Skip to main content

Advertisement

SpringerLink
Log in

The Association Between Law Enforcement Encounters and Syringe Sharing Among IDUs on Skid Row: A Mixed Methods Analysis

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The legal environment is one factor that influences injection drug users’ (IDUs) risk for HIV and other bloodborne pathogens such as hepatitis C virus (HCV). We examined the association between law enforcement encounters (i.e., arrests and citations) and receptive syringe sharing among IDUs in the context of an intensified policing effort. We conducted a mixed methods analysis of 30 qualitative and 187 quantitative interviews with IDUs accessing services at a Los Angeles, CA syringe exchange program from 2008 to 2009. Qualitative findings illustrate concerns related to visibility, drug withdrawal, and previous history of arrest/incarceration. In quantitative analysis, the number of citations received, current homelessness, and perceiving that being arrested would be a “big problem” were independently associated with recent syringe sharing. Findings illustrate some of the unintended public health consequences associated with intensified street-level policing, including risk for HIV and HCV transmission.

Resumen

El ambiente legal es uno de factores que influyen en el riesgo de infección por VIH y otros patógenos trasmitidos por sangre tales como virus de hepatitis C (VHC) en los usuarios de drogas inyectables (UDIS). Examinamos la asociación entre los encuentros con elementos de seguridad pública (por ejemplo arrestos y citatorios) y el uso receptivo de jeringas compartidas dentro de los UDIS en el contexto de intensificar los esfuerzos policiacos. Conducimos un análisis de métodos mixtos de 30 entrevistas cualitativas y 187 entrevistas cuantitativas con UDIS que accedían a los servicios del programa de intercambio de jeringas en Los Ángeles, CA del 2008–2009. Los resultados cualitativos ilustran consternación relacionada con visibilidad, la malilla (sindrome de abstinencia) e historia previa de arrestos/encarcelación. En el análisis cuantitativo, el número de citatorios recibidos, situación de calle actual y la percepción de que el ser arrestado involucraría un mayor problema, fueron independientemente asociados con el uso reciente de jeringas compartidas. Los resultados ilustran algunas de las consecuencias de salud pública no intencionales asociadas con actividades policíacas intensificadas a nivel de calle, incluyendo el riesgo de trasmisión de VIH y VHC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, Case P, et al. Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop. Milbank Q. 2004;82(1):125–56.

    Article  PubMed  Google Scholar 

  2. Burris S, Strathdee SA, Vernick JS. Syringe access law in the United States: a state of the art assessment of law and policy; 2002. http://www.publichealthlaw.net/Research/PDF/syringe.pdf. Accessed 13 Jan 2013.

  3. Friedman SR, Cooper H, Templaski B, Keem M, Friedman R, Flom PL, et al. Relationships of Deterrence and Law Enforcement to Drug-related Harms Among Drug Injectors in US Metropolitan Areas. AIDS. 2006;20:93–9.

    Article  PubMed  Google Scholar 

  4. Bluthenthal RN, Kral AH, Lorvick J, Watters JK. Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco. Med Anthropol. 1997;18(1):61–83.

    Article  PubMed  CAS  Google Scholar 

  5. Davis CS, Burris S, Kraut-Becher J, Lynch KG, Metzger D. Effects of an intensive street-level police intervention on syringe exchange program use in Philadelphia PA. Am J Public Health. 2005;95(2):233–6.

    Article  PubMed  Google Scholar 

  6. Miller CL, Firestone M, Ramos R, Burris S, Ramos ME, Case P, et al. Injecting drug users’ experiences of policing practices in two Mexican-U.S. border cities: public health perspectives. Int J Drug Policy. 2008;19(4):324–31.

    Article  PubMed  Google Scholar 

  7. Martinez AN, Bluthenthal RN, Lorvick J, Anderson R, Flynn N, Kral AH. The Impact of Legalizing Syringe Exchange Programs on arrests among injection drug users in California. J Urban Health. 2007;84(3):423–35.

    Article  PubMed  Google Scholar 

  8. Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Drug paraphernalia laws and injection-related infectious disease risk among drug injectors. J Drug Issues. 1999;29(1):1–16.

    Google Scholar 

  9. Bluthenthal RN, Lorvick J, Kral AH, Erringer EA, Kahn JG. Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. Int J Drug Policy. 1999;10:25–38.

    Article  Google Scholar 

  10. Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodriguez C, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities. Addiction. 2008;103(1):101–8.

    Article  PubMed  Google Scholar 

  11. Kelling GL, Wilson JQ. Broken windows: the police and neighborhood safety. Atlantic Monthly; 1982. http://www.theatlantic.com/magazine/archive/1982/03/broken-windows/4465/. Accessed 14 May 2012.

  12. Los Angeles Police Department, editor. Central Area Safer Cities Initiative. Manhattan Institute/Milken Institute Policing “Skid Row” Conference; 2008. www.lapdonline.org. Accessed 10 Jan 2013.

