title: Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada.
abstract: In 2006, the Vancouver Police Department (VPD) developed an organization-wide drug policy approach, which included endorsing harm reduction strategies for people who inject drugs (PWID). We sought to examine rates of potentially harmful policing exposures and associated HIV risk behaviour among PWID in Vancouver, Canada before and after the VPD policy change.
  
  
  
  Data were derived from two prospective cohort studies of PWID. Multivariable generalized estimating equation models were used to examine changes in the risk of confiscation of drug use paraphernalia and physical violence by the police, as well as changes in the relationship between exposures to the two policing practices and sharing of drug use paraphernalia, before and after the policy change.
  
  
  
  Among 2193 participants, including 757 (34.5%) women, the rates of experiencing police confiscation of drug use paraphernalia declined from 22.3% in 2002 to 2.8% in 2014, and the rates of reporting experiencing physical violence by the police also declined from 14.1% in 2004 to 2.9% in 2014. In multivariable analyses, the post-policy change period remained independently and negatively associated with reports of confiscation of drug use paraphernalia (adjusted odds ratio (AOR): 0.25; 95% confidence interval (CI): 0.21 to 0.31) and reported physical violence by the police (AOR: 0.76; 95% CI: 0.63 to 0.91). However, experiencing both confiscation of drug use paraphernalia and physical violence by the police (AOR: 1.92; 95% CI: 1.10 to 3.33) and experiencing only confiscation of drug use paraphernalia (AOR: 1.71; 95% CI: 1.34 to 2.19) remained independently and positively associated with sharing of drug use paraphernalia during the post-policy change period.
  
  
  
  In our study, two policing practices known to increase HIV risk among PWID have declined significantly since the local police launched an evidence-based drug policy approach. However, these practices remained independently associated with elevated HIV risk after the post-policy change. Although there remains a continued need to ensure that policing activities do not undermine public health efforts, these findings demonstrate that a major shift towards a public health approach to policing is possible for a municipal police force.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Adina
authors.initials: A
authors.lastname: Landsberg
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Michael-John
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; khayashi@cfenet.ubc.ca.
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D055030:Drug Users / Q000331:legislation & jurisprudence* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008875:Middle Aged; D016495:Police; D011446:Prospective Studies; D011634:Public Health; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D000078329:Workforce; D055815:Young Adult
keywords: Canada; HIV/AIDS; drug law enforcement; epidemiology; harm reduction; injection drug use