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Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users.

https://arctichealth.org/en/permalink/ahliterature183497
Source
CMAJ. 2003 Sep 30;169(7):656-61
Publication Type
Article
Date
Sep-30-2003
Author
Evan Wood
Julio S G Montaner
Benita Yip
Mark W Tyndall
Martin T Schechter
Michael V O'Shaughnessy
Robert S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC. ewood@hivnet.ubc.ca
Source
CMAJ. 2003 Sep 30;169(7):656-61
Date
Sep-30-2003
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active
British Columbia
CD4 Lymphocyte Count
Female
HIV Infections - blood - drug therapy - etiology
HIV-1
Humans
Male
Patient compliance
RNA, Viral - blood - drug effects
Substance Abuse, Intravenous
Abstract
The benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV infection are well documented, but concerns regarding access and adherence to HAART are growing. We evaluated virological responses to HAART among HIV-1 infected patients who were injection drug users (IDUs) in a population-based setting where HIV/AIDS care is delivered free of charge.
We evaluated previously untreated HIV-1 infected men and women who initiated HAART between Aug. 1, 1996, and July 31, 2000, and who were followed until Mar. 31, 2002, in a province-wide HIV treatment program. We used Kaplan-Meier methods and Cox proportional hazards regression in our evaluation of time to suppression (i.e., less than 500 copies/mL) and rebound (i.e., 500 copies/mL or more) of plasma HIV-1 RNA, with patients stratified according to whether or not they had a history of injection drug use.
Overall, 1422 patients initiated HAART during the study period, of whom 359 (25.2%) were IDUs. In Kaplan-Meier analyses, the cumulative suppression rate at 12 months after initiation of HAART was 70.8% for non-IDUs and 51.4% for IDUs (p 0.1).
Non-IDUs and IDUs had similar rates of HIV-1 RNA suppression and rebound after the initiation of HAART, once lower levels of adherence were taken into account. Nevertheless, the lower virological response rates among IDUs suggest that, unless interventions are undertaken to improve adherence, these patients may experience elevated rates of disease progression and use of medical services in our setting.
Notes
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PubMed ID
14517122 View in PubMed
Less detail

AIDS in 2003: moving forward, falling back.

https://arctichealth.org/en/permalink/ahliterature186012
Source
Can J Public Health. 2003 Mar-Apr;94(2):85-7
Publication Type
Article
Author
Patricia M Spittal
Martin T Schechter
Source
Can J Public Health. 2003 Mar-Apr;94(2):85-7
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - drug therapy - mortality - prevention & control
Antiretroviral Therapy, Highly Active
Canada - epidemiology
Disease Outbreaks
Humans
Prevalence
World Health
Notes
Comment On: Can J Public Health. 2003 Mar-Apr;94(2):93-712675163
Comment On: Can J Public Health. 2003 Mar-Apr;94(2):135-912675171
PubMed ID
12675161 View in PubMed
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Alcohol use and incarceration adversely affect HIV-1 RNA suppression among injection drug users starting antiretroviral therapy.

