Police interactions are associated with higher HIV risks for people who inject drugs, according to new research. An analysis of data from studies conducted in nine different countries found that policing was associated with people’s avoidance of harm reduction services and with riskier injection behaviors—regardless of countries’ varying drug criminalization policies. The analysis was published on November 13 in Epidemiologic Review.
In six of the 27 studies analyzed, HIV infection among people who inject drugs (PWID) was “significantly associated” with police presence resulting in syringe confiscation, avoidance of carrying syringes due to fear of police, and rushed injection practices due to police presence. In nine of the studies, policing was associated with avoidance of services like syringe exchanges, methadone programs and safe consumption sites. And in 16 of the studies—more than half—policing practices were found to be associated with PWID using riskier injection practices, such as sharing syringes or going to “shooting galleries.”
The countries from which data were analyzed included: Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine and the United States.
“One of our assumptions early on was that places where drugs are criminalized, and where enforcement strategies are more intense, might have more of this research going on,” Pieter Baker, first author of the Epidemiologic Review paper, told Filter. “But we found this in North America, Eastern Europe, many places that represent a wide variety of drug contexts. So even in places like Tijuana, Mexico, where small amounts of drugs have been decriminalized, police officers still have a lot of tools in their tool belt.”
“One of the biggest takeaways was how globally prevalent this phenomenon is.”
Beyond just incarceration, those tools, as identified in the analysis, include: street harassment, extrajudicial arrest, bribery, intimidation, drug-planting, stop-and-frisk, extortion and physical abuse. The range of policing behaviors studied in the available data was so wide it that prevented the authors from doing a meta analysis, which would require more homogeneity among the analyzed variables.
“One of the biggest takeaways was how globally prevalent this phenomenon is,” Baker said. “There are many places where this particular line of research, on street-level enforcement practices, is under-represented … but we can assume that, because injection drug use has been documented, these interactions are taking place.”
Because the analysis showed lower-income PWID to be underrepresented in the data, it’s almost certain that the link between policing and HIV prevalence is significantly stronger than the existing research suggests. HIV prevalence linked with injection drug use is highest among low- to middle-income populations.
The data analyzed were gathered between 1981 and 2018, meaning that they does not reflect two seismic shifts in the landscape of US drug use—the COVID-19 pandemic; and the eruption of protests against racist police brutality and the ensuing escalation of police violence.
“My guess would be that these two factors—COVID disruptions and aggressive policing—have a similar affect of metering access to harm reductions facilities,” Baker said.
“These street-level interactions—regardless of what the drug policy is—are what’s important.”
In an election year that saw a record number of landmark drug policy reforms pushed through, evidence like this is a crucial reminder that progressive policy alone is not a victory—what matters is what’s enforced at the street level. Syringe exchange program cards authorizing participants to legally carry syringes have never prevented police from confiscating those syringes if that’s what they want to do. Naloxone can still be considered probable cause for a warrant. Police presence is a continued public health threat to PWID regardless of what the drug policy happens to be where they live.
“We can celebrate drug decriminalization from the point of view of protecting people who use drugs, because we know the harms of criminalization, but we have to take into account that policies themselves may not have that immediate impact on individuals’ lives,” Baker said. “Maybe the law will preclude someone from having a lot of jail time, but these street-level interactions—regardless of what the drug policy is—are what’s important.”
Photograph of police in Mexico via Needpix.com/Public Domain