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Bardwell G, Ivsins A, Wallace JR, Mansoor M, Kerr T. "The machine doesn't judge": Counternarratives on surveillance among people accessing a safer opioid supply via biometric machines. Soc Sci Med 2024; 345:116683. [PMID: 38364722 DOI: 10.1016/j.socscimed.2024.116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
People who use illegal drugs experience routine surveillance, including in healthcare and harm reduction settings. The MySafe Project - a safer supply pilot project that dispenses prescription opioids via a biometric vending machine - exists in the Canadian province of British Columbia. The machine scans a participant's palmprint and has a built-in camera that records every machine interaction. The aim of this paper is to understand participants' experiences of surveillance, privacy, and personal security when accessing this novel program. An integrative case study and grounded theory methodology was employed. Qualitative one-to-one interviews were conducted with 46 MySafe participants across three different program sites in Vancouver. We used a team-based approach to code interview transcripts and utilized directed and conventional content analyses for deductive and inductive analyses. While participants described negative experiences of surveillance in other public and harm reduction settings, they did not have concerns regarding cameras, collection of personal information, tracking, nor staff issues associated with MySafe. Similarly, while some participants had privacy concerns in other settings, very few privacy and confidentiality concerns were expressed regarding accessing the machine in front of others. Lastly, while some participants reported being targeted by others when accessing the machines, most participants described how cameras, staff, and machine locations helped ensure a sense of safety. Despite negative experiences of surveillance and privacy issues elsewhere, participants largely lacked concern regarding the MySafe program and machines. The machine-human interaction was characterized as different than some human-human interactions as the machine is completing tasks in a manner that is acceptable and comfortable to participants, leading to a social preference toward the machines in comparison to other surveilled means of accessing medications. These findings provide an opportunity to rethink how we conceptualize surveillance, medication access, and harm reduction programs targeting people who use drugs.
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Affiliation(s)
- Geoff Bardwell
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - James R Wallace
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Kimmel SD, Samet JH, Cheng DM, Vetrova M, Idrisov B, Rossi SL, Rateau L, Astone K, Michals A, Sisson E, Blokhina E, Milet-Carty N, Bovell-Ammon BJ, Gnatienko N, Truong V, Krupitsky E, Lunze K. Stigma and other correlates of sharing injection equipment among people with HIV in St. Petersburg, Russia. Glob Public Health 2024; 19:2296009. [PMID: 38158724 PMCID: PMC10764055 DOI: 10.1080/17441692.2023.2296009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Stigma that people with HIV who inject drugs experience negatively impacts HIV and substance use care, but stigma's association with sharing injection equipment is not known. This is a cross-sectional analysis of data from two studies of people with HIV reporting drug injection (N = 319) in St. Petersburg, Russia (September 2018-December 2020). We used logistic regression to examine associations between HIV stigma and substance use stigma scores (categorised into quartiles) and past 30-day equipment sharing, adjusting for demographic and clinical characteristics. Secondary analyses examined associations of arrest history and social support with sharing equipment. Almost half (48.6%) of participants reported sharing injection equipment. Among groups who did and did not share, mean HIV stigma (2.3 vs 2.2) and substance use stigma (32 vs 31) scores were similar. Adjusted analyses detected no significant associations between HIV stigma quartiles (global p-value = 0.85) or substance use stigma quartiles (global p-value = 0.51) and sharing equipment. Neither arrest history nor social support were significantly associated with sharing equipment. In this cohort, sharing injection equipment was common and did not vary based on stigma, arrest history, or social support. To reduce equipment sharing, investments in sterile injection equipment access in Russia should be prioritised over interventions to address stigma.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- Section of Infectious Diseases, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Marina Vetrova
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Bulat Idrisov
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Sarah L Rossi
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Lindsey Rateau
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Kristina Astone
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Amy Michals
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Emily Sisson
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Elena Blokhina
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Natasha Milet-Carty
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Benjamin J Bovell-Ammon
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- The Miriam Hospital, Lifespan, Providence, Rhode Island, USA
| | - Natalia Gnatienko
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Ve Truong
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Evgeny Krupitsky
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Karsten Lunze
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
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Jain JP, Hill M, Gamarel KE, Santos GM, Johnson MO, Neilands TB, Dilworth SE, Reback CJ, Sevelius J. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 2023; 27:2523-2534. [PMID: 36682008 PMCID: PMC10362091 DOI: 10.1007/s10461-023-03979-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.
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Affiliation(s)
- Jennifer P Jain
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Miranda Hill
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Samantha E Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Cathy J Reback
- Friends Research Institute, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Jae Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry, Columbia University, New York, USA
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Al-Ghafri Q, Radcliffe P, Gilchrist G. Barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in the Muslim communities: A systematic narrative review of studies on the experiences of people who receive services and service providers. Drug Alcohol Depend 2023; 244:109790. [PMID: 36805826 DOI: 10.1016/j.drugalcdep.2023.109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of drug use in Muslim communities is difficult to estimate due to religious, social, and cultural prohibition toward drug use. With Islam affecting all aspects of life in the Muslim world, people who use drugs do it clandestinely to avoid stigma and exclusion from the community, leading to a low number of them seeking treatment for their drug use. This review explored the barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in Muslim communities. METHODS This review was in accordance with PRISMA. Seven databases were systematically searched for qualitative, quantitative, and mixed methods studies conducted in countries where at least 70% of the population were Muslim or where data were presented separately for Muslim communities in other countries. Eligible articles were reviewed, and key qualitative themes were abstracted and compared across studies and settings. RESULTS Twenty-four studies were included from Iran, Bangladesh, Afghanistan, Tajikistan, Kazakhstan, Kyrgyzstan, Egypt, Lebanon, and UAE. Two themes were identified: a psychosocial theme included denial of the problem severity, lack of trust in the treatment system, fear of breach in confidentiality and privacy, the need for community support, religion and women who use drugs. Additionally, an organizational theme included affordability, treatment Service characteristics, lack of Awareness, service providers' Attitudes, drug use registration and fear of legal consequences of drug use. Stigma was also identified as an over-arching theme. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies with where 12 of the studies met all 5 the quality criteria. No studies were excluded for having lower quality scores. CONCLUSION This review reflected how diverse the Muslim world is in drug use. It is important to use mosques to raise awareness on people who use drugs and reduce stigma. Providing holistic services for people who use drugs specially women will improve their access to treatment and harm reduction services in the Muslim world.
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Affiliation(s)
- Qutba Al-Ghafri
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
| | - Polly Radcliffe
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
| | - Gail Gilchrist
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
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Bardwell G, Mansoor M, Van Zwietering A, Cleveland E, Snell D, Kerr T. The "goldfish bowl": a qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting. Harm Reduct J 2022; 19:136. [PMID: 36476225 PMCID: PMC9730691 DOI: 10.1186/s12954-022-00725-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing body of research has focused on contextual factors that shape health and well-being of people who use drugs (PWUD). However, most of this research focuses on large cities and less is known about the effects of social and structural contexts on drug use and associated risks in rural Canadian settings. Therefore, we undertook this study to examine rural-specific contextual factors that affect the day-to-day experiences of PWUD. METHODS Twenty-seven qualitative semi-structured interviews were conducted with PWUD in a rural and coastal setting in British Columbia, Canada. Participants had to be ≥ 19 years old, used illegal opioids and/or stimulants regularly, and lived in the qathet region. Interview transcripts were coded based on themes identified by the research team. RESULTS Participants described progressive shifts in politics and culture in the qathet region while also identifying resource scarcity, homelessness, and changes in the drug supply, where illicit drug contents have become highly toxic and unpredictable. Participants discussed the qualities of a small community where everyone knows each other and there is a lack of privacy and confidentiality around drug use, which resulted in experiences of stigma, discrimination, and surveillance. Participants also reported rural-specific policing issues and experiences of surveillance on ferries when traveling to larger cities to purchase drugs. This led to significantly higher drug prices for PWUD due to the time dedication and criminalized risks associated with drug possession and trafficking. CONCLUSIONS Our findings illustrate the unique experiences faced by PWUD in a rural and coastal setting. The "goldfish bowl" effect in this rural community created heightened social and structural surveillance of PWUD, which led to a variety of negative consequences. There is a clear need for interventions to address the larger contextual drivers affecting people who use drugs in rural settings, including decriminalization and peer-led anti-stigma strategies, in order to improve the lives of PWUD.
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Affiliation(s)
- Geoff Bardwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ashley Van Zwietering
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
| | - Ellery Cleveland
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
- Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
| | - Dan Snell
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
- Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
- Substance Users Society Teaching Advocacy Instead of Neglect (SUSTAIN), 218-6975 Alberni Street, Powell River, BC, V8A 2B8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103750. [PMID: 35667193 PMCID: PMC10024805 DOI: 10.1016/j.drugpo.2022.103750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. METHODS We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. RESULTS A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and Poly-Victimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. CONCLUSION Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan.
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Nordgren J, Richert T, Stallwitz A. Police officers’ attitudes and practices toward harm reduction services in Sweden – a qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103672. [DOI: 10.1016/j.drugpo.2022.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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West BS, Henry BF, Agah N, Vera A, Beletsky L, Rangel MG, Staines H, Patterson TL, Strathdee SA. Typologies and Correlates of Police Violence Against Female Sex Workers Who Inject Drugs at the México-United States Border: Limits of De Jure Decriminalization in Advancing Health and Human Rights. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8297-NP8324. [PMID: 33261533 PMCID: PMC8166925 DOI: 10.1177/0886260520975820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Decriminalization of sex work is increasingly promoted as a structural measure to improve the health of vulnerable groups. In México, sex work is not illegal, but knowledge of policies' street-level impact is limited. This study describes typologies of police violence against female sex workers who inject drugs (FSWID), identifying risk and protective factors for violence exposure to inform policy responses. Survey data were collected during 2008-2010 among HIV-negative FSWID in a behavioral intervention in Tijuana and Ciudad Juarez (N = 584). Latent class analysis identified typologies of police violence in the past 6 months: asked for money, money taken, syringes taken, asked for sex, and sexually assaulted. Structural equation modeling (SEM) predicted latent class membership using sociodemographic, behavioral and risk environment factors, controlling for age, education, marital status, and city. Recent police violence was reported by 68% of FSWID, with three typologies emerging: Low (36.6%); Material (47.8%): having money/syringes taken or being asked for money; and Material/Sexual (15.7%): material violence and being asked for sex or sexually assaulted. In multivariable SEM, Material Violence was associated with: being jailed [adjusted Odds Ratio (aOR) = 4.34], HIV testing (aOR = 2.18), and trading sex indoors (aOR = 1.66). Factors associated with Material/Sexual Violence included: being jailed (aOR = 41.18), injecting with clients (aOR = 3.12), earning more money for sex without a condom (aOR = 2.88), being raped by a client (aOR = 2.13), drinking with clients (aOR = 2.03), receiving substance use treatment (aOR = 1.95), being <18 when first trading sex (aOR = .43), trading sex outdoors (aOR = .53), and poor working conditions (aOR = .56). Despite de jure decriminalization of sex work, police violence against FSWID at the México-United States border is pervasive with implications for sex- and drug-related harms. Closing gaps in policy implementation and mitigating material/sexual violence from police is imperative to decreasing economic vulnerability, risk of overdose and HIV, and improving engagement in HIV and harm reduction services.
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Affiliation(s)
| | | | - Niloufar Agah
- University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- University of California San Diego, La Jolla, CA, USA
| | - Leo Beletsky
- University of California San Diego, La Jolla, CA, USA
| | | | - Hugo Staines
- Universidad Autónoma de Ciudad Juárez, Chihuahua, México
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Morales-Gómez A, McVie S, Pantoja F. Controlled Delivery of Illegal Drug Parcels in Scotland: Does Policing Practice Align With a Public Health Approach Focused on Drug-Related Harm? JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221098986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increase in the flow of drugs into the UK via international postal systems poses challenges for law enforcement. ‘Controlled delivery’ can be used to disrupt supply networks and secure intelligence for prosecution; however, critics argue that law enforcement should instead focus on reducing drug-related harm. In Scotland, national drugs strategy adopts a public health approach but it is unclear whether this extends to policing practice. Therefore, this paper examines whether controlled delivery of drug parcels aligns with a public health policing approach. We find evidence of alignment in terms of potential harm to individual users, particularly in relation to legal highs, but not in terms of drug-related harms within the communities to which parcels were destined. We argue that further investigation is required in order to assess the extent to which political intent and policing practice in Scotland align around the principles of harm reduction and public health.
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Affiliation(s)
| | - Susan McVie
- School of Law, University of Edinburgh, Edinburgh, Scotland, UK
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Walker S, Dietze P, Poznyak V, Campello G, Kashino W, Dzhonbekov D, Kiriazova T, Nikitin D, Terlikbayeva A, Nevendorff L, Busse A, Krupchanka D. More than saving lives: Qualitative findings of the UNODC/WHO Stop Overdose Safely (S-O-S) project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103482. [PMID: 35042142 DOI: 10.1016/j.drugpo.2021.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants. METHODS Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically. RESULTS Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation. CONCLUSION Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.
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Affiliation(s)
- Shelley Walker
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia.
| | - Paul Dietze
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Vladimir Poznyak
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Giovanna Campello
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Wataru Kashino
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Office 20, 27, Kyiv, 04050, Ukraine
| | - Danil Nikitin
- Global Research Institute (GLORI) Foundation, 125 Suyumbaev Street Bishkek, 720011, Kyrgyzstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia (GHRCCA), 38B Shashkina Street, Almaty, Kazakhstan
| | - Laura Nevendorff
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Dzmitry Krupchanka
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
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11
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Lee JO, Yoon Y, Idrisov B, Kiriazova T, Makarenko O, Sereda Y, Bendiks S, Cody K, Schoenberger SF, Nurius PS, Halim N, Flanigan T, Samet JH, Liebschutz J, Lunze K. Violence, HIV Risks, and Polysubstance Use Among HIV-Positive People Who Inject Drugs in Ukraine. AIDS Behav 2021; 25:2120-2130. [PMID: 33385280 PMCID: PMC9184239 DOI: 10.1007/s10461-020-03142-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Violence experience has been consistently associated with HIV risks and substance use behaviors. Although many studies have focused on intimate partner violence (IPV), the role of violence at a structural level (i.e., police abuse) remains relevant for people who inject drugs. This study evaluated the association of IPV and police-perpetrated violence experiences with HIV risk behaviors and substance use in a cohort of HIV-positive people who inject drugs in Ukraine. We also evaluated possible moderation effects of gender and socioeconomic status in the links between violence exposure and HIV risk and polysubstance use behaviors. Data came from the Providence/Boston-CFAR-Ukraine Study involving 191 HIV-positive people who inject drugs conducted at seven addiction treatment facilities in Ukraine. Results from logistic regressions suggest that people who inject drugs and experienced IPV had higher odds of polysubstance use than those who did not experience IPV. Verbal violence and sexual violence perpetrated by police were associated with increased odds of inconsistent condom use. The odds of engaging in polysubstance use were lower for women in relation to police physical abuse. We found no evidence supporting socioeconomic status moderations. Violence experiences were associated with substance use and sexual HIV risk behaviors in this cohort of HIV-positive people who inject drugs in Ukraine. Trauma-informed prevention approaches that consider both individual and structural violence could improve this population's HIV risks.
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Affiliation(s)
- Jungeun Olivia Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th St., Los Angeles, CA, 90089, USA.
| | - Yoewon Yoon
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th St., Los Angeles, CA, 90089, USA
| | - Bulat Idrisov
- Bashkir State Medical University, Ufa, Russia
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | | | | | | | - Sally Bendiks
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
| | - Kate Cody
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th St., Los Angeles, CA, 90089, USA
| | | | - Paula S Nurius
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Nafisa Halim
- School of Public Health, Boston University, Boston, MA, USA
| | - Timothy Flanigan
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam and Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Jane Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Karsten Lunze
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
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12
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Khan SI, Irfan SD, Khan MNM. "I held on to the police's leg for mercy": Experiences of adversity, risk and harm among people who inject drugs during an anti-drug drive in Dhaka, Bangladesh. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103299. [PMID: 34030931 DOI: 10.1016/j.drugpo.2021.103299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND A number of countries across Asia have instituted "drug wars", aimed at eradicating drug supply and consumption. These wars often employ strategies like arbitrary arrest and detention, increased surveillance, harassment and sometimes extrajudicial killings. However, these measures have not been shown to effectively eliminate drug supply and consumption; rather they often predispose people who use drugs to increased risk and harm. Such a drug war was declared in the form of an anti-drug drive (ADD) in Bangladesh in 2018. This article examined the impact of the ADD on drug injecting activities and harm reduction service uptake among people who inject drugs (PWID). METHODS An ethnographic study was conducted in Dhaka, Bangladesh. Study participants included PWID, harm reduction service providers and other drug and alcohol experts. Data collection consisted of 2500 hours of observations, 25 in-depth interviews, five focus group discussions and 15 key informant interviews. Data were analysed using thematic analysis. RESULTS ADD operations and activities subjected PWID to multifaceted forms of violence and harassment including extrajudicial killings, which significantly affected drug procurement and drug using practices and led to increased needle and syringe sharing and a likely increase in HIV transmission. The gradual disappearance of established drug markets, alongside the emergence of new ones at alternate locations, resulted in the dislocation of PWID from outreach services and further increased risky injecting practices such as needle and syringe sharing between new and unfamiliar injecting partners. These harms were compounded by unpredictable drug supply and price increases stemming from the ADD, which in turn also increased needle and syringe sharing. Harm reduction outreach services were not able to adequately adapt to the volatile, dynamic and risky nature of the ADD. CONCLUSION The ADD not only precipitated risky injecting practices but also hindered the effective implementation of harm reduction outreach services and thus undermined public health. This warrants concerted efforts to nurture local evidence-based harm reduction approaches as opposed to punitive measures.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, icddr,b68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, icddr,b68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, icddr,b68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
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13
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Kuteesa MO, Webb EL, Kawuma R, Naluwugge J, Thadeus K, Ndekezi D, Seeley J. 'We shall drink until Lake Victoria dries up': Drivers of heavy drinking and illicit drug use among young Ugandans in fishing communities. Glob Public Health 2021; 17:538-554. [PMID: 33460355 DOI: 10.1080/17441692.2021.1873399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated patterns and drivers of alcohol misuse and illicit drug use among young fisherfolk. We undertook this study in fishing communities on Koome Island, Lake Victoria, Uganda, from December 2017-July 2018. We conducted six group discussions with men (3) and women (3) and 33 in-depth interviews with: young people [users (n = 10); non-users (n = 2)], local leaders (n = 3), health workers (n = 2), parents (n = 5), alcohol/illicit drugs sellers/distributors (n = 5), law enforcement officers (n = 5). We sampled participants using purposive and snowball strategies. Interview themes included: knowledge, experiences and perceptions of alcohol use/illicit drug use, HIV risk behaviour and harm reduction. We mapped alcohol/illicit drug use outlets using a Geographic Information System to capture density, distribution and proximity to young people's homes. We coded and analysed qualitative data using thematic content analysis. Motivations for heavy drinking and illicit drug use were multifaceted and largely beyond individual control. Key contextual determinants included social norms around consumption (acceptability), price (affordability), and ease of purchase (availability). Prevention and harm reduction interventions to tackle alcohol misuse and illicit drug use should be aimed at the structural rather than individual level and must be conducted in tandem with strategies to control poverty and HIV.
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Affiliation(s)
- Monica O Kuteesa
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Racheal Kawuma
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Josephine Naluwugge
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kiwanuka Thadeus
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Denis Ndekezi
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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14
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Ezell JM, Walters S, Friedman SR, Bolinski R, Jenkins WD, Schneider J, Link B, Pho MT. Stigmatize the use, not the user? Attitudes on opioid use, drug injection, treatment, and overdose prevention in rural communities. Soc Sci Med 2020; 268:113470. [PMID: 33253992 DOI: 10.1016/j.socscimed.2020.113470] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
Stigma is a known barrier to treating substance use disorders and dramatically diminishes the quality of life of people who use drugs (PWUD) nonmedically. Stigma against PWUD may be especially pronounced in rural areas due to their decreased anonymity and residents' limited access, or resistance, to "neutralizing" information on factors associated with drug use. Stigma often manifests in the attitudes of professionals whom stigmatized individuals regularly interact with and often materially impact. We analyzed interviews conducted between July 2018 and February 2019 with professional stakeholders in rural southern Illinois who interact with PWUD, specifically those who use opioids nonmedically or who inject drugs (n = 30). We further analyzed interview data from a complementary PWUD sample (n = 22). Interviews addressed perspectives around nonmedical drug use and treatment/harm reduction, with analysis centered around the Framework Integrating Normative Influences on Stigma and its focus on micro, meso and macro level stigmatization processes. Stakeholder participants included professionals from local law enforcement, courts, healthcare organizations, emergency management services, and faith-based and social services organizations. Most stakeholders, particularly law enforcement, negatively perceived PWUD and nonmedical drug use in general, questioned the character, agency and extrinsic value of PWUD, and used labels (e.g. "addict," "abuser," etc.) that may be regarded as stigmatizing. Further, most respondents, including PWUD, characterized their communities as largely unaware or dismissive of the bio-medical and sociocultural explanations for opioid use, drug injection and towards harm reduction services (e.g., syringe exchanges) and naloxone, which were frequently framed as undeserved usages of taxpayer funds. In conclusion, rural stigma against PWUD manifested and was framed as a substantial issue, notably activating at micro, meso and macro levels. Stigma prevention efforts in these communities should aim to improve public knowledge on the intricate factors contributing to opioid use and drug injection and harm reduction programming's moral and fiscal value.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA.
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rebecca Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - John Schneider
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Bruce Link
- Department of Sociology, University of California, Riverside, CA, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
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15
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Olgin GK, Bórquez A, Baker P, Clairgue E, Morales M, Bañuelos A, Arredondo J, Harvey-Vera A, Strathdee S, Beletsky L, Cepeda JA. Preferences and acceptability of law enforcement initiated referrals for people who inject drugs: a mixed methods analysis. Subst Abuse Treat Prev Policy 2020; 15:75. [PMID: 33008431 PMCID: PMC7530855 DOI: 10.1186/s13011-020-00319-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Law enforcement officers (LEOs) come into frequent contact with people who inject drugs (PWID). Through service referrals, LEOs may facilitate PWID engagement in harm reduction, substance use treatment, and other health and supportive services. Little is known about PWID and LEO attitudes and concerns about service referrals, however. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico. METHODS We assessed service referral preferences and perceived likelihood of participation in health and social services, integrating data from structured questionnaires with 280 PWID and 306 LEOs, contextualized by semi-structured interviews and focus groups with 15 PWID and 17 LEOs enrolled in two parallel longitudinal cohorts in Tijuana, Mexico. RESULTS Among potential service referral options, both PWID (78%) and LEOs (88%) most frequently cited assistance with drug- and alcohol-use disorders. Over half of PWID and LEOs supported including harm reduction services such as syringe service programs, overdose prevention, and HIV testing. The majority of PWID supported LEO referrals to programs that addressed basic structural needs (e.g. personal care [62%], food assistance [61%], housing assistance [58%]). However, the proportion of LEOs (30-45%) who endorsed these service referrals was significantly lower (p < 0.01). Regarding referral acceptability, 71% of PWID reported they would be very likely or somewhat likely to make use of a referral compared to 94% of LEOs reporting that they thought PWID would always or sometimes utilize them. These results were echoed in the qualitative analysis, although practical barriers to referrals emerged, whereby PWID were less optimistic that they would utilize referrals compared to LEOs. CONCLUSIONS We identified strong support for LEO service referrals among both LEO and PWID respondents, with the highest preference for substance use treatment. LEO referral programs offer opportunities to deflect PWID contact with carceral systems while facilitating access to health and social services. However, appropriate investments and political will are needed to develop an evidence-based (integrated) service infrastructure.
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Affiliation(s)
- Gabriella K Olgin
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
| | - Mario Morales
- School of Government and Public Policy, University of Arizona, Tucson, AZ, USA
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Jaime Arredondo
- Centro de Investigación y Docencia Económica, Aguascalientes, Mexico
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California,San Diego, La Jolla, CA, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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16
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Footer KHA, Park JN, Rouhani S, Galai N, Silberzahn BE, Huettner S, Allen ST, Sherman SG. The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City. PLoS One 2020; 15:e0227809. [PMID: 31978164 PMCID: PMC6980607 DOI: 10.1371/journal.pone.0227809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022] Open
Abstract
Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (β = 0.71, p = 0.037), in daily sex work (β = 1.32, p = 0.026), arrested in the past 12 months (β = 1.44, p<0.001) or injecting drugs in the past 3 months (β = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations’ health outcomes, including HIV risk.
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Affiliation(s)
- Katherine H. A. Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
- * E-mail:
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Bradley E. Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Steven Huettner
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
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17
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Collins AB, Boyd J, Mayer S, Fowler A, Kennedy MC, Bluthenthal RN, Kerr T, McNeil R. Policing space in the overdose crisis: A rapid ethnographic study of the impact of law enforcement practices on the effectiveness of overdose prevention sites. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:199-207. [PMID: 31542327 PMCID: PMC7147938 DOI: 10.1016/j.drugpo.2019.08.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/14/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
North America is in the midst of an overdose crisis. In some of the hardest hit areas of Canada, local responses have included the implementation of low-threshold drug consumption facilities, termed Overdose Prevention Sites (OPS). In Vancouver, Canada the crisis and response occur in an urban terrain that is simultaneously impacted by a housing crisis in which formerly 'undesirable' areas are rapidly gentrifying, leading to demands to more closely police areas at the epicenter of the overdose crisis. We examined the intersection of street-level policing and gentrification and how these practices re/made space in and around OPS in Vancouver's Downtown Eastside neighborhood. Between December 2016 and October 2017, qualitative interviews were conducted with 72 people who use drugs (PWUD) and over 200 h of ethnographic fieldwork were undertaken at OPS and surrounding areas. Data were analyzed thematically and interpreted by drawing on structural vulnerability and elements of social geography. While OPS were established within existing social-spatial practices of PWUD, gentrification strategies and associated police tactics created barriers to OPS services. Participants highlighted how fear of arrest and police engagement necessitated responding to overdoses alone, rather than engaging emergency services. Routine policing near OPS and the enforcement of area restrictions and warrant searches, often deterred participants from accessing particular sites. Further documented was an increase in the number of police present in the neighborhood the week of, and the week proceeding, the disbursement of income assistance cheques. Our findings demonstrate how some law enforcement practices, driven in part by ongoing gentrification efforts and buttressed by multiple forms of criminalization present in the lives of PWUD, limited access to needed overdose-related services. Moving away from place-based policing practices, including those driven by gentrification, will be necessary so as to not undermine the effectiveness of life-saving public health interventions amid an overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9, Canada
| | - Ricky N Bluthenthal
- Department of Preventive Medicine Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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18
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Nelson EUE, Brown AS. Extra-legal policing strategies and HIV risk environment: accounts of people who inject drugs in Nigeria. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2019.1684446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Rouhani S, Gudlavalleti R, Atzmon D, Park JN, Olson SP, Sherman SG. Police attitudes towards pre-booking diversion in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 65:78-85. [PMID: 30710878 DOI: 10.1016/j.drugpo.2018.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND In the context of high rates of drug-related incarceration that disproportionately affect urban communities of colour, advocates for drug policy criminal justice reform have called for alternatives to mass incarceration. The Law Enforcement Assisted Diversion (LEAD) program redirects low-level drug offenders to health and social services rather than immediately into the criminal justice system. In advance of piloting LEAD in Baltimore City, we assessed police perceptions towards harm reduction and specifically pre-booking diversion in effort to inform training and implementation activities in Baltimore City and elsewhere. METHODS We administered a survey to Baltimore City Police Officers (N = 83) in the planned implementation district using two scales: the first measured police attitudes toward people who use drugs (PWUD), current drug policies and public health measures, and the second measured police perceptions of pre-booking diversion programs. We calculated Cronbach's alpha (α) to assess internal consistency of both scales. Bivariate χ2 tests and multivariate logistic regression examined correlates of scale items stratified by new and seasoned officers. RESULTS Seasoned officers were significantly less likely to believe that drug treatment is easily available (51% vs. 81%, p = 0.005). The belief that current policies are effective and that PWUD should be arrested for small drug purchases decreased significantly per year on the force (aOR: 0.92; 95%CI 0.85,0.99; aOR: 0.94, 95% CI 0.88, 0.99, respectively), as did concerns about needle-stick injuries (aOR: 0.85, 95% CI 0.74, 0.98). Seasoned officers were significantly more comfortable referring PWUD to social services (100% vs. 83%, p = 0.006), and agree that such pre-booking diversion could be effective in improving public safety within (72% vs. 43%; p = 0.009) and beyond the intervention area (56% vs. 33%, p = 0.04). CONCLUSIONS The study indicates the value of intervening early and consistently throughout police career trajectories and engaging seasoned officers as allies to promote recognition and support of public health and harm reduction strategies within ongoing police reform efforts. LEAD provides important and broad opportunities for training police to enhance their understanding the intersection of public safety and public health.
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Affiliation(s)
- Saba Rouhani
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Rajani Gudlavalleti
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Daniel Atzmon
- Behavioral Health System Baltimore, 100 S. Charles Street, Baltimore, MD, 21201, USA.
| | - Ju Nyeong Park
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Steven P Olson
- Baltimore Police Department, 242 W. 29th Street, Baltimore, MD, 21211, USA.
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway, Baltimore, MD, 21205, USA.
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20
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Morales M, Rafful C, Gaines TL, Cepeda JA, Abramovitz D, Artamonova I, Baker P, Clairgue E, Mittal ML, Rocha-Jimenez T, Arredondo J, Kerr T, Bañuelos A, Strathdee SA, Beletsky L. Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:36. [PMID: 30219105 PMCID: PMC6139125 DOI: 10.1186/s12914-018-0175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/29/2018] [Indexed: 12/04/2022]
Abstract
Background Mexican law permits syringe purchase and possession without prescription. Nonetheless, people who inject drugs (PWID) frequently report arrest for syringe possession. Extrajudicial arrests not only violate human rights, but also significantly increase the risk of blood-borne infection transmission and other health harms among PWID and police personnel. To better understand how police practices contribute to the PWID risk environment, prior research has primarily examined drug user perspectives and experiences. This study focuses on municipal police officers (MPOs) in Tijuana, Mexico to identify factors associated with self-reported arrests for syringe possession. Methods Participants were active police officers aged ≥18 years, who completed a self-administered questionnaire on knowledge, attitudes and behaviors related to occupational safety, drug laws, and harm reduction strategies. Univariable and multivariable logistic regression was used to identify correlates of recent syringe possession arrest. Results Among 1044 MPOs, nearly half (47.9%) reported always/sometimes making arrests for syringe possession (previous 6mo). Factors independently associated with more frequent arrest included being male (Adjusted Odds Ratio [AOR] = 1.62; 95% Confidence Interval [95% CI] =1.04–2.52; working in a district along Tijuana River Canal (where PWID congregate) (AOR = 2.85; 95%CI = 2.16–3.77); having recently experienced a physical altercation with PWID (AOR = 2.83; 95% CI = 2.15–3.74); and having recently referred PWID to social and health services (AOR = 1.97; 95% CI = 1.48–2.61). Conversely, odds were significantly lower among officers reporting knowing that syringe possession is legal (AOR = 0.61; 95% CI = 0.46–0.82). Conclusions Police and related criminal justice stakeholders (e.g., municipal judges, prosecutors) play a key role in shaping PWID risk environment. Findings highlight the urgent need for structural interventions to reduce extra-judicial syringe possession arrests. Police training, increasing gender and other forms of diversity, and policy reforms at various governmental and institutional levels are necessary to reduce police occupational risks, improve knowledge of drug laws, and facilitate harm reduction strategies that promote human rights and community health.
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Affiliation(s)
- Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, 22110, Tijuana, Baja California, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Thomas Kerr
- Center of Excellence in HIV/AIDS, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, 2141 Blvd Cuauhtémoc Sur y Río Suchiate, 22015, Tijuana, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA. .,Health in Justice Action Lab, School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, 02115, USA.
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Hughes CE, Barratt MJ, Ferris JA, Maier LJ, Winstock AR. Drug-related police encounters across the globe: How do they compare? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 56:197-207. [PMID: 29699837 DOI: 10.1016/j.drugpo.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Drug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 Global Drug Survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs. METHODS The Global Drug Survey was administered in late 2016. Across 26 countries including Australia, Germany, Italy, Mexico, Switzerland, the UK and the USA a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug-related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country). RESULTS Drug-related police encounters were most commonly reported in Italy and Scotland. Conversely, police encounters were most likely to lead to arrest in Norway, Finland and Sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in Greece and Colombia, and encounters with drug detection dogs most reported in Scotland, Italy, UK and Australia. Multi-level models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre-existing national differences in drug use prevalence and policing, and that drug policing encounters were 4 to 14 times more common in some nations than others. CONCLUSION The findings unearth significant cross-national differences in the incidence and nature of drug-related policing of people who use drugs. This suggests that there may be opportunities for countries to learn from each other about how and why they differ, and the potential benefits of switching to lower intensity modes of drug policing.
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Affiliation(s)
- Caitlin E Hughes
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.
| | - Monica J Barratt
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, VIC, Australia
| | - Jason A Ferris
- Institute for Social Science Research, The University of Queensland, St Lucia, QLD, Australia
| | | | - Adam R Winstock
- Institute of Epidemiology & Health Care, Faculty of Population Health Sciences, University College London, UK; Global Drug Survey Ltd, London, UK
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Police crackdowns, structural violence and impact on the well-being of street cannabis users in a Nigerian city. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:114-122. [PMID: 29414483 DOI: 10.1016/j.drugpo.2018.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/28/2017] [Accepted: 01/09/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is abundant literature on the impact of law enforcement on cannabis markets, but scant literature on the effects of law enforcement on cannabis users. This study undertook a qualitative exploration of police crackdowns as a form of structural violence and examined their impact on the well-being of street cannabis users in a Nigerian city. METHODS The study was qualitative and descriptive. It was carried out in Uyo, southern Nigeria. Ninety-seven (97) frequent cannabis users (78 males and 19 females) took part. They were aged between 21 and 34 years and recruited from 11 cannabis hot-points in the city. Data were collected through in-depth, individual interviews, conducted over six-months. Data analysis was thematic and data-driven, involving identifying themes, assigning codes, revising codes and verification by independent qualitative methodology experts. RESULTS Police crackdowns are commonly experienced by street cannabis users. These do not reduce cannabis use, but displace cannabis markets. Crackdowns are associated with police brutality, confiscation of funds, drugs and belongings, stigma and discrimination, arrest and incarceration, which impacts negatively on the health, livelihoods and well-being of cannabis users. Cannabis users try to escape arrest by running from police, disposing of cannabis, disguising themselves and, when caught, bribing officers to secure release. CONCLUSION Crackdowns constitute a form of structural violence in the everyday life of cannabis users, and have negative effects on their health and social and economic well-being. Cannabis use should be decriminalized de facto and arrested users directed to treatment and skills training programmes. Treatment and social services for users should be expanded and legal aid interventions should be mounted to support users in addressing discriminatory practices and human rights violations.