https://arctichealth.org/en/permalink/ahliterature182124
Source
J Urban Health. 2003 Dec;80(4):667-75
Publication Type
Article
Date
Dec-2003
Author
Anita Palepu
Mark W Tyndall
Kathy Li
Benita Yip
Michael V O'Shaughnessy
Martin T Schechter
Julio S G Montaner
Robert S Hogg
Author Affiliation
All the authors are with the University of British Columbia, British Columbia, Canada. anita@hivnet.ubc.ca
Source
J Urban Health. 2003 Dec;80(4):667-75
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Adult
Alcohol drinking - epidemiology
Antiretroviral Therapy, Highly Active
British Columbia - epidemiology
CD4 Lymphocyte Count
Female
HIV Infections - drug therapy - virology
Humans
Logistic Models
Male
Patient compliance
Prisons
RNA, Viral - blood
Statistics, nonparametric
Substance Abuse, Intravenous - complications
Abstract
We conducted this study among HIV-infected injection drug users to determine the effect of self-reported alcohol use and prior incarceration at the time of initiating antiretroviral therapy on subsequent HIV-1 RNA suppression. We examined the demographics, recent incarceration history, and drug and alcohol use history from the Vancouver Injection Drug User Study (VIDUS) questionnaire closest to the date of initiating antiretroviral therapy. We linked these data to the HIV/AIDS Drug Treatment Program. There were 234 VIDUS participants who accessed antiretroviral therapy through the Drug Treatment Program from August 1, 1996, to July 31, 2001. In terms of illicit drug use, 196 (84%) reported injecting heroin and cocaine at the time of initiating antiretroviral therapy. Multiple logistic regression revealed that in the 6 months prior to initiating antiretroviral therapy, alcohol use (adjusted odds ratio [AOR] 0.32; 95% CI 0.13-0.81) and incarceration (AOR 0.22; 95% CI 0.09-0.58) were independently associated with lower odds of HIV-1 RNA suppression. Factors positively associated with HIV-1 RNA suppression included: adherence (AOR 1.27; 95% CI 1.06-1.51); lower baseline HIV-1 RNA (AOR 1.30; 95% CI 1.01-1.66); highly active antiretroviral therapy (AOR 4.10; 95% CI 1.56-10.6); months on therapy (AOR 1.1; 95% CI 1.06-1.14). Among HIV-infected injection drug users who were on antiretroviral therapy, any alcohol use and incarceration in the 6 months prior to initiating antiretroviral therapy were negatively associated with achieving HIV-1 RNA suppression. In addition to addiction treatment for active heroin and cocaine use, the identification and treatment of alcohol problems should be supported in this setting. As well, increased outreach to HIV-infected drug users recently released from prison to ensure continuity of care needs to be further developed.
Notes
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PubMed ID
14709714 View in PubMed
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An external evaluation of a peer-run "unsanctioned" syringe exchange program.

https://arctichealth.org/en/permalink/ahliterature183989
Source
J Urban Health. 2003 Sep;80(3):455-64
Publication Type
Article
Date
Sep-2003
Author
Evan Wood
Thomas Kerr
Patricia M Spittal
William Small
Mark W Tyndall
Michael V O'Shaughnessy
Martin T Schechter
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. BC V6Z 1Y6. ewood@hivnet.ubc.ca
Source
J Urban Health. 2003 Sep;80(3):455-64
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
HIV Infections - prevention & control - transmission
Humans
Male
Middle Aged
Needle Sharing - adverse effects
Needle-Exchange Programs - organization & administration
Peer Group
Program Evaluation
Prospective Studies
Questionnaires
Risk Reduction Behavior
Risk-Taking
Substance Abuse, Intravenous - virology
Syringes - utilization
Abstract
In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.
Notes
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PubMed ID
12930883 View in PubMed
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Baseline self-perceived risk of HIV infection independently predicts the rate of HIV seroconversion in a prospective cohort of injection drug users.

https://arctichealth.org/en/permalink/ahliterature177233
Source
Int J Epidemiol. 2005 Feb;34(1):152-8
Publication Type
Article
Date
Feb-2005
Author
Evan Wood
Kathy Li
Cari L Miller
Robert S Hogg
Julio S G Montaner
Martin T Schechter
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Vancouver, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. ewood@cfenet.ubc.ca
Source
Int J Epidemiol. 2005 Feb;34(1):152-8
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
British Columbia - epidemiology
Epidemiologic Methods
Female
HIV Infections - prevention & control
HIV Seropositivity - epidemiology - psychology - transmission
Humans
Male
Patient Selection
Risk-Taking
Substance Abuse, Intravenous - complications - psychology
Abstract
The identification of individuals at the highest risk of human immunodeficiency virus (HIV) infection is critical for targeting prevention strategies. We evaluated self-perceived risk of HIV infection and rates of subsequent HIV seroconversion among a prospective cohort study of injection drug users (IDUs).
We performed an analysis of the time to HIV infection among 994 baseline HIV negative IDUs enrolled in the Vancouver injection drug users study (VIDUS). IDUs were stratified based on their baseline self-perceived risk of HIV seroconversion (higher than others vs same or lower). Kaplan-Meier methods were used to estimate cumulative HIV incidence rates and Cox regression was used to determine adjusted relative hazards for HIV seroconversion.
At the end of 24 months after enrolment into the cohort, the cumulative HIV incidence rate was significantly elevated among the 5.9% of the sample who perceived their risk for HIV infection to be higher at baseline (26.6% vs 7.8% log-rank P
Notes
Comment In: Int J Epidemiol. 2005 Feb;34(1):158-915649963
PubMed ID
15561747 View in PubMed
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Binge drug use independently predicts HIV seroconversion among injection drug users: implications for public health strategies.

