.

“You have a very, very small proportion of who refuse testing,” he said, “but unfortunately a relatively large proportion of doctors who don’t make it routine.”

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Euro zone, IMF reach deal on long-term Greek debt

BRUSSELS (Reuters) – Euro zone finance ministers and the International Monetary Fund clinched agreement on a new debt target for Greece on Monday in a breakthrough towards releasing an urgently needed tranche of loans to the near-bankrupt economy, officials said.

After nearly 10 hours of talks at their third meeting on the issue in as many weeks, Greece’s international lenders agreed to reduce Greek debt by 40 billion euros, cutting it to 124 percent of gross domestic product by 2020, via a package of steps.

The deal should open the way for a major aid installment needed to recapitalize Greece’s teetering banks and enable the government to pay wages, pensions and suppliers in December.

However, discussions were continuing on the methods to be used to lower Athens‘ debt burden, including a possible debt buyback and a lowering of interest rates on loans to Greece.

The euro strengthened against the dollar after news of a deal was reported by Reuters.

“It’s going very slow, but we have financing and a Debt Sustainability Analysis. We’ve filled the financing gap until the end of program in 2014,” one official engaged with the talks said. A second official confirmed the figures.

Greek Finance Minister Yannis Stournaras said earlier that Athens had fulfilled its part of the deal by enacting tough austerity measures and economic reforms, and it was now up to the lenders to do their part.

“I’m certain we will find a mutually beneficial solution today,” he said on arrival for the marathon talks.

Greece, where the euro zone’s debt crisis erupted in late 2009, is the currency area’s most heavily indebted country, despite a big “haircut” this year on privately-held bonds. Its economy has shrunk by nearly 25 percent in five years.

Negotiations had been stalled over how Greece’s debt, forecast to peak at 190-200 percent of GDP in the coming two years, could be cut to a more sustainable 120 percent by 2020.

The agreed figure fell slightly short of that goal, and the IMF was still insisting that euro zone ministers should make a firm commitment to further steps to reduce the debt stock if Athens implements its adjustment program faithfully.

The key question remained whether Greek debt can become sustainable without euro zone governments having to write off some of the loans they have made to Athens.

A source familiar with IMF thinking said the global lender was demanding immediate measures to cut Greece’s debt by 20 percentage points of GDP, with a commitment to do more to reduce the debt stock in a few years if Greece fulfills its program.

To reduce the debt to 124 percent by 2020, the ministers were putting together a package of steps including a debt buyback funded by a euro zone rescue fund, reducing the interest rate on loans and returning euro zone central bank ‘profits’ to Greece.

Germany and its northern European allies have so far rejected any idea of forgiving official loans to Athens.

DEBT RELIEF “NOT ON TABLE”

German Finance Minister Wolfgang Schaeuble told reporters that a debt cut was legally impossible, not just for Germany but for other euro zone countries, if it was linked to a new guarantee of loans.

“You cannot guarantee something if you’re cutting debt at the same time,” he said. That did not preclude possible debt relief at a later stage if Greece completed its adjustment program and no longer needs new loans.

The source familiar with IMF thinking said a loan write-off once Greece has established a track record of compliance would be the simplest way to make its debt viable, but other methods such as foregoing interest payments, or lending at below market rates and extending maturities could all help.

The German banking association (BDB) said a fresh “haircut” or forced reduction in the value of Greek sovereign debt, must only happen as a last resort.

Two European Central Bank policymakers, vice-president Vitor Constancio and executive board member Joerg Asmussen, said debt forgiveness was not on the agenda for now.

The options under consideration included reducing interest on already extended bilateral loans to Greece from the current 150 basis points above financing costs.

How much lower was still being debated — France and Italy wanted to reduce the rate to 30 basis points (bps), while Germany and some other countries sought a 90 bps margin.

Another option, which could cut Greek debt by almost 17 percent of GDP, was to defer interest payments on loans to Greece from the EFSF, a temporary bailout fund, by 10 years.

The European Central Bank could forego profits on its Greek bond portfolio, bought at a deep discount, cutting the debt pile by a further 4.6 percent by 2020, a document prepared for the ministers’ talks last week showed.

Not all euro zone central banks are willing to forego their profits, however, the German Bundesbank among them.

Greece could also buy back its privately-held bonds on the market at a deep discount, with gains from the operation depending on the scope and price. Officials have spoken of a 10 billion euro buy-back at around 30 cents on the euro, that would retire around 30 billion euros of debt, although since the idea was raised the potential gain has fallen as prices have risen.

FORGIVING OFFICIAL LOANS?

German central bank governor Jens Weidmann has suggested that Greece could “earn” a reduction in debt it owes to euro zone governments in a few years if it diligently implements all the agreed reforms. The European Commission backs that view.

An opinion poll published on Monday showed Greece’s anti-bailout SYRIZA party with a four-percent lead over the Conservatives who won election in June, adding to uncertainty over the future of reforms.

German paper Welt am Sonntag said on Sunday that euro zone ministers were considering a write-down of official loans for Greece from 2015, but gave no sources, and a euro zone official said such an option was never seriously discussed.

(Additional reporting by Robert-Jan Bartunek, Ethan Bilby, Luke Baker in Brussels, Reinhardt Becker in Berlin,; Writing by Paul Taylor; Editing by Luke Baker)

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