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Tran MTN, Dunne MP, Minh Le G, Han HD, Nguyen TT, Luong HT, Luong QH, Pham HN, Baker P. Understanding Vietnam's drug policy for amphetamine-type stimulants misuse. Harm Reduct J 2022; 19:45. [PMID: 35562829 PMCID: PMC9103057 DOI: 10.1186/s12954-022-00621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The emergence of widespread amphetamine-type stimulants (ATSs) usage has created significant challenges for drug control and treatment policies in Southeast Asian countries. This study analyses the development of drug policies and examines current treatment program constraints in Vietnam to deal with ATS misuse. The aim was to gain insights that may be useful for national and international drug-related policy development and revision. Methods A desk review of national policy documents and 22 in-depth key informant interviews were conducted from 2019 to 2021. Thematic content analysis was employed to identify key themes and their connections. Results Analysis identified Vietnam’s 30-year history of developing policies and formulating strategies to reduce supply, demand, and harm from illicit drugs. With the increasing number of people who use ATS (PWUA), Vietnam has recently promoted harsh policy and law enforcement to deter drug use and supply. This policy trend prevails in many Asian countries. The three main constraints in dealing with ATS misuse emerged from punitive and restrictive drug policies. First, the general public believed that Centre-based compulsory treatment (CCT) is the only appropriate treatment for all types of illicit drug addiction despite its low-quality service provision. The rigid drug policy has led to social persuasion with impractical expectations for CCT effectiveness. Second, the emphasis on punishment and detention has hampered new drug treatment service development in Vietnam. CCT has become monopolistic in the context of impoverished services. Third, people who use drugs tend to hide their needs and avoid formal treatment and support services, resulting in declined social coherence. Conclusion While new drugs are constantly evolving, the current law enforcement approach potentially constrains expertise to adopt effective treatment services. This study suggests that the top-down policing mechanism presently hinders the development of an appropriate intervention strategy for ATS misuse and diminishes social support to service providers.
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Affiliation(s)
- Mai Thi Ngoc Tran
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. .,Centre for Research and Training on Substance Abuse -HIV, Hanoi Medical University, Hanoi, Vietnam. .,Nursing and Midwifery Faculty, Hanoi Medical University, Hanoi, Vietnam.
| | - Michael P Dunne
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia.,Institute for Community Health Research, Hue University, Hue, Vietnam
| | - Giang Minh Le
- Centre for Research and Training on Substance Abuse -HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Hoe Dinh Han
- Centre for Research and Training on Substance Abuse -HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Trang Thu Nguyen
- Centre for Research and Training on Substance Abuse -HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Thanh Luong
- School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Quang Hung Luong
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Ha Nguyen Pham
- Vietnam Union of Science and Technology Associations (VUSTA), Hanoi, Vietnam
| | - Philip Baker
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
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Nguyen TT, Tran MTN, Le GM, Jauffret-Roustide M. Drug Harm Reduction in Vietnam: A Review of Stakeholders' Perspectives and Implications for Future Interventions. Am J Public Health 2022; 112:S182-S190. [PMID: 35349313 PMCID: PMC8965182 DOI: 10.2105/ajph.2022.306764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To determine how harm reduction should be applied in low-resource countries such as Vietnam by exploring the perspectives of people who use drugs (PWUD), health care professionals, and policymakers regarding methadone treatment and harm reduction strategies. Methods. We conducted 2 qualitative studies in Vietnam between 2016 and 2021. We interviewed 62 PWUD and 22 experts in drug policy development and drug treatment programs, conducted observations at methadone clinics and harm reduction program meetings, and analyzed drug policy documents. Results. PWUD considered methadone treatment only as a transition to a drug-free life. Policymakers deemed harm reduction ineffective and continued to enforce arrest and incarceration of PWUD. Drug intervention programs are not yet geared to providing specialized services. Effective communication strategies and information on evidence-based harm reduction models are inadequate to help policymakers make the right decisions. Conclusions. Harm reduction principles have not been fully adopted in Vietnam. A harm reduction strategy based on a more humanistic approach that goes beyond a biomedicalized approach is urgently needed in Vietnam and other countries in the Global South. (Am J Public Health. 2022;112(S2):S182-S190. https://doi.org/10.2105/AJPH.2022.306764).
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Affiliation(s)
- Trang Thu Nguyen
- Trang Thu Nguyen, Mai Thi Ngoc Tran, and Giang Minh Le are with the Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Vietnam. Tran Thi Ngoc Mai is also with the School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia. Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (CNRS UMR8044/Inserm U1276/EHESS), Paris, France and the British Columbia Center on Substance Use, Vancouver, BC, Canada. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Mai Thi Ngoc Tran
- Trang Thu Nguyen, Mai Thi Ngoc Tran, and Giang Minh Le are with the Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Vietnam. Tran Thi Ngoc Mai is also with the School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia. Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (CNRS UMR8044/Inserm U1276/EHESS), Paris, France and the British Columbia Center on Substance Use, Vancouver, BC, Canada. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Giang Minh Le
- Trang Thu Nguyen, Mai Thi Ngoc Tran, and Giang Minh Le are with the Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Vietnam. Tran Thi Ngoc Mai is also with the School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia. Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (CNRS UMR8044/Inserm U1276/EHESS), Paris, France and the British Columbia Center on Substance Use, Vancouver, BC, Canada. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Marie Jauffret-Roustide
- Trang Thu Nguyen, Mai Thi Ngoc Tran, and Giang Minh Le are with the Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Vietnam. Tran Thi Ngoc Mai is also with the School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia. Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (CNRS UMR8044/Inserm U1276/EHESS), Paris, France and the British Columbia Center on Substance Use, Vancouver, BC, Canada. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
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King C, Cook R, Giang LM, Bart G, Hoffman K, Waddell EN, Korthuis PT. Incarceration and compulsory rehabilitation impede use of medication for opioid use disorder and HIV care engagement in Vietnam. J Subst Abuse Treat 2022; 134:108451. [PMID: 33962813 PMCID: PMC8558110 DOI: 10.1016/j.jsat.2021.108451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-prescribed opioid use is illegal in Vietnam. People who are apprehended for use of non-prescribed opioids may be arrested and incarcerated or sent to compulsory rehabilitation centers. For those on medication to treat opioid use disorder (MOUD), incarceration in either setting may disrupt treatment. This study estimates the effects of incarceration and compulsory rehabilitation on MOUD and HIV treatment outcomes in Vietnam. METHODS Data are from a clinical trial testing the effects of MOUD on HIV viral suppression in six Vietnamese HIV clinics. Participants were assessed quarterly for 12 months. We assessed the associations between incarceration or compulsory rehabilitation during months 0-9 and study outcomes of receipt of MOUD, HIV clinic engagement, and antiretroviral therapy prescription during months 9-12, among those who were released by month 9 of the study, using logistic regression and zero-inflated negative binomial models. RESULTS At nine months, 25 of 258 participants (9.7%) were incarcerated or sent to compulsory rehabilitation at least once and completed the month 9 assessment. Of those, 19 (76.0%) did not receive MOUD in months 9 through 12. Both incarceration and compulsory rehabilitation were negatively associated with subsequent receipt of MOUD (aOR = 0.05, 95% CI = (0.01, 0.24); 0.14 (0.04, 0.50), respectively) and HIV clinic engagement (aOR = 0.13, 95% CI = (0.03, 0.71); 0.09 (0.02, 0.39), respectively). In the final three months of the study, participants who were incarcerated had 42.5 fewer days of MOUD (95% CI = 23.1, 61.9), and participants in compulsory rehabilitation had 46.1 fewer days of MOUD (95% CI = 33.8, 58.4) than those not incarcerated or in compulsory rehabilitation. CONCLUSION Our findings suggest that both incarceration and compulsory rehabilitation disrupt MOUD and HIV treatment among people with HIV and Opioid Use Disorder in Vietnam. Prioritization of evidence-based strategies to support engagement in care for people who use drugs could potentially expand HIV and Opioid Use Disorder treatment access and curb substance use more effectively than reliance on incarceration or compulsory rehabilitation.
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Affiliation(s)
- Caroline King
- MD/PhD Program, Oregon Health & Science University, Portland, OR, USA; Dept. of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Ryan Cook
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Viet Nam
| | - Gavin Bart
- Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Kim Hoffman
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Needham Waddell
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Greer A, Zakimi N, Butler A, Ferencz S. Simple possession as a 'tool': Drug law enforcement practices among police officers in the context of depenalization in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103471. [PMID: 34600414 DOI: 10.1016/j.drugpo.2021.103471] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/28/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Examining drug law enforcement practices in the context of an evolving drug policy environment is critical for informing policy reforms and practices as they unfold. In this study, we aimed to examine police officer accounts of drug law enforcement practices, including officer use of discretion in simple possession cases, within the sociolegal context in British Columbia, Canada. METHODS Using a qualitative approach, we conducted a thematic analysis of interviews with sixteen police officers across nine jurisdictions in the province. The analysis provided insights into police officers' recent experiences enforcing drug laws. Two major themes and several subthemes are presented which relate to drug law enforcement practices within the context of depenalization. FINDINGS Officers' experiences and views towards simple possession enforcement suggested a model of de facto depenalization in the province, although enforcement practices including police discretion were inconsistent across officers and jurisdictions. Prosecutorial discretion was a major factor that shaped officers' enforcement practices. While officers reported not pursuing simple possession offences, many used simple possession charges as a 'tool' to do investigations, pursue other charges, and to promote social order. CONCLUSION This study provides unique insights into drug law enforcement in an evolving sociolegal context, highlighting the potential inconsistencies, inequities, and harms that may arise from relying on a model of depenalization. In the face of drug law reforms both in Canada and elsewhere, these findings have important implications regarding the design and implementation of alternatives, such as depenalization, decriminalization, and diversion programs, which may potentially rely on, remove, and/or enhance police discretion. Where drug possession is formally decriminalized, police officers may need alternative enforcement 'tools' to support their work moving forward.
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Affiliation(s)
- Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
| | - Naomi Zakimi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby BC V5A 1S6, Canada
| | - Amanda Butler
- School of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby BC V5A 1S6, Canada
| | - Sarah Ferencz
- Peter A. Allard School of Law, University of British Columbia, 1822 East Mall, Vancouver BC V6T 1Z1, Canada
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Manu E, Douglas M, Ntsaba MJ, Tarkang EE. Perspectives of illicit marijuana growers and traders on commercial legalisation of marijuana in South Africa: considerations for policy formulation. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:54. [PMID: 34174921 PMCID: PMC8236131 DOI: 10.1186/s13011-021-00391-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Background Over the years, there has been a clarion call for legalising marijuana cultivation and trading for commercial purposes in South Africa. Proponents of the call argue that the criminalisation of commercial marijuana cultivation and trading has failed to halt illicit marijuana cultivation and trading. However, the views of those who economically benefit from the illicit marijuana trade on its legalisation remain empirically unsolicited. Objective This study aimed to solicit the views of illegal marijuana growers and traders from two selected communities in the Eastern Cape Province of South Africa regarding the commercial legalisation of marijuana cultivation and trading to inform policy on the debate. Methods In-depth key informant interview approach was used to interview 18 purposively sampled participants that were selected through the snowball sampling technique. The data were analysed using the thematic content analysis approach. Results Participants had both positive and negative perceptions of the possible legalisation of marijuana cultivation and trading. On the positive side, participants indicated freedom from police, the opportunity to grow marijuana on a larger scale, capital acquisition for commercial marijuana cultivation and trading, and regulation of marijuana prices through unionisation as some of the benefits they would derive from the commercial legalisation of marijuana cultivation and trading. On the negative side, loss of their source of livelihood, fall in the price of marijuana and perceived increase in school drop-out rates were the concerns raised. Conclusion While participants relished improvement in their economic fortunes upon commercial legalisation of marijuana cultivation and trading, they were also apprehensive about this policy due to the perceived consequences it may have on their livelihoods and communities. We, therefore, recommend that future discussions of the commercial legalisation of marijuana cultivation and trading in South Africa should be done in consultation with illicit marijuana growers and traders to ensure that their interests are safeguarded by such a policy. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00391-w.
