Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, Pa

Davis, Corey S.; Burris, Scott; Kraut-Becher, Julie R.; Lynch, Kevin G.; Metzger, David S.

doi:10.2105/ajph.2003.033563

Cited by 134 publications

(104 citation statements)

References 26 publications

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“…[31][32][33][34][35][36][37][38][39][40][41] Notably, however, some past research suggests that SEPs are able to maintain the volume of syringes they distribute during police drug crackdowns, though the number of injectors going to the SEPs declines. 82,83 Our findings suggest that sustaining the volume of syringes flowing into communities when drug-related enforcement activities intensify is not enough; drug-related arrests appear to hinder injectors' ability to actually use these syringes.…”

Section: Discussionmentioning

confidence: 99%

“…Local drug-related law enforcement activities targeting drug users impede injectors' efforts both to go to SEPs, and to inject safely. [31][32][33][34][35][36][37][38][39][40][41] The relationship between spatial access to syringes and injecting with an unsterile syringe may be attenuated in heavily policed settings.…”

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

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Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

et al. 2012

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Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the USA, these interventions-and specifically SEP site locations-remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Annual measures of spatial access to syringes in each UHF district (N = 42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N = 4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in 975% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.

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Section: Discussionmentioning

confidence: 99%

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

et al. 2012

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“…22 Police surveillance of the service points and confiscation of legally obtained syringes in or around these programs may directly interfere in their functioning and reduce their public health impact. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Lozada²,

et al. 2012

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Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/ STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSWIDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48 %. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR]=2.54, 95 % confidence interval [CI]=1.11-5.80), reporting sexual abuse by police (aOR=12.76, 95 % CI=6.58-24.72), engaging in groin injection (aOR=1.84, 95 % CI=1.15-2.93), injecting in public (aOR=1.64; 95 % CI=1.14-2.36), and obtaining syringes from pharmacies (aOR=1.54; 95 % CI=1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR= 0.92, 95 % CI=0.87-0.98) as was frequent injection with clients within the last month (aOR=0.64,). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.

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“…In a recent study of 89 metropolitan areas in the United States, Friedman and colleagues [18] showed that higher levels of legal repressiveness (including number of arrests for heroin and cocaine possession) were associated positively with HIV prevalence among IDUs. In Philadelphia, intensified policing activity was associated with a significant reduction in syringe exchange program utilization [19]. At the individual level, a study of 424 IDUs in San Francisco found that those who feared arrest for drug paraphernalia possession were twice as likely to report syringe sharing than IDUs who did not share this concern; however, previous arrest was not associated independently with syringe sharing [20].…”

Section: Introductionmentioning

confidence: 99%

Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities

Pollini

Brouwer

Lozada³

et al. 2007

Addiction

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Aims To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing.Design Cross‐sectional study.Setting Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua.Participants IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent‐driven sampling (RDS). IDUs were ≥ 18 years and had injected illicit drugs in the past month.Measurements An interviewer‐administered survey was used to collect quantitative data on socio‐demographic, behavioral and contextual characteristics, including self‐reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment.Findings Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69).Conclusions We documented high levels of syringe‐related arrests in two Mexican–US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices.

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Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, Pa

Cited by 134 publications

References 26 publications

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

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

Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities

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