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Lasco G. Kalaban: Young drug users’ engagements with law enforcement in the Philippines. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 52:39-44. [DOI: 10.1016/j.drugpo.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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Silverman-Retana O, Serván-Mori E, McCoy SI, Larney S, Bautista-Arredondo S. Hepatitis C antibody prevalence among Mexico City prisoners injecting legal and illegal substances. Drug Alcohol Depend 2017; 181:140-145. [PMID: 29054033 DOI: 10.1016/j.drugalcdep.2017.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is highly prevalent among prisoners and this prevalence estimates reach 64% among prisoners who inject illicit drugs. Prisons are important sites for HCV transmission in the absence of access to sterile injecting equipment; hence, it can be transmitted between prisoners who share contaminated needles and syringes. We aimed to estimate the prevalence of risk factors for anti-HCV prevalence, with particular interest on injecting behavior, and to assess correlates of anti-HCV positivity among Mexico City prisoners. METHODS Cross-sectional study based on information -collected in three male and two female prisons in Mexico City during 2010-2011- about sexually transmitted infections, socio-demographics, criminal history, substance use, vitamin injection, tattooing, among others (n=3,910). Weighted multivariable adjusted logistic regression models were estimated to assess the overall and differential odds for anti-HCV due to injecting behavior. RESULTS Overall prevalence of anti-HCV was 3.3%. This figure rose to 43.1% among prisoners with a history of illicit drug injection. Prisoners with history of vitamin injection showed a similar prevalence of anti-HCV (43.8%). After stratifying by substance injected, the adjusted odds ratio was 9.8 (95% CI: 4.0, 23.8) for illicit drug injection and 11.9 (95% CI: 5.8, 23.8) for illicit drug and vitamin injection. CONCLUSION Based on data from the most populous prisons in Mexico City, this study showed that anti-HCV is highly prevalent among prisoners with history of injecting behavior. In this sense, injecting behavior per-se, independent of the substance used, is associated with increased odds of anti-HCV positivity.
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Affiliation(s)
- Omar Silverman-Retana
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México; Aarhus University, Department of Public Health, Section for Epidemiology, Building 1260, Batholins Allé 2, 8000 Aarhuc C, Denmark.
| | - Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México.
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley 779 University Hall, MC 7360, Berkeley, CA, 94720, USA.
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales. Sydney NSW 2052, Australia.
| | - Sergio Bautista-Arredondo
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México.
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DeBeck K, Cheng T, Montaner JS, Beyrer C, Elliott R, Sherman S, Wood E, Baral S. HIV and the criminalisation of drug use among people who inject drugs: a systematic review. Lancet HIV 2017; 4:e357-e374. [PMID: 28515014 PMCID: PMC6005363 DOI: 10.1016/s2352-3018(17)30073-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment. METHODS Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language. FINDINGS We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects. INTERPRETATION These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use. FUNDING Canadian Institutes of Health Research and US National Institutes of Health.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Beyrer
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Susan Sherman
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Prevalence and correlates of needle-stick injuries among active duty police officers in Tijuana, Mexico. J Int AIDS Soc 2016; 19:20874. [PMID: 27435711 PMCID: PMC4951532 DOI: 10.7448/ias.19.4.20874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/23/2023] Open
Abstract
Introduction Police officers are at an elevated risk for needle-stick injuries (NSI), which pose a serious and costly occupational health risk for HIV and viral hepatitis. However, research on NSIs among police officers is limited, especially in low- and middle-income countries. Despite the legality of syringe possession in Mexico, half of people who inject drugs (PWID) in Tijuana report extrajudicial syringe-related arrests and confiscation by police, which has been associated with needle-sharing and HIV infection. We assessed the prevalence and correlates of NSIs among Tijuana police officers to inform efforts to improve occupational safety and simultaneously reduce HIV risks among police and PWID. Methods Tijuana's Department of Municipal Public Safety (SSPM) is among Mexico's largest. Our binational, multi-sectoral team analyzed de-identified data from SSPM's 2014 anonymous self-administered occupational health survey. The prevalence of NSI and syringe disposal practices was determined. Logistic regression with robust variance estimation via generalized estimating equations identified factors associated with ever having an occupational NSI. Results Approximately one-quarter of the Tijuana police force was given the occupational health survey (N=503). Respondents were predominantly male (86.5%) and ≤35 years old (42.6%). Nearly one in six officers reported ever having a NSI while working at SSPM (15.3%), of whom 14.3% reported a NSI within the past year. Most participants reported encountering needles/syringes while on duty (n=473, 94%); factors independently associated with elevated odds of NSIs included frequently finding syringes that contain drugs (adjusted odds ratio (AOR): 2.98; 95% confidence interval (CI): 1.56–5.67) and breaking used needles (AOR: 2.25; 95% CI: 1.29–3.91), while protective factors included being willing to contact emergency services in case of NSIs (AOR: 0.39; 95% CI: 0.22–0.69), and wearing needle-stick resistant gloves (AOR: 0.43; 95% CI: 0.19–0.91). Conclusions Tijuana police face an elevated and unaddressed occupational NSI burden associated with unsafe syringe-handling practices, exposing them to substantial risk of HIV and other blood-borne infections. These findings spurred the development and tailoring of training to reduce NSI by modifying officer knowledge, attitudes and enforcement practices (e.g. syringe confiscation) – factors that also impact HIV transmission among PWID and other members of the community.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Socio-demographic correlates of injection drug use among male drug users: a cross sectional study in Nepal. J Community Health 2016; 39:1124-32. [PMID: 24705679 DOI: 10.1007/s10900-014-9867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Drug abuse is one of the major public health problems in Nepal. The objective of this study is to explore the factors responsible for the injecting drug use in Nepal. A cross sectional study was conducted among drug users in Pokhara sub metropolitan city in Nepal. Taking prevalence of 20% at 95% confidence interval and 20% non-response rate, 448 samples were calculated for face to face interviews. Most of the study participants were >24 year's age. Sixty-one percentage of the participants were unemployed. The largest percentage belonged to Gurung/Rai/Pun (37%) ethnic groups, and had completed secondary level of education (47.5%). In the logistic regression analysis occupation, motivating factors for drug use, ever been to custody, age at first drug use, age at first sex, money spent on drugs, ever been rehabilitated and age of the respondents showed a statistically significant association with injecting drug use status. The respondents having business [Adjusted Odds ratio (aOR) 4.506, 95% CI (1.677-12.104)], service [aOR 2.698, 95% CI (a1.146-6.355], having tragedy/turmoil [aOR 3.867, 95% CI (1.596-9.367)], family problem [aOR 2.010, 95% CI (2.010-53.496)], had sex at >19 years [aOR 1.683, 95% CI (1.017-2.785)], rehabilitated >2 times [aOR 4.699, 95% CI (1.401-15.763)], >24 years age group [aOR 1.741, 95% CI (1.025-2.957)] had higher odds of having injecting habits. Having money spent on drugs >3,000 NRs (300 USD) [aOR 0.489, 95%CI (0.274-0.870), not been to custody (aOR 0.330, 95%CI (0.203-0.537)] and having curiosity for drug use [aOR 0.147, 95% CI (0.029-0.737)] were found to be protective for injecting drug use. This study recommends the harm reduction program specifically focused on drug users of occupational groups like business, service and the youths through public health actions to stop transiting them to injecting drug use.
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Pinedo M, Burgos JL, Zuniga ML, Perez R, Macera CA, Ojeda VD. Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border. J Stud Alcohol Drugs 2016; 76:758-63. [PMID: 26402356 DOI: 10.15288/jsad.2015.76.758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. METHOD From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). RESULTS Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. CONCLUSIONS Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.
