Assessing police officers’ attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs

Abstract

Background Policing practices such as syringe confiscation and arrest can act as important social-structural drivers of HIV risk among people who inject drugs (PWID). However, police referral to treatment and other services may improve the health of PWID. Little is known about the role of modifiable attitudinal and knowledge factors in shaping officer behavior. Using baseline findings from a police education program (PEP), we assessed relationships between drug policy knowledge and attitudes towards public health interventions with self-reported syringe confiscation, drug arrest, and service referral among street-level police in Tijuana, Mexico. Methods Between February, 2015 and May, 2016 we surveyed 1,319 police officers who reported syringe contact. The self-administered survey focused on attitudes, knowledge, and behaviors related to drug policy, public health, and occupational safety. We used ordinal logistic regression to model the odds of syringe confiscation, arrest for heroin possession, and referring PWID to health/social programs. Results The sample was mostly male (87%) and had at least a high school education (80%). In the last six months, a minority reported always/sometimes confiscating syringes (49%), arresting someone for heroin possession (43%), and referring PWID to health and social programs (37%). Those reporting needlestick injuries (NSI) had 1.38 (95% CI: 1.02–1.87) higher odds of reporting syringe confiscation. Officers who had favorable views on laws that treat addiction as a public health issue had lower odds (aOR= 0.78; 95% CI: 0.59–1.03) of arresting PWID. Those agreeing that it was their role to refer PWID to health and social programs had higher odds of reporting such referrals (aOR: 3.32, 95% CI: 2.52–4.37). Legal knowledge was not associated with these practices. Conclusion Changing drug policy and knowledge may be insufficient in shifting police behavior. Modifying officers’ occupational risks and attitudes towards harm reduction interventions can facilitate efforts to align police practices with PWID health.

A scoping review of harm reduction training for police officers

“…Two training programs discussed immunity protections for civil liability of individuals in possession of small amounts of drugs . Three trainings also discussed national drug strategies, including Australia's National Drug Strategy Framework and Mexico's National Drug Policy .…”

“…Cepeda et al . found that correct legal knowledge was negatively associated with referral of PWUD to health and social services 6 months after training completion, and thus found that changing police knowledge may be insufficient to shift policing behaviour.…”

“…However, shorter training programs, including 19-min [54] and 27-min [33] training videos, and 15 to 25 min training meetings, were seen as more apt to train an entire police station [18,49]. Longer single-session trainings ranged from 75 min to 3.5 h in length [4,17,18,35,41,47,48,52] and one was half a day in length [36]. Four of the longer programs were comprised of modules varying between 10 and 60 min in duration [35,41,47,52].…”

“…Across all sources, five programs were specific to naloxone administration [48,49,[54][55][56] and an additional 12 had the objective of increasing knowledge on both overdose response and naloxone use [30,34,35,37,38,[41][42][43][44][45]51,53]. Occupational safety was an overall objective of five training programs [17], which focused on increasing knowledge of needle-stick injuries (NSIs) and blood-borne infections [16], NSPs [40] and HIV prevention [29,31]. Two sources discussed a training program focused on NSPs [15,18].…”

The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

“…15 Preliminary findings suggest improved understanding of the legal status of syringe, heroin, and marijuana possession, along with better attitudes about public health-driven drug law reform. 28,30 Future work should assess the effect of this police education programme on HIV transmission in people who inject drugs.…”