https://arctichealth.org/en/permalink/ahliterature171303
Source
Subst Use Misuse. 2006;41(2):199-210
Publication Type
Article
Date
2006
Author
Cari L Miller
Thomas Kerr
James C Frankish
Patricia M Spittal
Kathy Li
Martin T Schechter
Evan Wood
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Source
Subst Use Misuse. 2006;41(2):199-210
Date
2006
Language
English
Publication Type
Article
Keywords
British Columbia - epidemiology
Cohort Studies
Female
HIV Seropositivity - epidemiology - transmission
Humans
Male
Prospective Studies
Public Health Practice
Questionnaires
Substance Abuse, Intravenous
Abstract
Several studies have highlighted risk factors that cause HIV vulnerability among injection drug users (IDUs); these studies in turn have prompted public health officials to take action to minimize these risks. We sought to evaluate the potential association between binge drug use and HIV seroconversion and, subsequently, risk factors associated with binge drug use among a cohort of IDUs. To do this, we performed analyses of (1) associations with HIV seroconversion and (2) associations with binge drug use among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of IDU. Because serial measures for each individual were available, we undertook a time-updated Cox regression analysis to detect associations with HIV incidence and variables potentially associated with binge drug use were evaluated by using generalized estimating equations (GEE). Overall, 1548 IDU were enrolled into the VIDUS cohort between May 1996 and May 2003. There were 1013 individuals who were HIV seronegative at enrollment and had at least one follow-up visit; 125 (12%) became HIV positive during the study period for a cumulative incidence rate of 14% at 64 months after enrollment. In the final multivariate model, binge drug use [Adjusted Hazards Ratio: 1.61 (CI: 1.12, 2.31)] was independently associated with HIV seroconversion. In subanalyses, when we evaluated associations with binge drug use in GEE analyses, borrowing [Odds Ratio (OR): 153 (CI: 1.33-1.76)] and lending [OR: 1.73 (CI: 1.50-1.98)] syringes, sex trade work [OR: 1.14 (CI: 1.01-1.29)], frequent cocaine [OR: 2.34 (CI: 2.11-2.60)] and heroin [OR: 1.29 (CI: 1.17-1.43)] injection were independently associated with binge drug use and methadone [OR: 0.80 (CI: 0.71-0.89)] was protective against binge drug use. Our study identified an independent association between binge drug use and HIV incidence and demonstrated several high-risk drug practices associated with bingeing. Given the unaddressed public health risks associated with bingeing, a public health response protocol must be developed to minimize the personal and public health risks associated with the binge use of drugs.
Notes
Comment In: Subst Use Misuse. 2006;41(6-7):841-316809174
PubMed ID
16393742 View in PubMed
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The Cedar Project: correlates of attempted suicide among young Aboriginal people who use injection and non-injection drugs in two Canadian cities.

