Abstract
Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (β = 0.71, p = 0.037), in daily sex work (β = 1.32, p = 0.026), arrested in the past 12 months (β = 1.44, p<0.001) or injecting drugs in the past 3 months (β = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations’ health outcomes, including HIV risk.
Highlights
Considerable progress has been made in demonstrating the role of social and structural factors in determining risk trajectories in public health
This paper describes the development and initial validation of a novel and brief scale that measures routine police patrol practices experienced by female sex workers (FSW), focusing on the micro environment of the street and in the context of policing street-based FSW, a large proportion of whom are people who use drugs (PWUD)
The police encounters measured through the Patrol Practices Scale (PPS) were grounded in existing ecological[10] and risk environment frameworks as well as ongoing ethnography.[1]. Drawing on these frameworks we explored policing as a micro factor impacting on the physical risk environment of the ‘street’ and explored how criminalization and surrounding policies translated to street-level routine police patrol practices towards FSW
Summary
Considerable progress has been made in demonstrating the role of social and structural factors in determining risk trajectories in public health. Structural violence refers to a form of violence embedded within social structures at multiple levels, wherein lack of power translates to tangible disadvantage or risk[9]. The law in this context can be conceptualized as an ecological risk factor[10], whose translation from ‘the books’ to ‘the street’ constitutes a form of structural violence at the macro and micro levels. At the micro level (‘the street’), police practices impact health behaviors and exposures among vulnerable street-based populations, such as female sex workers (FSW) and people who use drugs (PWUD), and oppressive and coercive practices are normalized in their day to day lives
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