Friedman Joseph, Syvertsen Jennifer L, Bourgois Philippe, Bui Alex, Beletsky Leo, Pollini Robin
Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States.
Department of Anthropology, University of California, Riverside, California, United States.
Int J Drug Policy. 2021 Jan;87:102981. doi: 10.1016/j.drugpo.2020.102981. Epub 2020 Oct 28.
Abusive and violent policing is an important determinant of health for people who inject drugs (PWID), which has been linked to structural vulnerability. However, further exploration of the intersectional nature of this vulnerability is warranted. California's Central Valley is a largely rural/suburban and politically conservative area, with high rates of injection drug use and overdose mortality, where rates of abusive policing of PWID have not been characterized.
We assessed self-reported experiences of abusive policing using a sequential mixed-methods approach, consisting of n = 54 in-depth qualitative interviews followed by a respondent driven survey of n = 494 PWID. Qualitative conclusions were used to guide the development a novel quantitative framework to explore intersectional structural vulnerability, drawing on UpSet visualization and multivariable logistic regression.
Qualitative analysis suggests that abusive policing is not random or isolated; instead it can be understood in the context of routinized police harassment of PWID, which can escalate into physical or other forms of violence. These cycles are mediated by various forms of social disadvantage-often articulated through the frame of "looking like a drug user"-with deep connections to markers of race, class, gender, occupation and other elements of personal identity. Quantitative results confirm high frequency of abusive encounters with police, including physical violence (42%), verbal abuse (62%), sexual violence (9%), and the confiscation of new/unused syringes (39%). Females report higher rates of sexual violence and exploitation (aOR= 4.2; 95% CI: 2.1-9.0) and males report higher rates of physical violence (aOR=3.6; 95% CI: 2.4-5.6) and all other outcomes. Experiencing homelessness, having traded sex, and living in a rural zip code, are independently associated with numerous forms of police abuse. Intersectional analysis reveals clusters of individuals with highly elevated vulnerability, and in general, having a greater number of vulnerability factors was associated with increased odds of police abuse.
We find that structural vulnerability is linked-in a highly intersectional manner-with experiencing abusive police encounters among PWID in California's Central Valley. Monitoring, prevention, and response to deleterious law enforcement practices must be integrated into structural interventions to protect vulnerable groups. Reform is especially urgent in rural/suburban areas that are increasingly important focal points to reduce social and health harms associated with injection drug use.
对注射吸毒者而言，警察的虐待和暴力行为是其健康的重要决定因素，这与结构性脆弱性相关联。然而，有必要进一步探究这种脆弱性的交叉性本质。加利福尼亚州中央谷地主要是农村/郊区地区，政治上较为保守，注射吸毒率和过量用药死亡率很高，但对注射吸毒者的警察虐待率尚无特征描述。
我们采用序贯混合方法评估了自我报告的警察虐待经历，包括54次深入的定性访谈，随后对494名注射吸毒者进行了应答驱动抽样调查。定性结论用于指导开发一个新的定量框架，以利用UpSet可视化和多变量逻辑回归探索交叉性结构脆弱性。
定性分析表明，警察的虐待行为并非随机或孤立的；相反，它可以在警察对注射吸毒者的常规骚扰背景下得到理解，这种骚扰可能升级为身体暴力或其他形式的暴力。这些循环由各种形式的社会劣势所介导，这些劣势通常通过“看起来像吸毒者”这一框架来表达，与种族、阶级、性别、职业和个人身份的其他要素的标志有着深刻联系。定量结果证实，与警察的虐待性接触频率很高，包括身体暴力（42%）、言语虐待（62%）、性暴力（9%）以及没收新的/未使用的注射器（39%）。女性报告的性暴力和剥削发生率更高（调整后比值比=4.2；95%置信区间：2.1-9.0），男性报告的身体暴力发生率更高（调整后比值比=3.6；95%置信区间：2.4-5.6）以及所有其他结果。经历过无家可归、从事过性交易以及居住在农村邮政编码地区，均与多种形式警察虐待独立相关。交叉性分析揭示了高度脆弱的个体集群，总体而言，拥有更多脆弱因素与警察虐待几率增加相关。
我们发现，在加利福尼亚州中央谷地的注射吸毒者中，结构性脆弱性以高度交叉的方式与遭受警察虐待性接触相关联。对有害执法行为的监测、预防和应对必须纳入结构性干预措施，以保护弱势群体。在农村/郊区地区，改革尤为迫切，这些地区日益成为减少与注射吸毒相关的社会和健康危害的重要焦点。
