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Operationalizing the Enabling Environment: A Binational Partnership

Operationalizing the Enabling Environment: A Binational Partnership . Steffanie A. Strathdee (University of California San Diego, La Jolla, CA, USA), Leo Beletsky (Northeastern University School of Law and Bouvé College of Health Sciences , Boston, U.S), . Local Context: Mexico.

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Operationalizing the Enabling Environment: A Binational Partnership

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  1. Operationalizing the Enabling Environment: A Binational Partnership Steffanie A. Strathdee (University of California San Diego, La Jolla, CA, USA), Leo Beletsky (Northeastern University School of Law and BouvéCollege of Health Sciences, Boston, U.S),

  2. Local Context: Mexico • Legal to purchase and/or carry syringes without a prescription yet police regularly confiscate syringes • Recent drug policy reform (“narcomenudeo”) partially decriminalizing small amounts of drugs for personal possession

  3. Case Study: Where syringe purchase and possession is legal without a prescription • Q: Can you tell me, do you know if it is legal for you to carry syringes? • A: No. Every time I’ve had them I’ve gotten into trouble. It’s a joke! I have bought them literally for six pesos. But you can’t carry them on you; I don’t understand that. How come you’re allowed to buy them but not carry? • (Female, 31 years)

  4. Direct Effects of Law Enforcement on HIV Risks • Discourages PWID from carrying sterile or used syringes • Fuel risky injection via “hurried injecting” • Pressures PWID to inject in unsafe spaces (e.g., shooting galleries) • Prompts risky drug and syringe storage practices that can contribute to needlestick injuries (NSI)

  5. Indirect Effects of Law Enforcement on HIV Risks • Displaces PWID into unsafe environments • Discourages PWID from accessing HIV prevention programs (e.g., NSP, OST) • Discourages PWID from accessing emergency response

  6. Extra-Legal Behaviors:Police Misconduct • Sexual Abuse • Physical Abuse • Soliciting Bribes • Evidence Planting • Precipitating forced drug withdrawal

  7. Of 33% who reported sexual favors for police, 86.2% of these were in exchange for not being arrested. Beletsky et al, 2012

  8. Police Perspective Fear of needle stick injury (NSI) and other occupational risks Poor knowledge of infectious disease transmission Often unaware of evidence demonstrating effectiveness of harm reduction, laws relating to syringe purchase and possession and availability and location of local harm reduction services Beletsky et al, 2005

  9. Structural Interventions to Realign Policing and Public Health • Two main types of intervention approaches: • Law on the Books: through legislative advocacy or impact litigation, change the laws affecting PWID • Law on the Streets: Change the way the laws on the books are enforced (or not)

  10. Police Education Programs Davis & Beletsky, 2009 Bundling occupational safety with HIV prevention information • Occupational Safety • Basic infectious disease info and Prevention tips • Glove and sharps containers distribution • Law relating to harm reduction efforts (e.g., syringe possession) • Public health rationale for harm reduction efforts • Service referral information 4. Law Enforcement and HIV Network (LEAHN) Statement of Support

  11. Chronology of Partnership between UCSD and Tijuana Police Department • MOU with police chief (2013) • Tijuana Mayor mandates police education including harm reduction (May, 2014) • First survey of NSI among TJ police department (June, 2014) • Launch of NSI reporting and surveillance (Fall, 2014) • Pre-post PEP pilot (Fall, 2014)

  12. *among those ever report NSI

  13. Percentage

  14. *among those ever reporting encountering needles/syringes while on duty

  15. Conclusions • Policing practices are a pervasive barrier to the implementation and effectiveness of harm reduction programs • There is an urgent need to re-align harm reduction and law enforcement approaches to support prevention and treatment of HIV and viral hepatitis among PWID • Police departments can be willing partners receptive to harm reduction when framed as occupational safety

  16. Acknowledgements • Collaborators: Gudelia Rangel, Jaime Arredondo, Efrain Patino, Maria Luisa Rolon, Arnulfo Banuelos, Dir. Olivarria • People who use drugs who have shared their stories of abuse, humiliation, violence, torture, and loss • National Institute on Drug Abuse grant R37 DA019829, • Open Society Foundation

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