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Affiliation(s)
- Emmanuel Manu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Mbuyiselo Douglas
- Department of Public Health, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Mohlomi Jafta Ntsaba
- Department of Nursing, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
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Ritterbusch AE, Pinzon Niño EL, Reyes Páez RA, Pardo Triana J, Jaime Peña D, Correa-Salazar C. ‘I feel safer in the streets than at home’: Rethinking harm reduction for women in the urban margins. Glob Public Health 2020; 15:1479-1495. [DOI: 10.1080/17441692.2020.1751234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Amy E. Ritterbusch
- Department of Social Welfare, University of California, Los Angeles, CA, USA
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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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Footer KHA, Silberzahn BE, Lim S, Huettner S, Kumar VA, Loeffler D, Peitzmeier SM, Sherman SG. "An ethnographic exploration of factors that drive policing of street-based female sex workers in a U.S. setting - identifying opportunities for intervention". BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:12. [PMID: 32410616 PMCID: PMC7227297 DOI: 10.1186/s12914-020-00232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
Background Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
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Affiliation(s)
- Katherine H A Footer
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Bradley E Silberzahn
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sahnah Lim
- New York University School of Medicine, Department of Population Health and Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Steven Huettner
- Johns Hopkins School of Medicine, Department of Pediatrics, 5200 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victor A Kumar
- Johns Hopkins Krieger School of Arts and Sciences, Department of Anthropology, 466 Mergenthaler Hall, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Derek Loeffler
- Baltimore City Police Department, Northwestern District, 5271 Reistertown Road, Baltimore, MD, 21215, USA
| | - Sarah M Peitzmeier
- Johns Hopkins Bloomberg School of Publissc Health, Department of Population, Family, and Reproductive Health, Baltimore, MD, 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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Stangl AL, Singh D, Windle M, Sievwright K, Footer K, Iovita A, Mukasa S, Baral S. A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know? BMC Infect Dis 2019; 19:209. [PMID: 30832599 PMCID: PMC6399958 DOI: 10.1186/s12879-019-3692-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. Methods We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003–28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS’ key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. Results Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. Conclusion Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection. Electronic supplementary material The online version of this article (10.1186/s12879-019-3692-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA.
| | - Devaki Singh
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Michael Windle
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kirsty Sievwright
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Katherine Footer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Alexandrina Iovita
- Human Rights Division, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Stella Mukasa
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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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] [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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Kadowaki H, Duc PP, Sato K, Phuong PTM, Hagiwara K, Makita K. Socio-economic factors associated with voluntary rabies control measures in Vietnam. Prev Vet Med 2018; 157:105-114. [PMID: 30086838 DOI: 10.1016/j.prevetmed.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
Rabies is a fatal zoonosis, and in Vietnam, it remains problematic despite the availability of dog rabies vaccination. The purpose of this study was to clarify the socio-economic factors associated with voluntary rabies control measures among the general population using a "Knowledge, Attitudes, and Practice" framework to provide health and veterinary authorities in Vietnam with baseline information for better planning of policy supports. A questionnaire survey with interviews was conducted in 495 households (64 mountainous and 431 plain-area households) in Thai Nguyen Province in September 2016. After the survey, uni- and multivariable analyses were performed to detect factors associated with the practices of dog rabies vaccination and tethering dogs. Structural equation modelling (SEM) was performed to understand the structures associated with practice decisions. Contingent valuation was performed to calculate willingness-to-pay for vaccination. Vaccination coverage was 77.4% (724/935 dogs), and was significantly lower in mountainous areas dominated by ethnic minorities (63.8%, 67/105) than in plains (79.2%, 657/830, x2 = 11.7, df = 1, p < 0.001). Mean estimation of willingness-to-pay for a vaccination was 2.30 USD (51,959 Vietnamese dong), which was more than double the current price. The willingness-to-pay in mountainous areas was 2.16 USD, while that in plain areas was 2.32 USD. The proportion that never confined dogs was significantly higher in mountainous areas (65.6%, 42/64 households) than in plain areas (26.5%, 114/430, x2 = 37.7, df = 1, p < 0.001). Despite the low proportion of households tethering dogs, the majority answered that they would confine (479/489, 98.0%) or leash while walking (482/491, 98.2%) if such orders were enforced. SEM result showed that higher social status promoted better knowledge (β, the coefficient, = 0.75, se = 0.05, p < 0.001), better knowledge positive attitudes (β = 1.0, se = 0.0, p value not calculated), and positive attitudes better practices of confinement (β = 0.4, se = 0.05, p < 0.001), vaccination (β = 0.52, se = 0.06, p < 0.001), and sterilization (β = 0.11, se = 0.04, p < 0.001). Our study suggested that rabies education targeted to mountainous areas using local languages for ethnic minority groups as well as the national language, and higher subsidies on dog rabies vaccination for poor households may improve vaccination coverage. Dog management may be improved by promotion campaigns.