  13. Los Angeles Police Department. Central Area Safer Citieis Initiative Fact Sheet (February 15, 2011). www.lapdpolicecom.lacity.org/030811/BPC_11-0103.pdf. Accessed 10 Jan 2013.

  14. Patton MQ. Qualitative research & evaluation methods. Thousand Oaks, CA: Sage Publications, Inc.; 2002.

    Google Scholar 

  15. Wagner KD, Lankenau SE, Palinkas LA, Richardson JL, Chou C-P, Unger JB. The perceived consequences of safer injection: An exploration of qualitative findings and gender differences. Psychol Health Med. 2010;15(5):560–73.

    Article  PubMed  Google Scholar 

  16. Garfein RS, Golub ET, Greenberg A, Hagan H, Hanson DL, Hudson SM, et al. A peer-education intervention to reduce injection risk behaviors for HIV and HCV infection in young injection drug users. AIDS. 2007;21(14):1923–32.

    Article  PubMed  Google Scholar 

  17. Needle RH, Fisher DG, Weatherby N, Chitwood D, Brown B, Cesari H, et al. Reliability of self-reported HIV risk behaviors of drug users. Psychol Addict Behav. 1995;9(4):242–50.

    Article  Google Scholar 

  18. Miles MS, Huberman AM. Qualitative data analysis: An expanded sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications; 1994.

    Google Scholar 

  19. Strauss AL, Corbin J, editors. Grounded theory in practice. Thousand Oaks, CA: Sage Publications; 1997.

    Google Scholar 

  20. Martinez AN, Bluthenthal RN, Neilands T, Kral AH. Assessing geographic and individual level factors associated with arrests among injection drug users in California. Health Place. 2011;17(6):1258–65.

    Article  PubMed  Google Scholar 

  21. Wagner KD, Davidson PJ, Pollini RA, Strathdee SA, Washburn R, Palinkas LA. Reconciling incongruous qualitative and quantitative findings in mixed methods research: Exemplars from research with drug using populations. Int J Drug Policy. 2011;23(2012):54–61.

    PubMed  Google Scholar 

  22. Davidson PJ. Space, Place, and Young Injecting Drug Users in San Francisco (Ph.D. Dissertation) University of California, San Francisco; 2009.

  23. Small W, Kerr T, Charette J, Schechter MT, Spittal PM. Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation. Int J Drug Policy. 2006;17(2):85–95.

    Article  Google Scholar 

  24. Beletsky L, Grau LE, White E, Bowman S, Heimer R. The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs. Addiction. 2011;106(2):357–65.

    Article  PubMed  Google Scholar 

  25. Berk R, MacDonald J. Policing the homeless: An evaluation of efforts to reduce homeless-related crime. Criminol Public Policy. 2010;9(4):813–40.

    Article  Google Scholar 

  26. Beletsky L, Agrawal A, Moreau B, Kumar P, Weiss-Laxer N, Heimer R. Police training to align law enforcement and HIV prevention: preliminary evidence from the field. Am J Public Health. 2011;101(11):2012–5.

    Article  PubMed  Google Scholar 

  27. Tsemberis S, Gulcur L, Nakae M. Housing first, consumer choice, and harm reduction for homeless Individuals with a dual diagnosis. Am J Public Health. 2004;94(4):651–6.

    Article  PubMed  Google Scholar 

  28. Semaan S, Fleming P, Worrell C, Stolp H, Baack B, Miller M. Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug Alcohol Depend. 2011;118(2–3):100–10.

    Article  PubMed  Google Scholar 

  29. Gorman A. L.A. Could Resume Controversial Cleanup Sweeps in Skid Row. Los Angeles Times. 2012. latimes.com/news/local/la-me-skid-row-violation-20120605,0,3611495.story. Accessed 23 July 2012.

Download references

Acknowledgments

We would like to thank the study participants who provided the data for this report. Thanks are also due to Brett Mendenhall and the field site directors and staff, particularly Mark Casanova and James Hundley. And finally, thanks to Professor Gary Blasi. This study was supported by National Institutes of Health Grants: R36DA024698 (Wagner), K01DA031031 (Wagner), and R01DA027689 (Bluthenthal). The funders had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0849, La Jolla, CA, 92093-0849, USA

    Karla D. Wagner

  2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Rebecca Simon-Freeman

  3. Department of Preventive Medicine, Keck School of Medicine, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA

    Ricky N. Bluthenthal

Authors
  1. Karla D. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca Simon-Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricky N. Bluthenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karla D. Wagner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wagner, K.D., Simon-Freeman, R. & Bluthenthal, R.N. The Association Between Law Enforcement Encounters and Syringe Sharing Among IDUs on Skid Row: A Mixed Methods Analysis. AIDS Behav 17, 2637–2643 (2013). https://doi.org/10.1007/s10461-013-0488-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0488-y

Keywords

Search

Navigation