https://arctichealth.org/en/permalink/ahliterature148942
Source
Int J Circumpolar Health. 2009 Jun;68(3):261-73
Publication Type
Article
Date
Jun-2009
Author
Akm Moniruzzaman
Margo E Pearce
Sheetal H Patel
Negar Chavoshi
Mary Teegee
Warner Adam
Wayne M Christian
Earl Henderson
Kevin J P Craib
Martin T Schechter
Patricia M Spittal
Author Affiliation
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
Source
Int J Circumpolar Health. 2009 Jun;68(3):261-73
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Drug Users - statistics & numerical data
Female
Humans
Indians, North American - statistics & numerical data
Male
Prevalence
Suicide, Attempted - ethnology - statistics & numerical data
Young Adult
Abstract
Aboriginal leadership and families are deeply concerned about the rate of suicide attempt among their young people. The objectives of this study were to (a) describe the prevalence of suicide attempt and (b) to describe correlates of vulnerability to suicide attempts within a cohort of young Aboriginal people who use drugs in 2 Canadian cities. We aimed to situate the findings within the context of historical and lifetime trauma. Study design. The Cedar Project is a prospective cohort study involving 605 young Aboriginal people aged 14-30 who use drugs in Vancouver and Prince George, British Columbia, Canada.
Multivariable logistic regression modelling identified independent predictors of suicide attempts. Estimates of adjusted odds ratios and 95% confidence intervals were calculated.
In multivariable analysis, residing in Prince George (Adjusted Odds Ratio [AOR]: 1.80, 95% CI: 1.23, 2.64), ever having been sexually abused (AOR: 2.07, 95% CI: 1.39, 3.08), and ever having overdosed (AOR: 2.29, 95% CI: 1.53, 3.42) independently predicted lifetime attempted suicide.
Suicide prevention and intervention programs must address historical and lifetime trauma among Aboriginal young people who struggle with substance dependence.
PubMed ID
19705658 View in PubMed
Less detail

The Cedar Project: high incidence of HCV infections in a longitudinal study of young Aboriginal people who use drugs in two Canadian cities.

https://arctichealth.org/en/permalink/ahliterature121793
Source
BMC Public Health. 2012;12:632
Publication Type
Article
Date
2012
Author
Patricia M Spittal
Margo E Pearce
Negar Chavoshi
Wayne M Christian
Akm Moniruzzaman
Mary Teegee
Martin T Schechter
Author Affiliation
Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada. spittal@sm.hivnet.ubc.ca
Source
BMC Public Health. 2012;12:632
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Confidence Intervals
Female
Hepatitis C - epidemiology - ethnology - etiology
Hepatitis C Antibodies - blood
Humans
Indians, North American - statistics & numerical data
Inuits - statistics & numerical data
Male
Population Groups
Proportional Hazards Models
Prospective Studies
Substance Abuse, Intravenous - complications - ethnology
Urban Population
Young Adult
Abstract
Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities.
The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants' venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion.
In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing.
This study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.
Notes
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PubMed ID
22877418 View in PubMed
Less detail

The Cedar Project: historical trauma, sexual abuse and HIV risk among young Aboriginal people who use injection and non-injection drugs in two Canadian cities.