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Affiliation(s)
- Hazumu Kadowaki
- Veterinary Epidemiology Unit, Division of Health and Environmental Sciences, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Japan
| | - Phuc Pham Duc
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health, 1A Duc Thang Street, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Kazuo Sato
- Laboratory of Food Economic Analysis, Department of Sustainable Agriculture, College of Agriculture, Food and Environment Sciences, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Japan
| | - Pham Thi Minh Phuong
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health, 1A Duc Thang Street, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Katsuro Hagiwara
- Veterinary Virology Unit, Division of Pathobiology, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Japan
| | - Kohei Makita
- Veterinary Epidemiology Unit, Division of Health and Environmental Sciences, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Japan.
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Blackburn NA, Lancaster KE, Ha TV, Latkin CA, Miller WC, Frangakis C, Chu VA, Sripaipan T, Quan VM, Minh NL, Vu PT, Go VF. Characteristics of persons who inject drugs and who witness opioid overdoses in Vietnam: a cross-sectional analysis to inform future overdose prevention programs. Harm Reduct J 2017; 14:62. [PMID: 28882143 PMCID: PMC5590141 DOI: 10.1186/s12954-017-0188-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons who use opioids have a high risk of overdose and associated mortality. In Vietnam, little is known about the characteristics of this population and the persons who are witness to those overdoses. One approach to combatting fatal overdose has been the use of peer interventions in which a friend or injecting partner administers overdose reversal medication, but availability in Vietnam of these medications is limited to pilot programs with aims to expand in the future (Le Minh and V.F. Go, Personal Communication, 2016). The primary objective of this paper is to explore the characteristics associated with witnessing three or more overdoses in a lifetime. METHODS This cross-sectional analysis used baseline data from a four-arm randomized control trial conducted in Thai Nguyen, Vietnam, known as the Prevention for Positives project. One thousand six hundred seventy-three PWID were included in the analysis. We conducted bivariable and multivariable logistic regression to identify characteristics associated with witnessing three or more overdoses in a lifetime. Characteristics explored included education, employment, marital status, risky drug use behaviors, locations for accessing syringes, recent overdose, history of incarceration, drug treatment, and having slept outside in the past 3 months. RESULTS Seventy-two percent (n = 1203) of participants had witnessed at least one overdose in their lifetime, and 46% had witnessed three or more overdoses (n = 765). In the multivariable model, having less than secondary education (AOR 0.70; 95% CI 0.57, 0.86), having slept outside in the past 3 months (AOR 1.77; 95% CI 1.31, 2.40), having a history of incarceration (AOR 1.33; 95% CI 1.07, 1.65), having a history of drug treatment (AOR 1.41; 95% CI 1.12, 1.77), experiencing a recent non-fatal overdose (AOR 3.84; 95% CI 2.36, 6.25), injecting drugs daily (AOR 1.79; 95% CI 1.45, 2.20), receptive needle sharing (AOR 1.30; 95% CI 1.04, 1.63), and number of years injecting (AOR 1.04; 95% CI 1.02, 1.07) were significantly associated with witnessing three or more overdoses. CONCLUSIONS Targeted interventions are needed to train persons witnessing an overdose to administer overdose-reversal medication. This includes targeting persons prior to release from prisons, drug treatment centers, and those accessing syringe exchange programs. Additional research should assess the burden of witnessing an overdose as well as locations for medication distribution. Assessments of the training capacity and needs for implementing these programs among drug using peers in Vietnam are of the utmost importance.
