Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA.
Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.
Harm Reduct J. 2022 Sep 30;19(1):109. doi: 10.1186/s12954-022-00684-8.
Existing research in urban areas has documented a multitude of ways in which law enforcement may affect risks for bloodborne infectious disease acquisition among people who inject drugs (PWID), such as via syringe confiscation and engaging in practices that deter persons from accessing syringe services programs (SSPs). However, limited work has been conducted to explore how law enforcement may impact SSP implementation and operations in rural counties in the United States. This creates a significant gap in the HIV prevention literature given the volume of non-urban counties in the United States that are vulnerable to injection drug use-associated morbidity and mortality.
This study explores the influence of law enforcement during processes to acquire approvals for SSP implementation and subsequent program operations in rural Kentucky counties.
From August 2020 to October 2020, we conducted eighteen in-depth qualitative interviews among persons involved with SSP implementation in rural counties in Kentucky (USA). Interviews explored the factors that served as barriers and facilitators to SSP implementation and operations, including the role of law enforcement.
Participants described scenarios in which rural law enforcement advocated for SSP implementation; however, they also reported police opposing rural SSP implementation and engaging in adverse behaviors (e.g., targeting SSP clients) that may jeopardize the public health of PWID. Participants reported that efforts to educate rural law enforcement about SSPs were particularly impactful when they discussed how SSP implementation may prevent needlestick injuries.
The results of this study suggest that there are multiple ways in which rural SSP implementation and subsequent operations in rural Kentucky counties are affected by law enforcement. Future work is needed to explore how to expeditiously engage rural law enforcement, and communities more broadly, about SSPs, their benefits, and public health necessity.
现有的城市研究已经记录了执法部门可能通过多种方式影响注射吸毒者（PWID）获得血源性病原体感染的风险，例如没收注射器和采取措施阻止人们使用注射器服务项目（SSP）。然而，在美国农村县，对于执法部门如何影响 SSP 的实施和运作，相关工作有限，这在艾滋病毒预防文献中留下了一个重大空白。鉴于美国大量的非城市县容易受到与注射毒品使用相关的发病率和死亡率的影响，这是一个重大的空白。
本研究探讨了执法部门在获得 SSP 实施批准和随后在肯塔基州农村县开展项目运作过程中的影响。
从 2020 年 8 月至 2020 年 10 月，我们在肯塔基州（美国）农村县参与 SSP 实施的人员中进行了 18 次深入的定性访谈。访谈探讨了影响 SSP 实施和运作的障碍和促进因素，包括执法部门的作用。
参与者描述了农村执法部门倡导 SSP 实施的情况；然而，他们也报告了警察反对农村 SSP 实施和采取不利行为（例如，针对 SSP 客户）的情况，这可能危及 PWID 的公共卫生。参与者报告说，当他们讨论 SSP 的实施如何预防针刺伤时，向农村执法部门教育 SSP 的努力特别有影响力。
本研究结果表明，执法部门对肯塔基州农村县的 SSP 实施和随后的运作有多种影响方式。未来需要进一步研究如何迅速让农村执法部门以及更广泛的社区了解 SSP、它们的益处以及公共卫生的必要性。