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Affiliation(s)
- Miguel Pinedo
- Alcohol Research Group, University of California, Berkeley, California
| | - Jose Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego, California
| | - Maria Luisa Zuniga
- School of Social Work, San Diego State University, San Diego, California
| | - Ramona Perez
- Department of Anthropology, San Diego State University, San Diego, California
| | - Caroline A Macera
- School of Public Health, San Diego State University, San Diego, California
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, California
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Ti L, Hayashi K, Kaplan K, Suwannawong P, Wood E, Kerr T. Contextual factors associated with rushed injecting among people who inject drugs in Thailand. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:313-20. [PMID: 24599484 DOI: 10.1007/s11121-014-0477-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
People who inject drugs (IDU) often rush their injections; however, the prevalence and predictors of rushing during injecting has not been well studied. We sought to identify correlates of rushed injecting among a community-recruited sample of IDU in Bangkok, Thailand. Data were derived from IDU who participated in the Mitsampan Community Research Project in Bangkok between July and October in 2011. Multivariate logistic regression was used to identify the prevalence and factors associated with frequent rushed injecting, defined as rushing injections at least 25 % of the time in the last 6 months. Among 437 participants, 27 % reported frequent rushed injecting. In multivariate analyses, factors positively and independently associated with frequent rushed injecting included: syringe sharing, injecting in public places, and having noticed increased police presence where drugs are bought or used. Many Thai IDU in this setting reported frequent rushed injecting and factors known to increase HIV risk were found to be associated with this behavior. These findings reinforce the need for public health interventions that address the broader social and physical risk environment where drug injecting takes place.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
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Calabrese SK, Burke SE, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, Heimer R. Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia. AIDS Behav 2016; 20:85-97. [PMID: 26050155 DOI: 10.1007/s10461-015-1100-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
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Affiliation(s)
- Sarah K Calabrese
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Sara E Burke
- Department of Psychology, Yale University, New Haven, CT, USA
| | - John F Dovidio
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Anneli Uusküla
- Department of Public Health, University of Tartu, Tartu, Estonia
| | - Linda M Niccolai
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Robert Heimer
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
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Bastami F, Mostafavi F, Hassanzadeh A. Effect of educational intervention on knowledge, perceived benefits, barriers and self-efficacy regarding AIDS preventive behaviors among drug addicts. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2015; 4:90. [PMID: 27462632 PMCID: PMC4946267 DOI: 10.4103/2277-9531.171804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Addicts account for approximately 68.15% of AIDS cases in Iran and injection drug users are considered as a major factor in the spread of AIDS in Iran. The purpose of this study was to determine the effect of an educational intervention on the perceived self-efficacy, benefits, and barriers concerning AIDS preventive behaviors among drug addicts in Khorramabad, Iran. METHODS This is a quasi-experimental study carried out in 2013 on 88 addicts kept in rehabilitations center in Khorramabad. The data collection instruments included a questionnaire on self-efficacy, perceived benefits, perceived barriers, knowledge and preventive behaviors regarding HIV. Data were analyzed by paired t-test, independent t-test, Chi-square and analysis of covariance. RESULTS Paired t-test showed that the mean scores for perceived benefits and barriers, knowledge and preventive behaviors significantly increased in the intervention group after the intervention than before the intervention. But the increase in self-efficacy score was not statistically significant. CONCLUSIONS The results of this study showed that training and education based on the health belief model led to an increase in knowledge, self-efficacy, perceived benefits, performance and reduction in perceived barriers in addicts. It is recommended that future studies should include strategies for enhancing self-efficacy and perceived benefits as well as strategies for reducing barriers to the adoption of preventive behaviors.
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Affiliation(s)
- Fatemeh Bastami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Kennedy MC, Milloy MJ, Markwick N, McNeil R, Dong H, Wood E, Kerr T. Encounters with private security guards among people who inject drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 28:124-7. [PMID: 26708944 DOI: 10.1016/j.drugpo.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
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Lunze K, Lunze FI, Raj A, Samet JH. Stigma and Human Rights Abuses against People Who Inject Drugs in Russia--A Qualitative Investigation to Inform Policy and Public Health Strategies. PLoS One 2015; 10:e0136030. [PMID: 26305697 PMCID: PMC4549320 DOI: 10.1371/journal.pone.0136030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Drug policing practices in the Russian Federation (Russia) are often punitive and have been shown to be associated with HIV risk behaviors among people who inject drugs (PWID). Less is known about strategies to address the problem in that setting, where substance use stigma is highly persistent. A better understanding of forms, causes and consequences of drug policing in Russia could inform drug policy in a context of substantial policy resistance. This qualitative study's goal is to characterize the phenomenon of police involvement with Russian PWID and to explore strategies for drug policing in the Russian country context. METHODS Using a semi-structured interview guide, we collected data from a purposive sample of 23 key informants including PWID, police officers, and experts from civil society and international organizations in Russia. We used a thematic analysis approach to inductively generate new insight into the phenomenon of police involvement and potential strategies to address it. RESULTS Policing practices involving PWID include unjustified arrests, planting of false evidence and extrajudicial syringe confiscations, and often constitute human rights violations. Russian PWID personally experienced police violence as ubiquitous, taking on various forms such as beating, unjustified arrests, verbal harassment, and coercion. The persistent societal stigma dehumanizes PWID, and such stigmatization facilitates police abuse. To address stigma and overcome the PWID-police adversity, study participants suggested fostering a mutual understanding between the police and public health sectors. CONCLUSIONS Participants describe substantial human rights violations as part of policing illicit drug use in Russia. Police should include principles of effective prevention of substance use and HIV risk reduction in their trainings. Alignment of public safety and public health goals could address drug use-related risks and HIV prevention among key populations in Russia.
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Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America
- * E-mail:
| | - Fatima I. Lunze
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Anita Raj
- Division of Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, San Diego, CA, United States of America
| | - Jeffrey H. Samet
- Boston University School of Medicine, Boston, MA, United States of America
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Beletsky L, Cochrane J, Sawyer AL, Serio-Chapman C, Smelyanskaya M, Han J, Robinowitz N, Sherman SG. Police Encounters Among Needle Exchange Clients in Baltimore: Drug Law Enforcement as a Structural Determinant of Health. Am J Public Health 2015; 105:1872-9. [PMID: 26180948 DOI: 10.2105/ajph.2015.302681] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We piloted a monitoring mechanism to document police encounters around programs targeting people who inject drugs (PWID), and assessed their demographic predictors at 2 Baltimore, Maryland, needle exchange program (NEP) sites. METHODS In a brief survey, 308 clients quantified, characterized, and sited recent police encounters. Multivariate linear regression determined encounter predictors, and we used geocoordinate maps to illustrate clusters. RESULTS Within the past 6 months, clients reported a median of 3 stops near NEP sites (interquartile range [IQR] = 0-7.5) and a median of 1 arrest in any location (IQR = 0-2). Three respondents reported police referral to the NEP. Being younger (P = .009), being male (P = .033), and making frequent NEP visits (P = .02) were associated with reported police stops. Among clients reporting arrest or citation for syringe possession, Whites were significantly less likely than non-Whites to report being en route to or from an NEP (P < .001). Reported encounters were clustered around NEPs. CONCLUSIONS Systematic surveillance of structural determinants of health for PWID proved feasible when integrated into service activities. Improved monitoring is critical to informing interventions to align policing with public health, especially among groups subject to disproportionate levels of drug law enforcement.
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Affiliation(s)
- Leo Beletsky
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jess Cochrane
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Anne L Sawyer
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Chris Serio-Chapman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Marina Smelyanskaya
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jennifer Han
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Natanya Robinowitz
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Susan G Sherman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
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Khampang R, Assanangkornchai S, Teerawattananon Y. Perceived barriers to utilise methadone maintenance therapy among male injection drug users in rural areas of southern Thailand. Drug Alcohol Rev 2015; 34:645-53. [PMID: 25867927 DOI: 10.1111/dar.12268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/13/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND AIMS Methadone maintenance therapy (MMT) has been proven to be effective and cost-effective in treating dependence on opioids. However, concerns remain that geographical, financial and other hidden barriers may hinder access to MMT, especially in rural areas where health services are limited. The objective of this study was to determine factors associated with utilisation of MMT by injection drug users (IDUs) living in Songkhla province. DESIGN AND METHODS A cross-sectional study among 159 IDUs in Songkhla province of southern Thailand was conducted. Participants were recruited using a snowball technique. Data were collected from July 2013 to January 2014 via face-to-face interviews. RESULTS Around one-forth (24.5%) of participants had difficulties travelling to MMT clinics because of the long distance, long travelling time and lack of a private vehicle. Twenty-four percent faced difficulties with the clinic's opening hours and 28% faced difficulties paying for the cost of travel. IDUs who utilised the MMT perceived risks of injection drug use differently compared with those who did not. Younger or Muslim IDUs were less likely to attend MMT. IDUs who perceived that MMT was effective were more likely to utilise MMT. DISCUSSION AND CONCLUSIONS Physical accessibility, affordability and acceptability play an essential role in MMT utilisation. Developing alternatives that reduce the travelling time, costs for IDUs and more convenient operation hours to suit their lifestyles may increase the utilisation of MMT. Intensive consultation before starting MMT is highly recommended.
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Affiliation(s)
- Roongnapa Khampang
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
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Gaines TL, Beletsky L, Arredondo J, Werb D, Rangel G, Vera A, Brouwer K. Examining the spatial distribution of law enforcement encounters among people who inject drugs after implementation of Mexico's drug policy reform. J Urban Health 2015; 92:338-51. [PMID: 25300503 PMCID: PMC4411320 DOI: 10.1007/s11524-014-9907-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2009, Mexico decriminalized the possession of small amounts of illicit drugs for personal use in order to refocus law enforcement resources on drug dealers and traffickers. This study examines the spatial distribution of law enforcement encounters reported by people who inject drugs (PWID) in Tijuana, Mexico to identify concentrated areas of policing activity after implementation of the new drug policy. Mapping the physical location of law enforcement encounters provided by PWID (n = 461) recruited through targeted sampling, we identified hotspots of extra-judicial encounters (e.g., physical/sexual abuse, syringe confiscation, and money extortion by law enforcement) and routine authorized encounters (e.g., being arrested or stopped but not arrested) using point density maps and the Getis-Ord Gi* statistic calculated at the neighborhood-level. Approximately half of the participants encountered law enforcement more than once in a calendar year and nearly one third of these encounters did not result in arrest but involved harassment or abuse by law enforcement. Statistically significant hotspots of law enforcement encounters were identified in a limited number of neighborhoods located in areas with known drug markets. At the local-level, law enforcement activities continue to target drug users despite a national drug policy that emphasizes drug treatment diversion rather than punitive enforcement. There is a need for law enforcement training and improved monitoring of policing tactics to better align policing with public health goals.
