Drug-related arrest rates and spatial access to syringe exchange programs in New York City health districts: Combined effects on the risk of injection-related infections among injectors

Self Cite

This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research

Friedman

Tempalski

Brady

et al. 2016

Self Cite

“…This observation is supported by results (not shown) suggesting bivariate relationships between reduced police harassment without arrest and increased: percent commercial zoning (P=0.001); number of light posts (P=0.032); and percent building footprint (P=0.089) (i.e., markers of spatial isolation). Heavier police presence has been associated with increased risk for transmission of blood-borne or sexually transmitted infections to SWs and drug users through a number of spatial pathways; for example, heavier arrest rates have negatively affected the association between increased spatial access to sterile syringes and the use of safe drug use equipment (Cooper, et al, 2012a; Cooper, et al, 2012b); increased police presence and previous arrests/harassment by police have been associated with rushed negotiations with clients or rushed and unsafe drug use, injecting and doing sex work in unsafe spaces and having safer sex and drug use equipment confiscated (Kerr & Wood, 2005; Shannon, et al, 2008a; Small, Kerr, Charette, Schechter, & Spittal, 2006); and being able to access safer indoor drug use spaces has alleviated the pressures of policing and violence in public drug use spaces and facilitated use of safer drug use equipment (Fairbairn, Small, Shannon, Wood, & Kerr, 2008). Such research helps explain our association between increased spatial isolation as measured by our index and exchanging sex for drugs.…”

Section: Discussionmentioning

confidence: 99%

“…The term ‘built environment’, has broad uses and applications, and in our paper refers to features of human-made spaces, places or surroundings in which human activity takes place. For example, the relationship between spatial access to sterile syringes, policing of drug use (arrests) and the use of safe drug use equipment has been assessed (Cooper, et al, 2012a; Cooper, et al, 2012b). An index measuring the cumulative effects of physical disorder within neighbourhoods (e.g., structural damage to homes; streets with trash, abandoned cars, graffiti; physical problems and building code violations in high schools), the ‘Broken Window Index’, was examined for its influence on neighborhood gonorrhea rates in New Orleans (Cohen, et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Piloting a ‘spatial isolation’ index: The built environment and sexual and drug use risks to sex workers

Deering

Rusch

Amram

et al. 2014

Background Employing innovative mapping and spatial analyses of individual and neighborhood environment data, we examined the social, physical and structural features of overlapping street-based sex work and drug scenes and explored the utility of a ‘spatial isolation index’ in explaining exchanging sex for drugs and exchanging sex while high. Methods Analyses drew on baseline interview and geographic data (Jan/10-Oct/11) from a large prospective cohort of street and off-street sex workers (SWs) in Metropolitan Vancouver and external publically-available, neighborhood environment data. An index measuring ‘spatial isolation’ was developed from seven indicators measuring features of the built environment within 50m buffers (e.g. industrial or commercial zoning, lighting) surrounding sex work environments. Bivariate and multivariable logistic regression was used to examine associations between the two outcomes (exchanged sex for drugs; exchanged sex while high) and the index, as well as each individual indicator. Results Of 510 SWs, 328 worked in street-based/outdoor environments (e.g. streets, parks, alleys) and were included in the analyses. In multivariable analysis, increased spatial isolation surrounding street-based/outdoor SWs’ main places of servicing clients as measured with the index was significantly associated with exchanging sex for drugs. Exchanging sex for drugs was also significantly positively associated with an indicator of the built environment suggesting greater spatial isolation (increased percent of parks) and negatively associated with those suggesting decreased spatial isolation (increased percent commercial areas, increased count of lighting, increased building footprint). Exchanging sex while high was negatively associated with increased percent of commercial zones but this association was removed when adjusting for police harassment. Conclusions The results from our exploratory study highlight how built environment shapes risks within overlapping street-based sex work and drug scenes through the development of a novel index comprised of multiple indicators of the built environment available through publicly available data, This study informs the important role that spatially-oriented responses, such as safer-environment interventions, and structural responses, such as decriminalization of sex work can play in improving the health, safety and well-being of SWs.

“…Policing can also indirectly increase transmission of HIV and blood-borne infections, for example by conducting ‘police sweeps/’crackdowns’ and random urine drug screens or by conducting surveillance and arresting PWIDs who attend NSPs or OST programmes, thereby actively discouraging access to such programmes (Bluthenthal, et al, 1999;Booth et al, 2013; Burris, et al, 2004; Cooper et al, 2012; Friedman et al, 2006; Global Commission on Drugs, 2012; Rhodes et al, 2003; Robertson et al, 2010; Ti et al, 2013; Werb et al, 2008; Wood et al, 2004). A survey of U.S. NSPs reported the following police interactions at least monthly: client harassment: 43%; confiscation of clients’ syringes: 31%, client arrest: 12% (Beletsky et al, 2011).…”

Section: Policing Practices and Hiv Riskmentioning

confidence: 99%

HIV, drugs and the legal environment

Strathdee

Beletsky

Kerr

2015

A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs' behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs' risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.