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Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas

Friedman, Samuel Ra,b; Cooper, Hannah LFc,d; Tempalski, Barbaraa; Keem, Mariaa; Friedman, Risaa; Flom, Peter La; Des Jarlais, Don Ca,e

doi: 10.1097/01.aids.0000196176.65551.a3
Epidemiology and Social

Objective: To understand associations of punitive policies to the population prevalence of injection drug users and to HIV seroprevalence among injectors.

Design and methods: A lagged-cross-sectional analysis of metropolitan statistical area data. Estimates of drug injectors per capita and of HIV seroprevalence among injectors in 89 large US metropolitan areas were regressed on three measures of legal repressiveness (hard drug arrests per capita; police employees per capita; and corrections expenditures per capita) controlling for other metropolitan area characteristics.

Results: No legal repressiveness measures were associated with injectors per capita; all three measures of legal repressiveness were positively associated with HIV prevalence among injectors.

Conclusions: These findings suggest that legal repressiveness may have little deterrent effect on drug injection and may have a high cost in terms of HIV and perhaps other diseases among injectors and their partners – and that alternative methods of maintaining social order should be investigated.

From the aNational Development and Research Institutes, New York, New York

bDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

cMedical and Health Research Association of New York/National Development and Research Institutes, Inc., New York

dColumbia Mailman School of Public Health, New York

eBeth Israel Medical Center, New York, New York, USA.

Received 22 June, 2005

Revised 15 September, 2005

Accepted 20 September, 2005

Correspondence to Samuel R. Friedman, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY 10010, USA. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.