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Affiliation(s)
- Tommi L Gaines
- Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA,
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Zheluk A, Quinn C, Meylakhs P. Internet search and krokodil in the Russian Federation: an infoveillance study. J Med Internet Res 2014; 16:e212. [PMID: 25236385 PMCID: PMC4180331 DOI: 10.2196/jmir.3203] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 06/03/2014] [Accepted: 08/22/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Krokodil is an informal term for a cheap injectable illicit drug domestically prepared from codeine-containing medication (CCM). The method of krokodil preparation may produce desomorphine as well as toxic reactants that cause extensive tissue necrosis. The first confirmed report of krokodil use in Russia took place in 2004. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States. OBJECTIVE This exploratory study had two main objectives: (1) to determine if Internet search patterns could detect regularities in behavioral responses to Russian CCM policy at the population level, and (2) to determine if complementary data sources could explain the regularities we observed. METHODS First, we obtained krokodil-related search pattern data for each Russia subregion (oblast) between 2011 and 2012. Second, we analyzed several complementary data sources included krokodil-related court cases, and related search terms on both Google and Yandex to evaluate the characteristics of terms accompanying krokodil-related search queries. RESULTS In the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average (mean) of 16.67 searches per 100,000 population for terms associated with krokodil. In the 6 months following restrictions, mean national searches dropped to 9.65 per 100,000. Further, the number of oblasts recording a higher than average search rate dropped from 30 to 16. Second, we found krokodil-related court appearances were moderately positively correlated (Spearman correlation=.506, P≤.001) with behaviors consistent with an interest in the production and use of krokodil across Russia. Finally, Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study. CONCLUSIONS Illicit drug use data are generally regarded as difficult to obtain through traditional survey methods. Our analysis suggests it is plausible that Yandex search behavior served as a proxy for patterns of krokodil production and use during the date range we investigated. More generally, this study demonstrates the application of novel methods recently used by policy makers to both monitor illicit drug use and influence drug policy decision making.
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Affiliation(s)
- Andrey Zheluk
- Menzies Centre for Health Policy, University of Sydney, University of Sydney, Australia.
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Punitive policing and associated substance use risks among HIV-positive people in Russia who inject drugs. J Int AIDS Soc 2014; 17:19043. [PMID: 25014321 PMCID: PMC4093768 DOI: 10.7448/ias.17.1.19043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/23/2014] [Accepted: 05/30/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Drug law enforcement is part of the HIV risk environment among people who inject drugs (PWID). Punitive policing practices such as extrajudicial arrests for needle possession and police planting of drugs have been described anecdotally in Russia, but these experiences and their associations with risky drug behaviours have not been quantified. This study aims to quantify the burden of extrajudicial police arrests among a cohort of HIV-positive PWID in Russia and to explore its links to drug-related health outcomes. METHODS In a cross-sectional study of 582 HIV-positive people with lifetime injection drug use (IDU) in St. Petersburg, Russia, we estimated the prevalence of self-reported extrajudicial police arrests. We used multiple logistic regression to evaluate associations between arrests and the following outcomes: overdose, recent IDU and receptive needle sharing. FINDINGS This cohort's mean age was 29.8 years, 60.8% were male; 75.3% reported non-fatal drug overdose, 50.3% recent IDU and 47.3% receptive needle sharing. Extrajudicial arrests were reported by more than half (60.5%, 95% confidence interval [CI]: 56.5-64.5) and were associated with higher odds of non-fatal drug overdose (AOR 1.52, 95% CI: 1.02-2.25) but not with recent IDU (AOR 1.17, arrests were associated with receptive needle sharing (AOR 1.84, 95% CI: 1.09-3.09). CONCLUSIONS Extrajudicial police arrests were common among this cohort of Russian HIV-positive PWID and associated with non-fatal overdose and, among those with recent IDU, receptive needle sharing. As a part of the HIV risk environment of PWIDs, these practices might contribute to HIV transmission and overdose mortality. Further research is needed to relate these findings to the operational environment of law enforcement and to better understand how police interventions among PWIDs can improve the HIV risk environment.
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Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study. J Int AIDS Soc 2014; 17:18855. [PMID: 24629844 PMCID: PMC3955762 DOI: 10.7448/ias.17.1.18855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/02/2014] [Accepted: 02/12/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care. Methods Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically. Results Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival. Conclusions This study highlights how adopting comprehensive harm reduction services can serve to improve access and equity in palliative and supportive care for drug-using populations.
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Beletsky L, Heller D, Jenness SM, Neaigus A, Gelpi-Acosta C, Hagan H. Syringe access, syringe sharing, and police encounters among people who inject drugs in New York City: a community-level perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:105-11. [PMID: 23916801 PMCID: PMC3842392 DOI: 10.1016/j.drugpo.2013.06.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 04/05/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Injection drug user (IDU) experience and perceptions of police practices may alter syringe exchange program (SEP) use or influence risky behaviour. Previously, no community-level data had been collected to identify the prevalence or correlates of police encounters reported by IDUs in the United States. METHODS New York City IDUs recruited through respondent-driven sampling were asked about past-year police encounters and risk behaviours, as part of the National HIV Behavioural Surveillance study. Data were analysed using multiple logistic regression. RESULTS A majority (52%) of respondents (n=514) reported being stopped by police officers; 10% reported syringe confiscation. In multivariate modelling, IDUs reporting police stops were less likely to use SEPs consistently (adjusted odds ratio [AOR]=0.59; 95% confidence interval [CI]=0.40-0.89), and IDUs who had syringes confiscated may have been more likely to share syringes (AOR=1.76; 95% CI=0.90-3.44), though the finding did not reach statistical significance. CONCLUSIONS Findings suggest that police encounters may influence consistent SEP use. The frequency of IDU-police encounters highlights the importance of including contextual and structural measures in infectious disease risk surveillance, and the need to develop approaches harmonizing structural policing and public health.
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Affiliation(s)
- Leo Beletsky
- Northeastern University School of Law and Bouvé College of Health Sciences, 400 Huntington Ave. Boston, MA 02115, USA and Division of Global Public Health, UCSD School of Medicine, La Jolla, CA, USA
| | - Daliah Heller
- New York City Department of Health and Mental Hygiene, 125 Worth St., New York, NY 10013, USA (at the time of writing)
| | - Samuel M. Jenness
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195, USA
| | - Alan Neaigus
- New York City Department of Health and Mental Hygiene, 125 Worth St., New York, NY 10013, USA
| | - Camila Gelpi-Acosta
- National Development and Research Institutes, 71 W. 23rd St. New York, NY 10010, USA
| | - Holly Hagan
- New York University College of Nursing, 726 Broadway, 10th floor, New York, NY 10003, USA
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Law enforcement attitudes toward overdose prevention and response. Drug Alcohol Depend 2013; 133:677-84. [PMID: 24051061 PMCID: PMC3947507 DOI: 10.1016/j.drugalcdep.2013.08.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Law enforcement is often the first to respond to medical emergencies in the community, including overdose. Due to the nature of their job, officers have also witnessed first-hand the changing demographic of drug users and devastating effects on their community associated with the epidemic of nonmedical prescription opioid use in the United States. Despite this seminal role, little data exist on law enforcement attitudes toward overdose prevention and response. METHODS We conducted key informant interviews as part of a 12-week Rapid Assessment and Response (RAR) process that aimed to better understand and prevent nonmedical prescription opioid use and overdose deaths in locations in Connecticut and Rhode Island experiencing overdose "outbreaks." Interviews with 13 law enforcement officials across three study sites were analyzed to uncover themes on overdose prevention and naloxone. RESULTS Findings indicated support for law enforcement involvement in overdose prevention. Hesitancy around naloxone administration by laypersons was evident. Interview themes highlighted officers' feelings of futility and frustration with their current overdose response options, the lack of accessible local drug treatment, the cycle of addiction, and the pervasiveness of easily accessible prescription opioid medications in their communities. Overdose prevention and response, which for some officers included law enforcement-administered naloxone, were viewed as components of community policing and good police-community relations. CONCLUSION Emerging trends, such as existing law enforcement medical interventions and Good Samaritan Laws, suggest the need for broader law enforcement engagement around this pressing public health crisis, even in suburban and small town locations, to promote public safety.
