Street Policing, Injecting Drug Use and Harm Reduction in a Russian City: A Qualitative Study of Police Perspectives

Abstract

We undertook a qualitative exploration of police perspectives on injecting drug use and needle and syringe access among injecting drug users (IDUs) in a Russian city which has witnessed explosive spread of HIV associated with drug injecting. Twenty-seven in-depth qualitative interviews were conducted in May 2002 with police officers of varying rank who reported having regular contact with IDUs. All interviews were tape-recorded, transcribed, translated and coded thematically. Accounts upheld an approach to policing which emphasised high street-based visibility and close surveillance of IDUs. IDUs were depicted as 'potential criminals' warranting a 'pre-emptive' approach to the prevention of drug-related crime. Street policing was described as a means of maintaining close surveillance leading to the official registration of persons suspected or proven to be users of illicit drugs. Such registration enabled further ongoing surveillance, including through stop and search procedures. While aware of drug users' reluctance to carry injecting equipment linked to their fears of detention or arrest, accounts suggested that the confiscation of previously used injecting equipment can constitute evidence in relation to drugs possession charges and that discovery of clean injecting equipment may be sufficient to raise suspicion and/or further investigation, including through stop and search or questioning. Our findings suggest an uneasy relationship between street policing and needle and syringe access, whereby policing strategies can undermine an HIV prevention ethos promoting needle and syringe accessibility among IDUs. We conclude that facilitating partnerships between policing agencies and HIV prevention initiatives are a critical feature of creating environments conducive for risk reduction.

Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

“…[7][8][9][10][11][12][13][14]23,26,46,48,49 Previous studies along Mexico's North Border have contributed to this international consensus by identifying a panoply of associations between criminal justice experiences and behavioral risk factors, including syringe sharing. 29,50,51 We have also observed independent associations between arrest and HIV status.…”

“…10,11,13,16 Police practices rooted in such laws can further facilitate individuals' risky behavior (including receptive syringe sharing and unprotected sex) 18,21 and interfere with public health efforts targeting high-risk populations. 9,[22][23][24] Formal policies and their enforcement are increasingly seen as critical structural factors that shape the "risk environment" for the production of health and disease among vulnerable groups and society at large, including vulnerability to HIV infection. 22,[24][25][26][27] This framework posits that health outcomes result from an interplay of multi-level influences originating from environmental and structural processes rather than a product of merely individual-level characteristics or behaviors.…”

“…Although police officers may perceive syringe confiscation as deterring drug use and furthering occupational safety, 31 evidence suggests that it instead triggers HIV risk behaviors: IDUs may react to confiscation by sharing syringes with others, rushing injection and injecting in public places most proximate to drug acquisition points, and using services of hit doctors or shooting galleries. 23,24,32,33 Syringe confiscation may also deter IDUs from carrying syringes to avoid detection, extortion, and abuse, meanwhile encouraging dangerous injection behaviors designed to conceal track marks, including groin injection. 5,29,33 More broadly, extra-judicial police practices undermine IDU trust in the laws authorizing syringe possession and erode the credibility of community health providers who promote syringe access.…”

“…22,34,35 In aggregate, the real and perceived barriers to safer practices and service access help explain the observed associations between report of syringe confiscation and risk behavior among IDUs. 23,24,29,36 Expanding on the findings from a broader initiative to understand the risk environment of FSW-IDUs along Mexico's Northern Border, 16,18 this analysis focuses on identifying behavioral and health status correlates of syringe confiscation. Based on existing empirical and theoretical literature, we hypothesized that exposure to syringe confiscation may be associated with respondent risk behavior (e.g., receptive syringe sharing, unprotected sex) and increase the odds of positive STI/HIV diagnoses.…”

Women, Harm Reduction and HIV

“…79 Registration can be especially threatening to women, whose custody of their children can be jeopardised and who face severe stigma and discrimination when their drug use is exposed. In Russia, a diagnosis of drug addiction is legal grounds for loss of parental rights, providing women with a clear reason to avoid drug treatment (Personal communication, Lev Levinson, 2007).…”