對警察進行減害教育有助於預防愛滋病毒和致命的過量用藥

羅莎莉.海耶斯/2022 年 7 月 31 日/aidsmap / 財團法人台灣紅絲帶基金會編譯

Javier Cepeda 博士在 2022 年愛滋病大會上。照片 ©Jordi Ruiz Cirera/IAS。

根據在第 24 屆國際愛滋病大會（AIDS 2022）上提出的研究，墨西哥蒂華納的一項警察教育計畫減少了對注射藥癮者的逮捕，並且是預防愛滋病毒和致命過量用藥的一種具有成本效益的方法。 Proyecto Escudo（Project Shield）為警察提供了有關愛滋病毒、肝炎和減害的培訓，導致在兩年的評估中逮捕注射藥癮者的人數顯著且持續下降。建模顯示，這種方法是減少 HIV 傳播和致命過量用藥的一種經濟有效的方法。

蒂華納是墨西哥和美國邊境的主要城市，也是販毒的重要中轉站。在墨西哥，注射毒品的人經常受到警察的騷擾和逮捕，他們特別針對美沙酮診所等減害的場所進行逮捕。擁有注射器經常被用作逮捕的理由——儘管這在墨西哥是合法的——這種逮捕幾乎使人們共用注射設備的風險增加了三倍。在監獄服刑會增加一個人感染愛滋病毒和C型肝炎的風險，並且在出獄後不久的時間內存在致命的過量服用的嚴重風險。

Proyecto Escudo 是加州大學聖地亞哥分校和美墨邊境衛生委員會之間的合作計畫，旨在使警務實踐符合循證的公共衛生原則。 2016 年 5 月，蒂華納的 1,806 名市政警察接受了以下培訓：

• 減少傷害，包括注射器服務計畫和美沙酮維持治療的公共衛生益處

• 聯邦政府於 2009 年通過的改革將持有少量供個人使用的藥物合法化，並強制對屢犯者進行治療

• 基本的愛滋病毒和C型肝炎流行病學

• 職業安全，包括如何避免針紮刺傷。

為了衡量該計畫的成功與否，評估在兩年多的時間裡追踪了官員，以及在培訓之前、期間和之後生活在提華納的一群注射吸毒者。

警察報告說，在培訓結束後的兩年內逮捕人數明顯減少。提劑他們有時或總是因持有海洛因而被捕的比例從 44% 下降到 31%，而因持有注射器而被捕的人數從 41% 下降到 20%。來自注射吸毒人群的數據證實了這一發現，與培訓前相比，他們在培訓後被監禁的可能性降低了 68%。

然後，研究人員使用建模技術來估計培訓在預防愛滋病毒傳播和致命過量方面的短期和長期影響和成本效益。他們發現培訓將對 HIV 傳播產生適度但重要的影響，培訓兩年後 HIV 感染減少 1.7%，培訓十年後 HIV 感染減少 3.1%。對致命過量的影響將更大，兩年內過量服用減少 9%，十年後過量服用減少 14%。他們還發現，雖然培訓計畫很昂貴，但其成本被監禁支出的減少所抵消——這使得介入措施具有成本效益。

Javier Cepeda 博士在 2022 年愛滋病大會上介紹了調查結果，他承認需要進一步的研究來確認實際上是培訓導致了逮捕和監禁的減少，因為他們的評估不包括對照組。儘管如此，對警察進行有關愛滋病毒、C型肝炎和減害的教育似乎確實可以減少對注射吸毒者的騷擾和逮捕，並為預防愛滋病毒和致命的過量用藥提供了一種具有成本效益的方法。

參考文獻：

Cepeda J. 墨西哥蒂華納注射藥癮者愛滋病毒和吸毒過量警察教育計畫的影響和成本效益。第 24 屆國際愛滋病大會，蒙特婁，2022 年 SY01 專題討論會。

Educating police on harm reduction can help to prevent HIV and fatal overdoses

Rosalie Hayes / 31 July 2022 / aidsmap

Dr Javier Cepeda at AIDS 2022. Photo ©Jordi Ruiz Cirera/IAS.

A police education programme in Tijuana, Mexico, has reduced arrests of people who inject drugs and is a cost-effective way to prevent HIV and fatal overdoses, according to research presented at the 24th International AIDS Conference (AIDS 2022) today. Proyecto Escudo (Project Shield) provided training to police on HIV, hepatitis, and harm reduction, resulting in a significant and sustained decline in arrests of people who inject drugs over the two-year evaluation. Modelling indicates this approach is a cost-effective way of reducing HIV transmission and fatal overdoses.

Tijuana is a major city on the border between Mexico and the United States, and an important staging post for drug trafficking. People who inject drugs in Mexico are frequently harassed and arrested by the police, who particularly target harm reduction sites such as methadone clinics to carry out arrests. Possession of syringes is often used as a reason for arrest – despite this being legal in Mexico – and such arrests almost triple the risk of people sharing injecting equipment. Serving prison time increases a person’s risk of acquiring HIV and hepatitis C, and there is a severe risk of fatal overdose in the immediate period following release from prison.

Proyecto Escudo was a collaboration between the University of California San Diego and the US-Mexico Border Health Commission, devised to bring policing practices in line with evidence-based public health principles. In May 2016, 1806 municipal police officers in Tijuana received training on:

•Harm reduction, including the public health benefits of syringe service programmes and methadone maintenance therapy

•Reforms passed by the federal government in 2009 which decriminalised possession of small quantities of drugs for personal use and mandated treatment for repeat offenders

•Basic HIV and hepatitis C epidemiology

•Occupational safety, including how to avoid needlestick injuries.

To measure the success of the project, the evaluation followed up with the officers over two years, as well as a cohort of people who inject drugs living in Tijuana before, during, and after the training.

Police officers reported making significantly fewer arrests in the two years after the training was delivered. The proportion saying they sometimes or always made arrests for heroin possession fell from 44% to 31%, while the number making arrests for syringe possession declined from 41% to 20%. This finding was corroborated by data from the cohort of people who inject drugs, who were 68% less likely to have been imprisoned in the post-training period compared to the time before the training. 

The researchers then used modelling techniques to estimate the short- and long-term impact and cost-effectiveness of the training on preventing HIV transmission and fatal overdoses. They found that the training would have a modest but important impact on HIV transmission, with 1.7% fewer HIV infections two years after the training and 3.1% fewer HIV infections ten years after the training. The impact on fatal overdoses would be more substantial, with 9% fewer overdoses within two years and 14% fewer overdoses after ten years. They also found that while the training programme was expensive, its cost was offset by reduced spending on imprisonment – making the intervention cost-effective.

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Dr Javier Cepeda, presenting the findings at AIDS 2022, conceded that further research is needed to confirm that it was in fact the training that led to the reduction in arrests and imprisonment, since their evaluation did not include a control group. Nevertheless, it does appear that educating police about HIV, hepatitis C and harm reduction can reduce harassment and arrest of people who inject drugs and offers a cost-effective approach to preventing HIV and fatal overdoses.

References

Cepeda J Impact and cost-effectiveness of a police education programme on HIV and overdose among people who inject drugs in Tijuana, Mexico. 24th International AIDS Conference, Montreal, symposium SY01, 2022.