British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Lancet HIV. 2017 Aug;4(8):e357-e374. doi: 10.1016/S2352-3018(17)30073-5. Epub 2017 May 14.
Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment.
Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language.
We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects.
These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use.
Canadian Institutes of Health Research and US National Institutes of Health.
越来越多的证据表明，禁止非法使用毒品的法律和政策可能在塑造注射毒品者（PWID）的健康结果方面发挥核心作用。迄今为止，尚无系统评价描述禁止毒品使用的法律和法律框架对 HIV 预防和治疗的影响。
根据 PRISMA 指南，我们对描述药物使用刑事定罪与 PWID 的 HIV 预防和治疗相关结果之间关联的同行评议科学证据进行了系统评价。我们检索了 MEDLINE、Embase、SCOPUS、PsycINFO、Sociological Abstracts、CINAHL、Web of Science 和其他来源。要纳入我们的综述，研究必须符合以下纳入标准：在同行评议的期刊上发表或在科学会议上作为同行评议摘要呈现；通过任何研究设计，检查预先设定的与毒品刑事定罪相关的一系列指标与 PWID 的 HIV 预防或治疗之间的关联；提供足够详细的方法细节，以便对质量进行批判性评估；发表或呈现时间为 2006 年 1 月 1 日至 2014 年 12 月 31 日；并以英文发表。
我们确定了 106 项符合条件的研究，包括 29 项纵向研究、49 项横断面研究、22 项定性研究、2 项混合方法研究、4 项数学模型研究和没有随机对照试验。确定了 120 个刑事定罪指标（每项研究 1-3 个）和 150 个 HIV 指标（每项研究 1-5 个）。最常见的刑事定罪指标是监禁（n=38）和街头警务（n=39），而最常见的 HIV 预防和治疗指标是共用注射器（n=35）和 PWID 中 HIV 感染的流行率（n=28）。在本综述中纳入的 106 项研究中，85 项（80%）表明药物刑事定罪对 HIV 预防和治疗有负面影响，10 项（9%）表明没有关联，5 项（5%）表明有有益影响，1 项（1%）表明既有有益影响也有负面影响，5 项（5%）表明既有中性影响也有负面影响。
这些数据证实，药物使用的刑事定罪对 HIV 预防和治疗有负面影响。我们的结果为支持许多改革毒品使用刑事定罪的法律和政策框架的国际政策倡议提供了客观的证据基础。
加拿大卫生研究院和美国国立卫生研究院。