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Abstract
In an accompanying Perspective, Scott Burris and Stephen Koester discuss the association between punitive policies and health inequalities and argue for more research focusing on policing and health. Please see later in the article for the Editors' Summary
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Beletsky L, Thomas R, Shumskaya N, Artamonova I, Smelyanskaya M. Police education as a component of national HIV response: lessons from Kyrgyzstan. Drug Alcohol Depend 2013; 132 Suppl 1:S48-52. [PMID: 23896307 PMCID: PMC3825798 DOI: 10.1016/j.drugalcdep.2013.06.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recognition of the police's role in shaping HIV spread and prevention among people who inject drugs, sex workers, and other at-risk groups has generated interest in educational interventions targeting law enforcement. With input from civil society, trainings covering HIV prevention science, policy, and occupational safety were developed and delivered to cadets and active-duty police across Kyrgyzstan. METHODS We administered a multi-site cross-sectional survey of Kyrgyz police to assess whether having undergone HIV trainings was associated with improved legal and public health knowledge, positive attitudes toward public health programs and policies, occupational safety awareness, and intended practices . RESULTS In a 313-officer sample, 38% reported undergoing the training. In a multivariate analysis, training was associated with the officer being significantly more likely to support referring individuals to public health organizations (aOR 2.21; 95%CI 1.33-3.68), expressing no intent to extrajudicially confiscate syringes (aOR 1.92; 95%CI 1.09-3.39), and better understanding sex worker detention procedure (aOR 2.23; 95%CI 1.19-4.46), although trainee knowledge of policy on routine identification checks for sex workers was significantly lower (aOR 3.0; 95%CI 1.78-5.05). Training was also associated with improved occupational safety knowledge (aOR 3.85; 95%CI 1.66-8.95). CONCLUSION Kyrgyzstan's experience suggest that police trainings have the potential to improve the integration of policing and public health efforts targeting at-risk groups. Regardless of the legal environment, such structural approaches should be considered elsewhere in Central Asia and beyond. As these initiatives gain acceptance, further research is needed to inform their design and tailoring.
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Affiliation(s)
- Leo Beletsky
- Northeastern University School of Law and Bouvé College of Health Sciences, Boston, USA; Division of Global Public Health, UCSD School of Medicine, San Diego, USA.
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Jardine M. Building partnerships between law enforcement and harm reduction programs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:377-8. [DOI: 10.1016/j.drugpo.2013.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022]
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Odinokova V, Rusakova M, Urada LA, Silverman JG, Raj A. Police sexual coercion and its association with risky sex work and substance use behaviors among female sex workers in St. Petersburg and Orenburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:96-104. [PMID: 23916802 PMCID: PMC4211608 DOI: 10.1016/j.drugpo.2013.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/31/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
Background Extensive research documents that female sex workers (FSWs) in Russia are very vulnerable to abuses from police, including police sexual coercion. However, despite qualitative data suggesting abusive policing practices are more likely for FSWs contending with substance abuse issues and risky sex work contexts, there is a paucity of quantitative study evaluating these associations specifically in terms of police sexual coercion. Such research is needed to guide structural interventions to improve health and safety for FSWs in Russia and globally. Objective The purpose of this study is to assess the prevalence of police sexual coercion among FSWs from two Russian cities, St. Petersburg and Orenburg, and to determine whether riskier sex work behaviors and contexts and substance use behaviors, including both IDU and risky alcohol use, are associated with increased risk for sexual coercion from police Method FSWs in St. Petersburg and Orenburg were recruited via time-location and convenience sampling and completed structured surveys on demographics (age, education), sex work risks (e.g., violence during sex work) and substance use. Logistic regression analyses assessed associations of substance use and risky sex work with police sexual coercion, adjusting for demographics. Results Participants (N=896) were aged 15 and older (94% were 20+ years). Most (69%) reported past year binge alcohol use, and 48% reported IDU the day before. Half (56%) reported 4+ clients per day. Rape during sex work ever was reported by 64%. Police sexual coercion in the past 12 months was reported by 38%. In the multivariate model, both current IDU (AOR=2.09, CI=1.45–3.02) and past year binge alcohol use (AOR=1.46, CI=1.03–2.07) were associated with police sexual coercion, as was selling sex on the street (not in venues) (AOR=7.81, CI=4.53–13.48) and rape during sex work (AOR=2.04, CI=1.43–2.92). Conclusion Current findings document the substantial role police sexual violence plays in the lives of FSWs in Russia. These findings also highlight heightened vulnerability to such violence among self-managed and substance abusing FSWs in this context. Structural interventions addressing police violence against FSWs may be useful to improve the health and safety of this population.
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Affiliation(s)
| | - Maia Rusakova
- NGO Stellit, 197101 St. Petersburg, Russian Federation; Deviance and Social Control, The Sociological Institute of the Russian Academy of Sciences, 198005 St. Petersburg, Russian Federation
| | - Lianne A Urada
- Division of Global Public Health, School of Medicine, University of California at San Diego, 92093-0507 La Jolla, CA, USA
| | - Jay G Silverman
- Division of Global Public Health, School of Medicine, University of California at San Diego, 92093-0507 La Jolla, CA, USA; Center on Global Justice, University of California at San Diego, 92093-0507 La Jolla, CA, USA
| | - Anita Raj
- Division of Global Public Health, School of Medicine, University of California at San Diego, 92093-0507 La Jolla, CA, USA; Boston University, School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education, 02118 Boston, MA, USA; Center on Global Justice, University of California at San Diego, 92093-0507 La Jolla, CA, USA
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Beletsky L, Lozada R, Gaines T, Abramovitz D, Staines H, Vera A, Rangel G, Arredondo J, Strathdee SA. Syringe confiscation as an HIV risk factor: the public health implications of arbitrary policing in Tijuana and Ciudad Juarez, Mexico. J Urban Health 2013; 90:284-98. [PMID: 22806453 PMCID: PMC3675719 DOI: 10.1007/s11524-012-9741-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSW-IDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48%. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.11-5.80), reporting sexual abuse by police (aOR = 12.76, 95% CI = 6.58-24.72), engaging in groin injection (aOR = 1.84, 95% CI = 1.15-2.93), injecting in public (aOR = 1.64; 95% CI = 1.14-2.36), and obtaining syringes from pharmacies (aOR = 1.54; 95% CI = 1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR = 0.92, 95% CI = 0.87-0.98) as was frequent injection with clients within the last month (aOR = 0.64, 95% CI = 0.44-0.94). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.
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Affiliation(s)
- Leo Beletsky
- Division of Global Public Health, University of California-San Diego, La Jolla, CA, USA.
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Rosenblum D, Jones M. Did the Taliban's opium eradication campaign cause a decline in HIV infections in Russia? Subst Use Misuse 2013; 48:470-6. [PMID: 23528145 DOI: 10.3109/10826084.2013.778282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We offer a new hypothesis for why HIV infections fell rapidly after 2001 in Russia: the Taliban's opium eradication campaign in Afghanistan reduced the supply of heroin, causing use to fall and, thus, transmission of HIV to fall. We present evidence of the impact of the eradication campaign on the heroin market and show that the fall in HIV infections happened simultaneously in Russia and surrounding countries soon after the eradication campaign. We also show that the decline in HIV infections only occurred in injecting drug users, while other risk groups were unaffected. Limitations to our analysis are discussed.
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Affiliation(s)
- Daniel Rosenblum
- Department of Economics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Mago VK, Bakker L, Papageorgiou EI, Alimadad A, Borwein P, Dabbaghian V. Fuzzy cognitive maps and cellular automata: An evolutionary approach for social systems modelling. Appl Soft Comput 2012. [DOI: 10.1016/j.asoc.2012.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Police confrontations among street-involved youth in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:46-51. [PMID: 22883543 DOI: 10.1016/j.drugpo.2012.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 06/21/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Street-level policing has been recognized as a driver of health-related harms among people who inject drugs (IDU). However, the extent of interaction between police and street-involved youth has not been well characterized. We examined the incidence and risk factors for police confrontations among street-involved youth in a Canadian setting. METHODS Using data derived from participants enrolled in the At-Risk Youth Study (ARYS) between 2005 and 2011, we assessed factors associated with being stopped, searched, or detained by police without arrest in the previous six months using generalized estimating equations (GEE) with logit link for binary outcomes. RESULTS Among 991 participants followed during the study period, 440 (44.4%) reported being stopped, searched, or detained by police for an incidence density of 49.20 (95% confidence interval [CI]: 36.42-65.01) per 100 person years. In multivariate GEE analyses, factors associated with police confrontations included: male gender (adjusted odds ratio [AOR]=1.35), homelessness (AOR=2.05), recent incarceration (AOR=1.78), daily cannabis use (AOR=1.31), daily heroin injecting (AOR=1.36), crack pipe/syringe sharing (AOR=1.61), injection drug use (AOR=1.37), public drug use (AOR=2.19), sex work involvement (AOR=1.67), and drug dealing (AOR=1.49) (all p<0.05). In total, 19.0% of participants reported that police confiscated their drug paraphernalia without arresting them. Additionally, 16.9% of individuals reported experiencing violence at the hands of police. CONCLUSION We found that various factors, such as homelessness and markers of more severe addiction, increased the likelihood of being confronted by police, and police confrontations were associated with markers of health-related harm among street youth. These findings highlight the need for social and structural interventions that best enable police to fulfil public safety and public order objectives without negatively influencing health behaviours of street youth.
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