The Portapotty Experiment: Neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South Bronx

Impact of a Homeless Encampment Closure on Crime Complaints in the Bronx, New York City, 2017: Implications for Municipal Policy

Purpose

As part of COVID-19 control policy, the Centers for Disease Control and Prevention has advised local jurisdictions to permit the formation of homeless encampments to prevent community disease spread. This new federal public health guidance is in conflict with existing police policies in many jurisdictions to raze or evict homeless encampments upon discovery. However, no empirical research on homeless encampment policy actions exists.

Methods

This study utilized interrupted time series to estimate the impact of the 2017 closure of "the Hole"-a longstanding encampment of homeless people who use drugs in the Bronx, New York City-on crime complaints. Daily crime complaints originating from public spaces within 1 mile of the encampment were captured during the 30-day periods before and after closure.

Results

Closure was associated with no short-term changesin complaints [IRR=1.01; 95% CI (0.81-1.27)], with daily complaints remaining at baseline levels during the post-closure period [IRR 0.99; 95% CI (0.98-1.00)].

Discussion

Findings preliminarily suggest that the presence of a homeless encampment may not have been associated with increased levels of crime in the neighborhood where it was located. Future research is necessary to understand the health and social impacts of homeless encampments and inform municipal policymakers.

Impacts of mandated data collection on syringe distribution programs in the United States

OBJECTIVES

Syringe Distribution Programs (SDPs) are a well-proven public health response to the spread of HIV and other blood borne illnesses among people who inject drugs. Many SDPs in the United States are required to collect data from service users as a condition of either legal authorization to operate or as a condition of funding. We sought to describe the prevalence of such externally mandated data collection and impact on service delivery at syringe distribution programs (SDPs) in the United States via an online survey.

METHODS

Online survey of SDPs in the US.

RESULTS

63 SDPs participated. 95•2% collected data about individual service users, with 76•7% being mandated to do so by an external entity as a condition of legal authorization, and/or as a condition of funding. Only 21•7% of mandated respondents received any report back on how data was used. 60•0% reported that data collection acted as a barrier to providing syringes to people who use drugs due to service user fears about loss of anonymity and/or law enforcement. 33•3% reported that the computer literacy and language skills required to collect data meant otherwise appropriate members of the community could not he hired as staff or volunteers.

CONCLUSIONS

Data collection at SDPs may act as a barrier to service provision to populations at high risk for HIV and other blood born viruses, and place considerable logistic burdens on often under-resourced public health programs. Further, it is often unclear to SDPs what purpose their data is being put to. We argue that to be ethical, the purpose of data collection should be carefully considered and regularly reviewed to ensure data is being put to meaningful purpose which is commensurate with impacts on service delivery.

Rapid Identification and Investigation of an HIV Risk Network Among People Who Inject Drugs -Miami, FL, 2018

Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States. The first legal syringe services program (SSP) in Florida implemented routine screening in 2018 leading to the identification of ten anonymous HIV seroconversions. The SSP collaborated with the Department of Health to conduct an epidemiologic investigation. All seven acute HIV seroconversions were linked to care (86% within 30 days) and achieved viral suppression (mean 70 days). Six of the seven individuals are epidemiologically and/or socially linked to at least two other seroconversions. Analysis of the HIV genotypes revealed that two individuals are connected molecularly at 0.5% genetic distance. We identified a risk network with complex transmission dynamics that could not be explained by epidemiological methods or molecular analyses alone. Providing wrap-around services through the SSP, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.

Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States

BACKGROUND

Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an 'underground' facility since September 2014.

METHODS

Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples' lives, including the impact of lack of formal legal sanction on service provision.

RESULTS

Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being 'underground' included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services.

CONCLUSION

Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction.