AIDS and Behavior

, Volume 17, Issue 8, pp 2637–2643 | Cite as

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

  • Karla D. Wagner
  • Rebecca Simon-Freeman
  • Ricky N. Bluthenthal
Original Paper


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.


HIV Policing Injection drug use Syringe sharing 


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.


  1. 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.PubMedCrossRefGoogle Scholar
  2. 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. Accessed 13 Jan 2013.
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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. 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.CrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Kelling GL, Wilson JQ. Broken windows: the police and neighborhood safety. Atlantic Monthly; 1982. Accessed 14 May 2012.
  12. 12.
    Los Angeles Police Department, editor. Central Area Safer Cities Initiative. Manhattan Institute/Milken Institute Policing “Skid Row” Conference; 2008. Accessed 10 Jan 2013.
  13. 13.
    Los Angeles Police Department. Central Area Safer Citieis Initiative Fact Sheet (February 15, 2011). Accessed 10 Jan 2013.
  14. 14.
    Patton MQ. Qualitative research & evaluation methods. Thousand Oaks, CA: Sage Publications, Inc.; 2002.Google Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 18.
    Miles MS, Huberman AM. Qualitative data analysis: An expanded sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications; 1994.Google Scholar
  19. 19.
    Strauss AL, Corbin J, editors. Grounded theory in practice. Thousand Oaks, CA: Sage Publications; 1997.Google Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 22.
    Davidson PJ. Space, Place, and Young Injecting Drug Users in San Francisco (Ph.D. Dissertation) University of California, San Francisco; 2009.Google Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 29.
    Gorman A. L.A. Could Resume Controversial Cleanup Sweeps in Skid Row. Los Angeles Times. 2012.,0,3611495.story. Accessed 23 July 2012.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Karla D. Wagner
    • 1
  • Rebecca Simon-Freeman
    • 2
  • Ricky N. Bluthenthal
    • 3
  1. 1.Division of Global Public Health, Department of MedicineUniversity of California San DiegoLa JollaUSA
  2. 2.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Preventive Medicine, Keck School of Medicine, Institute for Health Promotion and Disease Prevention ResearchUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations