HIV and the criminalisation of drug use among people who inject drugs: a systematic review

Abstract

SUMMARY 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.

Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan

“…Findings from this study support a growing body of literature pointing to the collateral effects of criminalizing drug use by PWID on increasing injection drug risk behaviors and HIV/HCV infection (Altice et al, 2016; DeBeck et al, 2017; Dolan et al, 2016; Rubenstein et al, 2016). Several implications for HIV prevention and drug policy with FWID and MWID arise from this study.…”

“…In social contexts in which drug use is criminalized, public injection spaces of stairwells, vehicles, alleyways and other injecting spaces attract drug law enforcement activities thus increasing risk of drug crime conviction of PWID (Beletsky et al, 2013; Darke, Kaye, & Ross, 2001; Blankenship & Koester, 2002; Booth et al, 2013; Ti et al, 2015; Wood et al, 2017). Lifetime conviction for drug crimes leads to imprisonment, registration as a drug user, compulsory treatment, future discrimination by the police, exclusion from employment and prevention from participation in voting and other political activities (Azbel et al, 2015; Brewer et al, 2014; DeBeck et al, 2017). Lack of access to harm reduction information in prison systems may be associated with lower knowledge and awareness of HIV prevention, and may be correlated with greater injection drug risk behaviors and HIV/HCV infection (Belenko, Langley, Crimmins, & Chaple, 2004; Dolan et al, 2015).…”

Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations

“…Often, KP experience structural barriers and societal discrimination that may increase their HIV/STI vulnerability by encumbering their access to healthcare [12][13][14][15][16][17]. In settings where behaviours are criminalized [18][19][20], KP members may be at increased risk for HIV because of lack of access to condoms or sterile syringes, or may engage in avoidant behaviours due to the anticipation that insensitive providers might mistreat them [21], and fear of punitive action if they disclose unapproved sexual practices. lack of access to testing or treatment), but also shape behaviours and networks (e.g.…”

Power to participants: a call for person‐centred HIV prevention services and research

“…The target was a 50% reduction in new infections acquired through sexual transmission or injecting drug use between 2010 and 2015 [4]. Social and structural factors continue to compromise access to and use of evidence-based biomedical HIV prevention strategies among populations most affected by HIV [5][6][7]. Indeed, approximately 45% of all new seroconversions globally are among sex workers, gay, bisexual and other men who have sex with men and people who inject drugs [3].…”