https://arctichealth.org/en/permalink/ahliterature157402
Source
Soc Sci Med. 2008 Jun;66(11):2185-94
Publication Type
Article
Date
Jun-2008
Author
Cedar Project Partnership
Margo E Pearce
Wayne M Christian
Katharina Patterson
Kat Norris
Akm Moniruzzaman
Kevin J P Craib
Martin T Schechter
Patricia M Spittal
Author Affiliation
Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada. margo@mail.hivnet.ubc.ca
Source
Soc Sci Med. 2008 Jun;66(11):2185-94
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - ethnology
Cohort Studies
Female
HIV Infections - epidemiology - ethnology
Humans
Indians, North American
Male
Prevalence
Prospective Studies
Risk factors
Sex Offenses - ethnology - statistics & numerical data
Substance abuse, intravenous - epidemiology - ethnology
Violence - ethnology - statistics & numerical data
Abstract
Recent Indigenist scholarship has situated high rates of traumatic life experiences, including sexual abuse, among Indigenous peoples of North America within the larger context of their status as colonized peoples. Sexual abuse has been linked to many negative health outcomes including mental, sexual and drug-related vulnerabilities. There is a paucity of research in Canada addressing the relationship between antecedent sexual abuse and negative health outcomes among Aboriginal people including elevated risk of HIV infection. The primary objectives of this study were to determine factors associated with sexual abuse among participants of the Cedar Project, a cohort of young Aboriginal people between the ages of 14 and 30 years who use injection and non-injection drugs in two urban centres in British Columbia, Canada; and to locate findings through a lens of historical and intergenerational trauma. We utilized post-colonial perspectives in research design, problem formulation and the interpretation of results. Multivariate modeling was used to determine the extent to which a history of sexual abuse was predictive of negative health outcomes and vulnerability to HIV infection. Of the 543 eligible participants, 48% reported ever having experienced sexual abuse; 69% of sexually abused participants were female. The median age of first sexual abuse was 6 years for both female and male participants. After adjusting for sociodemographic variables and factors of historical trauma, sexually abused participants were more likely to have ever been on the streets for more than three nights, to have ever self-harmed, to have suicide ideation, to have attempted suicide, to have a diagnosis of mental illness, to have been in the emergency department within the previous 6 months, to have had over 20 lifetime sexual partners, to have ever been paid for sex and to have ever overdosed. The prevalence and consequences of sexual abuse among Cedar Project participants are of grave concern. Sexual trauma will continue to impact individuals, families and communities until unresolved historical trauma is meaningfully addressed in client-driven, culturally safe programming.
PubMed ID
18455054 View in PubMed
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The Cedar Project: impacts of policing among young Aboriginal people who use injection and non-injection drugs in British Columbia, Canada.

https://arctichealth.org/en/permalink/ahliterature113400
Source
Int J Drug Policy. 2013 Sep;24(5):449-59
Publication Type
Article
Date
Sep-2013
Author
Stephen W Pan
Chief Wayne M Christian
Margo E Pearce
Alden H Blair
Kate Jongbloed
Hongbin Zhang
Mary Teegee
Vicky Thomas
Martin T Schechter
Patricia M Spittal
Author Affiliation
University of British Columbia, School of Population and Public Health, Canada; Centre for Health Evaluation and Outcome Sciences, Canada.
Source
Int J Drug Policy. 2013 Sep;24(5):449-59
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Canada
Cohort Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Indians, North American - psychology
Male
Police - statistics & numerical data
Regression Analysis
Substance Abuse, Intravenous - psychology
Substance-Related Disorders - psychology
Abstract
Policing has profound health implications for people who use illicit drugs. Among Aboriginal communities, distrust of police is common, due partly to legacies of colonial policing. In response to the paucity of research among Aboriginal people who use drugs, this paper aims to: (1) Describe the policing experiences of young Aboriginal people who use drugs; (2) Identify policing activities associated with unsafe injection practices; and (3) Elucidate barriers to positive police relations.
The Cedar Project is a cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. This mixed-methods study (N=372) used period prevalence from 2007 to 2010 to describe policing experiences, mixed effects regression models to identify correlates of policing activities, and thematic qualitative analysis to assess attitudes to police relations.
Many participants were stopped by police (73%), experienced physical force by police (28%), had drug equipment confiscated (31%), and changed location of drug use because of police (43%). Participants who reported dealing drugs (40%) were significantly more likely to experience police engagement. Among participants in Prince George, 4% reported to have had non-consensual sex with members of the criminal justice system. Policing activity was significantly associated with syringe sharing, rushed injection, and reused syringe. Due to personal experience, practical concerns, and intergenerational legacies of unfair policing practices, most participants did not want a positive relationship with police (57%). Desire for a positive relationship with police was directly associated with being helped by police, and inversely associated with being stopped by police and experiencing physical force by police.
Policing activities may be impacting the well-being of Aboriginal people who use drugs. Due to focused prosecution of street-level drug dealing, some police may favor enforcement over harm reduction. Positive police engagement and less aggressive policing may enhance perceptions of police among young Aboriginal people who use drugs.
PubMed ID
23731672 View in PubMed
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