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Affiliation(s)
- N A Blackburn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - K E Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - T V Ha
- University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam
| | - C A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 737, Baltimore, Maryland, 21205, USA
| | - W C Miller
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.,Current affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, Ohio, 43210, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3642, Baltimore, MD, 21205, USA
| | - V A Chu
- University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - V M Quan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - N L Minh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - P T Vu
- Centre for Preventive Medicine of Thai Nguyen, 971 Duong Tu Minh Road, Thai Nguyen, Vietnam
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
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Windle J. A Slow March from Social Evil to Harm Reduction: Drugs and Drug Policy in Vietnam. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/jdpa-2015-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe suppression of drug consumption and trade is high on the Government of Vietnam’s agenda. To accomplish this goal, Vietnam employs repressive policies that often contravene international human rights law. Among the most detrimental and problematic policies are the incarceration of drug users in compulsory treatment centers, and the stigmatization and abuse of consumers by the police. Vietnamese drug policy is, however, slowly changing in the face of one of Asia’s worst ongoing HIV epidemics. While the Communist Government of the early-1990s designated illicit drugs as a “social evil” to be eradicated through punitive and often repressive means, the recent implementation of harm reduction approaches have reduced the level of needle sharing, and thus HIV transmission. This briefing will explore the current trends in drug consumption, production, and trafficking before looking at the key harms and threats associated with drugs in Vietnam. This will be followed by a summary of Vietnam’s drug policies, including the country’s approach to drug treatment, harm reduction, and illicit opium suppression: Vietnam is one of a small number of states to have suppressed illicit opium production, an intervention that centred upon coercive negotiations with limited alternative development. The briefing will conclude with some tentative recommendations for reform and thoughts on what could be expected from Vietnam during the Special Session of the United Nations General Assembly on the World Drug Problem (UNGASS 2016).
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Police must join the fast track to end AIDS by 2030. J Int AIDS Soc 2016; 19:21153. [PMID: 27435719 PMCID: PMC4951534 DOI: 10.7448/ias.19.4.21153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/09/2016] [Indexed: 01/23/2023] Open
Abstract
World leaders have committed to ending AIDS by 2030, but stigma and discrimination remain significant obstacles. In particular, police are critical, front-line determinants of risk for many people living with HIV (PLHIV) and members of other key affected populations (KAPs). The negative impact of adverse police behaviours and practices on HIV risk is well documented, and these risks undermine global efforts to end AIDS. Far less well documented, and less common, are attempts to ameliorate this impact by working to change police behaviours. This Special Issue seeks to help redress this imbalance by presenting a selection of original, provocative and important interventions from academics, police officers and other stakeholders concerned with documenting the potential for constructive, progressive and evidence-based approaches to the reduction of HIV risk. We recommend urgent boosting of efforts and funding to engage police in the HIV response. Among other strategies, this needs sustainable funding of programmes and their evaluation, and increased and continuing advocacy and education at all levels to match policy and law reform.
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Factors associated with physical and sexual violence by police among people who inject drugs in Ukraine: implications for retention on opioid agonist therapy. J Int AIDS Soc 2016; 19:20897. [PMID: 27435717 PMCID: PMC4951533 DOI: 10.7448/ias.19.4.20897] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/11/2016] [Accepted: 04/24/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction Ukraine's volatile HIV epidemic, one of the largest in Eastern Europe and Central Asia, remains concentrated in people who inject drugs (PWID). HIV prevalence is high (21.3% to 41.8%) among the estimated 310,000 PWID. Opioid agonist therapy (OAT) is the most cost-effective HIV prevention strategy there, yet OAT services are hampered by negative attitudes and frequent harassment of OAT clients and site personnel by law enforcement. This paper examines the various types of police violence that Ukrainian PWID experience and factors associated with the different types of violence, as well as the possible implications of police harassment on OAT retention. Methods In 2014 to 2015, we conducted a cross-sectional survey in five Ukrainian cities with 1613 PWID currently, previously and never on OAT, using a combination of respondent-driven sampling, as well as random sampling. We analysed correlates of police violence by multiple factors, including by gender, and their effects on duration of OAT retention. Self-reported physical and sexual violence by police were the two primary outcomes, while retention on OAT was used as a secondary outcome. Results Overall, 1033 (64.0%) PWID reported being physically assaulted by police, which was positively correlated with currently or previously being on OAT (69.1% vs. 60.2%; p<0.01). HIV prevalence rates were higher in those receiving OAT than those not on OAT (47.6% vs. 36.1%; p<0.01). Police violence experiences differed by sex, with men experiencing significantly more physical violence, while women experienced more sexual violence (65.9% vs. 42.6%; p<0.01). For PWID who had successfully accessed OAT, longer OAT retention was significantly correlated both with sexual assault by police and fewer non-fatal overdoses. Conclusions Police violence is a frequent experience among PWID in Ukraine, particularly for those accessing OAT, an evidence-based primary and secondary HIV prevention strategy. Police violence experiences, however, were different for men and women, and interventions with police that address these sexual differences and focus on non-violent interactions with PWID to improve access and retention on OAT are crucial for improving HIV prevention and treatment goals for Ukraine.
