Background: The law and its enforcement are structural determinants of the HIV risk environment among people who inject drugs (PWID). Certain policing practices, such as syringe confiscation are consistently associated with increased HIV risk, but these relationships have not been systematically assessed. Our objective was to conduct a systematic literature review to provide a quantitative synthesis of policing practices acting as structural risk factors for HIV and its risk behaviors among PWID.
Methods: From September 2017 to November 2018, we conducted a systematic literature review (PROSPERO #CRD42018105967) screening MEDLINE, sociological databases and grey literature for quantitative studies conducted from 1981-2018 that included estimates of HIV infection or risky IDU behaviors and associations with policing practices that are adversely related to PWID health (syringe confiscation, beatings, arrest, etc). Abstracts were screened and those identified to contain elements of HIV risk and policing behaviors among PWID were selected for further review. We abstracted data on drug related harms and policing practices from eligible studies.
Results: Of 8,201 abstracts screened, 175 full text articles were reviewed; 26 eligible articles presenting associations between policing and HIV risk behaviors among PWID were included. Eligible studies originated from nine countries (Russia, Mexico, USA, Canada, Ukraine, Thailand, Malaysia, China and India) across various per-capita GDP income levels. HIV infection was significantly associated with syringe confiscation (Odds Ratio [OR]=2.04;95% Confidence Interval [CI]=1.00-4.21 and OR=2.38;CI=1.17-4.81) new syringe confiscation (OR=5.50;CI=1.80-16.6), not buying syringes for fear of police (OR=3.30;CI=1.40-7.60), not carrying syringes for fear of police (OR=2.20;CI=1.10-4.40), rushed injection due to police presence (OR=20.6;CI=10.00-42.70), pre-loaded syringe confiscation (OR=3.50;CI=1.906.40), fear of arrest (OR=0.62;CI=0.42-0.93), forced to buy back syringe from police (OR=2.90;CI=1.50-5.40), arrested for planted drugs (OR=3.00;CI=1.30-6.80), beaten or tortured (OR=3.10;CI=1.50-6.50 and OR=1.35;CI=1.08-1.67).
Conclusions: Policing practices influencing HIV and drug-related risk were pervasive among PWID populations with high HIV burden across diverse global settings. There is an urgent need for interventions to transform police encounters with PWID from a source of harm to a source of harm reduction.