Policing practices and HIV Risk Among People Who Inject Drugs - a Systematic Literature Review.

Drug law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Police-PWID street encounters (e.g. syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review (PROSPERO#CRD42018105967) to evaluate the contribution of policing to HIV risk among PWID. We screened MEDLINE, sociological databases and grey literature for studies from 1981-November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles and included 27 eligible analyses from nine countries (Russia, Mexico, United States, Canada, Ukraine, Thailand, Malaysia, China and India). Heterogeneity in variable and endpoint selection precluded meta-analyses. In six (22%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to police presence, fear of arrest, being arrested for planted drugs, and physical abuse. A total of 16 (59%) studies identified policing practices to be associated with risky injection behaviors (e.g. syringe sharing, shooting gallery utilization). In nine (33%), policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.