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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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Mazhnaya A, Bojko MJ, Marcus R, Filippovych S, Islam Z, Dvoriak S, Altice FL. In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine. DRUGS (ABINGDON, ENGLAND) 2016; 23:163-175. [PMID: 27458326 PMCID: PMC4957015 DOI: 10.3109/09687637.2015.1127327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/27/2015] [Indexed: 11/13/2022]
Abstract
AIMS To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine. METHODS Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles. FINDINGS Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being "addiction-free". After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to 'break the cycle', however, law enforcement practices still thwart OAT capacity to improve individual and public health. CONCLUSION In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.
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Affiliation(s)
- Alyona Mazhnaya
- ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - Martha J. Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | | | - Sergey Dvoriak
- Ukrainian Institute for Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Perlman DC, Jordan AE, Uuskula A, Huong DT, Masson CL, Schackman BR, Des Jarlais DC. An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1056-63. [PMID: 26050614 PMCID: PMC4581906 DOI: 10.1016/j.drugpo.2015.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/28/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023]
Abstract
People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries-the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include (1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, (2) inconsistent use of OST as a platform for HCV services, (3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and (4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: (1) maintaining current HIV prevention efforts, (2) expanding efforts to reduce the stigmatization of drug use, (3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, (4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV.
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Affiliation(s)
- David C. Perlman
- Mount Sinai Beth Israel, 120 East 16 Street, 12 Floor, New York, NY, 10003 USA
| | - Ashly E. Jordan
- New York University, 726 Broadway, 10 Floor, New York, NY, 10003 USA
| | - Anneli Uuskula
- Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - Duong Thi Huong
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Socialist Republic of Viet Nam
| | - Carmen L. Masson
- University of California at San Francisco, 1001 Potrero, San Francisco, CA, 94110 USA
| | - Bruce R. Schackman
- Weill Cornell Medical College, 425 East 61 Street, Suite 301, New York, NY 10065 USA
| | - Don C. Des Jarlais
- Mount Sinai Beth Israel, Chemical Dependency Institute, 160 Water Street, 24 Floor, New York, NY 10038, USA
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Ahmed T, Long NT, Huong PTT, Stewart DE. HIV and Injecting Drug Users in Vietnam: An Overview of Policies and Responses. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:675-81. [PMID: 25532449 DOI: 10.1016/j.drugpo.2014.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Overdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. METHODS In 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. RESULTS All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9-16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI: 0.5-0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI: 1.9-3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI: 1.1-4.2), as was methamphetamine use (AOR 2.3, CI: 1.3-4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI: 1.5-5.9). CONCLUSION This study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment.
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Affiliation(s)
- Alexander R Bazazi
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA.
| | - Alexei Zelenev
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA
| | - Jeannia J Fu
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ilias Yee
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Evaluation of HIV prevention interventions for people who inject drugs in low- and middle-income countries—The current and future state of the art. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:336-9. [DOI: 10.1016/j.drugpo.2014.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022]
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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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Experiences with policing among people who inject drugs in Bangkok, Thailand: a qualitative study. PLoS Med 2013; 10:e1001570; discussion e1001570. [PMID: 24339753 PMCID: PMC3858231 DOI: 10.1371/journal.pmed.1001570] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite Thailand's commitment to treating people who use drugs as "patients" not "criminals," Thai authorities continue to emphasize criminal law enforcement for drug control. In 2003, Thailand's drug war received international criticism due to extensive human rights violations. However, few studies have since investigated the impact of policing on drug-using populations. Therefore, we sought to examine experiences with policing among people who inject drugs (PWID) in Bangkok, Thailand, between 2008 and 2012. METHODS AND FINDINGS Between July 2011 and June 2012, semi-structured, in-depth interviews were conducted with 42 community-recruited PWID participating in the Mitsampan Community Research Project in Bangkok. Interviews explored PWID's encounters with police during the past three years. Audio-recorded interviews were transcribed verbatim, and a thematic analysis was conducted to document the character of PWID's experiences with police. Respondents indicated that policing activities had noticeably intensified since rapid urine toxicology screening became available to police. Respondents reported various forms of police misconduct, including false accusations, coercion of confessions, excessive use of force, and extortion of money. However, respondents were reluctant to report misconduct to the authorities in the face of social and structural barriers to seeking justice. Respondents' strategies to avoid police impeded access to health care and facilitated transitions towards the misuse of prescribed pharmaceuticals. The study's limitations relate to the transferability of the findings, including the potential biases associated with the small convenience sample. CONCLUSIONS This study suggests that policing in Bangkok has involved injustices, human rights abuses, and corruption, and policing practices in this setting appeared to have increased PWID's vulnerability to poor health through various pathways. Novel to this study are findings pertaining to the use of urine drug testing by police, which highlight the potential for widespread abuse of this emerging technology. These findings raise concern about ongoing policing practices in this setting.
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Hayashi K, Ti L, Csete J, Kaplan K, Suwannawong P, Wood E, Kerr T. Reports of police beating and associated harms among people who inject drugs in Bangkok, Thailand: a serial cross-sectional study. BMC Public Health 2013; 13:733. [PMID: 23924324 PMCID: PMC3750638 DOI: 10.1186/1471-2458-13-733] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background Thailand has for years attempted to address illicit drug use through aggressive drug law enforcement. Despite accounts of widespread violence by police against people who inject drugs (IDU), the impact of police violence has not been well investigated. In the wake of an intensified police crackdown in 2011, we sought to identify the prevalence and correlates of experiencing police beating among IDU in Bangkok. Methods Community-recruited samples of IDU in Bangkok were surveyed between June 2009 and October 2011. Multivariate log-binomial regression was used to identify factors associated with reporting police beating. Results In total, 639 unique IDU participated in this serial cross-sectional study, with 240 (37.6%) participants reporting that they had been beaten by police. In multivariate analyses, reports of police beating were associated with male gender (Adjusted Prevalence Ratio [APR] = 4.43), younger age (APR = 1.69), reporting barriers to accessing healthcare (APR = 1.23), and a history of incarceration (APR = 2.51), compulsory drug detention (APR = 1.22) and syringe sharing (APR = 1.44), and study enrolment in 2011 (APR = 1.27) (all p < 0.05). Participants most commonly reported police beating during the interrogation process. Conclusions A high proportion of IDU in Bangkok reported having been beaten by the police. Experiencing police beating was independently associated with various indicators of drug-related harm. These findings suggest that the over-reliance on enforcement-based approaches is contributing to police-perpetrated abuses and the perpetuation of the HIV risk behaviour among Thai IDU.
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Affiliation(s)
- Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Latkin C. Carl Latkin on Mukta Sharma and Anindya Chatterjee's "Failure of substance use interventions: perspectives from Asia". Subst Use Misuse 2012. [PMID: 23186491 DOI: 10.3109/10826084.2012.723542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carl Latkin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205-2414, USA.
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Khuat TH, Nguyen VAT, Jardine M, Moore T, Bui TH, Crofts N. Harm reduction and "clean" community: can Viet Nam have both? Harm Reduct J 2012; 9:25. [PMID: 22769430 PMCID: PMC3537642 DOI: 10.1186/1477-7517-9-25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
The findings of our research show that while police play multiple roles in the fight against drug-related crime, they often perceived their tasks - especially preventing and controlling drug use on the one hand, and supporting harm reduction on the other - as contradictory, and this creates tensions in their work and relations with their communities. Although they are leaders and implementers of harm reduction, not all police know about it, and some remain skeptical or perceive it as contradictory to their main task of fighting drugs. Methadone treatment is seen by some as in competition with their main task of coordinating conventional drug treatment in the rehabilitation center.The history of drug use and the evolution of discourses on drug use in Viet Nam have created these conflicting pressures on police, and thus created contradictory expectations and led to different views and attitudes of police regarding various harm reduction measures. This might aid understanding why, despite the comprehensive and progressive policies on HIV/AIDS and harm reduction in Viet Nam, it is not easy for police to actively and effectively support and be involved in harm reduction at the ground level.To promote the wider acceptance of harm reduction the concept of community safety must be expanded to include community health; harm reduction must be integrated into the "new society" movement; and laws and policies need further revision to reduce contradiction between current drug laws and HIV laws.Harm reduction guidelines for police and other actors need to be disseminated and supported, embodying better ways of working between sectors, and all sectors in the partnership require support for building capacity to contribute to the overall goal.
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Affiliation(s)
- Thu Hong Khuat
- Institute for Social Development Studies, Suite 225, Entry 11, CT5 Building, My Dinh-Song Da Area, Pham Hung Road, Ha Noi, Viet Nam.
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