Case study

Harm Reduction Journal

, 9:17

Open Access This content is freely available online to anyone, anywhere at any time.

Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware

  • Basha SilvermanAffiliated withBrandywine Counseling and Community Services IncBryn Mawr Graduate School of Social Work, Social Work Research Email author 
  • , Corey S DavisAffiliated withNetwork for Public Health Law
  • , Julia GraffAffiliated withAmerican Civil Liberties Union Foundation of Delaware
  • , Umbreen BhattiAffiliated withAmerican Civil Liberties Union Foundation of Delaware
  • , Melissa SantosAffiliated withSantos Architecture and Graphic Design
  • , Leo BeletskyAffiliated withBouve College of Health Sciences, Northeastern University School of Law



Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference.

Case description

In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals.


We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety.


A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations.