Fear Of Arrest Research Articles

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

IntroductionIndividuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.MethodsThis qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.ResultsFindings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran’s health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants’ awareness of available services and eligibility criteria.ConclusionThe barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Beliefs, attitudes and experiences of virtual overdose monitoring services from the perspectives of people who use substances in Canada: a qualitative study

BackgroundSolitary use of substances is a risk factor for substance use-related mortality. Novel e-health harm reduction interventions such as virtual overdose monitoring services (VOMS) have emerged in North America to improve access to emergency overdose support for people who use substances (PWUS). To date, little research has been published, and the perspectives of PWUS are needed to inform evaluation and policy efforts.ObjectiveTo explore the beliefs, values and perceptions of PWUS around using and accessing VOMS in Canada.MethodsA qualitative study following grounded theory methodology was conducted. Using existing peer networks, purposive and snowball sampling was conducted to recruit PWUS (≥ 18 years) with previous experience with VOMS. Thematic analysis was used to analyze twenty-three interviews. Several methods were employed to enhance rigor, such as independent data coding and triangulation.ResultsTwenty-three one-on-one telephone interviews of PWUS with previous experience with VOMS were completed and analyzed. The following themes emerged: (1) feelings of optimism around VOMS to save lives; (2) privacy/confidentiality was highly valued due to stigma and fear of arrest; (3) concerns with reliable cell phones negatively impacting VOMS uptake; (4) concerns around emergency response times, specifically in rural/remote communities; (5) desire for trusting relationships with VOMS operators; (6) importance of mental health supports and referrals to psychosocial services; and (7) possible limited uptake due to low public awareness of VOMS.ConclusionThis qualitative study provided novel insights about the VOMS from the perspectives of PWUS. PWUS generally felt optimistic about the potential of VOMS as a suitable harm reduction intervention, but several potential barriers around accessing VOMS were identified that may limit uptake. Future research is warranted.

Rural Migrant Farmworker Demographics: Implications for Vocational Rehabilitation

Migrant populations have significant barriers for vocational rehabilitation (VR). Over one-quarter (26%) of farmworkers in the United States are migrant workers. Migrant farmwork often involves exposure to enhanced occupational hazards. Language barriers among farmworkers add additional challenges to vocational rehabilitation, as 77% of U.S. farmworkers identify Spanish as their primary language. Educational attainment is also a factor in vocational development for farmworkers, as the average level of education among farmworkers is eighth grade. Most migrant farmworkers are separated from all nuclear family members. A migratory lifestyle, isolated social conditions, lack of education, language differences, and fear of arrest or deportation establish barriers for VR service. In light of these unique barriers, the first step in improving VR outreach is to determine the geography of migrant work. This study utilizes data from the U.S. Department of Agriculture’s Atlas of Rural and Small-Town America to identify states and counties with the highest rates of Mexican-born residents and highest rates of non-English speakers, discussing that data in the context of unemployment and poverty rates. A State Average Score was developed to arrange states by multiple factors that may indicate the presence of migrant communities. These multiple factors include counties with the highest non-English speaking rates, counties with the highest Mexican-born rates, counties with the highest poverty rates, and counties with the highest unemployment rates. The convergence of these data points within a single county may indicate the presence of migrant communities. Examples of outreach to migrant farmworkers are also presented.

The Safe Passages program as approach to combat the heroin epidemic: case of Will County, IL

ABSTRACT Objective This research analyzes the police departments’ unconventional approach to fighting heroin by offering treatment instead. Police departments implement a program, the Safe Passages, that allows an individual addicted to heroin to enter the police department without fear of arrest or questioning. Methods A qualitative research design was used for this study that was centered on new initiatives that have been enacted by leaders in law enforcement in order to combat the heroin epidemic. This study analyzed the Safe Passages program in police departments in Will County: the overall cost of the program, information dissemination to the public, and the impact it has had on communities. Data was collected through in-depth interviews, and also available documentation that illustrated whether or not initiatives, such as the Safe Passages program, have been looked at as successful in certain communities. Results This qualitative study found three themes that emerged: heroin addiction was a problem in communities, the costs associated with the Safe Passages program, and the challenges, such as lack of recent participation and poor advertising, and effects the Safe Passages program has had on communities where the program was implemented. Conclusions The Safe Passages program is designed for intervention to assist police departments in combating the root problem of heroin addiction. The majority of respondents felt that Safe Passages program had made a positive impact in their communities, and they would encourage other police departments to utilize this program.

Barriers to accessing sterile injecting equipment for people who inject drugs: An integrative review.

The global prevalence of hepatitis C virus infection is estimated to be 71 million, with an estimated 6.1 million of those having recently injected drugs. The recognised measures to prevent hepatitis C transmission in people who inject drugs are needle and syringe programmes. As people who inject drugs are at considerable risk of hepatitis C transmission, understanding the barriers they encounter when accessing needle and syringe programmes is important to support the hepatitis C elimination goal. This integrative review aimed to synthesise research exploring the barriers to accessing sterile injecting equipment faced by people who inject drugs. An integrative review was conducted guided by the PRISMA 2020 checklist, based on a systematic literature search using the following databases: CINAHL, MEDLINE, PsycINFO, Embase, psychology & behavioural sciences collection, and Emcare, as well as Google Scholar. The search returned seven studies which met the criteria, and four key themes were identified: stigma; experienced and internalised, purchase experience, practical issues, and fear of negative consequences. Participants reported barriers such as the location of the services, and concerns around confidentiality when accessing services. In addition to this, the fear of arrest and the involvement of social services proved to discourage access to these services. People who inject drugs face many challenges when accessing sterile injecting equipment, such as stigma, purchase experience, practical issues and fears and concerns. To support the World Health Organisation Hepatitis C virus elimination plan, these barriers must be tackled to maximise the provision and reduce hepatitis C transmission and reinfection rates. Since the level of research on this topic is limited, further studies are strongly needed. Patient and public involvement were not used for this review.

Navigating the grey: Experiences of incremental cannabis reform in Australia.

There have been many changes to cannabis laws across the globe, some dramatic but more often incremental. This study explored the experiences after an incremental cannabis law reform in the Australian Capital Territory, Australia. Semi-structured interviews (n= 30) were conducted in March and April 2021, 14 months after the introduction of cannabis law reform, with people aged 18 and over who had grown and/or consumed cannabis in the previous 12 months. Participants were asked about recent and past cannabis use, growing cannabis and changes to their practices after the introduction of the legislation. Incremental cannabis law change resulted in regulatory grey areas. How people interpreted and navigated such grey areas were connected to their relative privileges, circumstances and histories. Those who were highly policed were more likely to experience the grey areas negatively. Those who were not highly policed found the grey areas confusing or 'half-arse' (insufficiently executed), but mostly experienced the new laws positively through new cannabis cultivation or perceived reduction in stigma and fear of arrest. Those with self-identified privilege were unconcerned with grey areas of the legislation. Incremental policy change can result in grey areas that require some navigation. Vulnerable populations appear less likely to experience the full benefits of such incremental drug law reform. It is vital to attend to the inequities that can arise from incremental law reform so that positive experiences are shared across the population regardless of relative privilege.

Protective Behavioural Mechanisms Against Cannabis Use Among Adolescents in Cannabis-Growing Settings of South Africa: Insights Into Adolescent Cannabis Use Prevention.

We aimed to explore the behavioural protective mechanisms against cannabis use among adolescents living in South African illicit cannabis-growing communities, based on the Self Determination Theory (SDT). Exploratory qualitative design techniques were followed in conducting the study. The snowball sampling technique was used to recruit thirty (30) non-cannabis smoking adolescents from 2 purposively selected communities and grouped into 4 focus groups and interviewed. A semi-structured focus group interview guide was used to moderate the discussions. Data were analysed inductively, using the ATLAS. ti software. Nine behavioural coping mechanisms, grouped under intrinsic and extrinsic protective behavioural mechanisms, protected participants from using cannabis. Intrinsically, participants' determination not to engage in bad behaviours, focus on their academic work during their free periods, their non-financial dependence on cannabis-using peers, self-preservation to ensure good marriages, and religious beliefs on substance abuse motivated them to not use cannabis. On the other hand, the concept of Ukuphoxa (preservation of family dignity), fear of arrest, fear of being tagged a social deviant, and the fear of contracting illnesses such as lung cancer served as protective behavioural mechanisms against cannabis use. Health promotion and education programmes for adolescents on non-cannabis use in communities where illicit cannabis abounds must identify and draw on contextual intrinsic and extrinsic motivations that ensure non-cannabis use.

Inhaling thick smoke: cannabis subculture, community forming and socio-structural challenges in Nigeria

Research on cannabis subcultures has a long history in Western countries. In Nigeria, there is a dearth of such studies. This study explored cannabis use and community forming and how users manage police’s extrajudicial practices and stigma from the broader society in Awka, Nigeria. We elicited data using participant observation and semi-structured interviews with men and women who use cannabis. Two forms of cannabis exchange rituals guided by reciprocity norms were common, facilitating social interaction and solidarity among cannabis users’ networks. These sharing rituals include passing joints from lip to lip and purchasing a single-use quantity for someone in need with the receiver expected to reciprocate that goodwill in the future. Cannabis users encounter challenges, including structural stigma, fear of arrest, and extrajudicial practices such as being pressured to offer bribes or pay for bail (constitutionally free) when arrested. Another (gendered) challenge was heightened social stigma, which women who use cannabis mostly experienced. Cannabis users form communities or subcultures around the drug, which cushion the effects of persecution by corrupt law enforcement agents and social discrimination. They also employ innovative ways of using cannabis to avoid detection, arrest, and stigmatization. With culturally specific findings from a non-Western context, our study furthers knowledge on cannabis subcultures. The findings have demonstrated that cannabis subcultures still exist in Nigeria despite the changing drug landscape and widely discussed tendencies towards normalization in the Global North. Our findings also indicated that cannabis users suffer stigmatization and human rights abuses. There is a need to address drug-related social-structural stigma and police corruption in Nigeria.

Facilitators and Barriers to Health Seeking among People Who Use Drugs in the Sunyani Municipality of Ghana: An Exploratory Study.

Drug use is one of the global public health issues, and its accompanying disorders have consequences on people's mental, physical, and environmental health. Nevertheless, the majority of people who use drugs have never been treated for drug dependence and other health conditions whilst others discontinue their treatment for drug use disorder. Using the health belief model, the study aimed at exploring facilitators and barriers to health-seeking among people who use drugs in the Sunyani Municipality of Ghana. A descriptive study design was used, employing a qualitative approach. In-depth interviews were conducted with a total of 22 participants, including two key informants (male and female). The first group of participants was recruited from the ghetto (an area in the municipality where people who use drugs are usually located). The other group of participants was recruited using hospital-based records. The interview data were transcribed, coded, and analysed for the generation of themes with the aid of Nvivo version 12 pro. The results showed that people who use drugs face health challenges such as drug dependence, malaria, lungs and breathing complications, cardiovascular complications, and skin complications. People who use drugs experienced poor perceived quality of life and low health status. Health-seeking behaviours of interviewees were influenced by the perceived benefit, perceived severity, cues to action, among others. Multiple sources of healthcare were used by the people who use drugs. Whereas ease of communication, perceived severity, benefit, among others were facilitators to their health-seeking behaviours, cost, dwindling social support, lack of knowledge of the condition, and fear of arrest by law enforcement agencies also served as barriers to seeking healthcare at the orthodox health facilities. This paper suggests a holistic approach to help improve the health and health-seeking behaviours of people who use drugs. The researchers wish to indicate that an earlier version of this manuscript has been presented at the University of Ghana as a thesis.

A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

BackgroundSpotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI’s) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees.MethodsResearch assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used.ResultsWe interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings.ConclusionSpotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI’s prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.

Community perspectives on supervised consumption sites: Insights from four U.S. counties deeply affected by opioids

BackgroundTo address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities—primarily in coastal urban areas—have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature. MethodsTo examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO. ResultsKey informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance. ConclusionsDespite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.

Order and Progress: A Brazilian Peace Corps Saga

Como voluntários do Programa Corpo de Paz, Jack Epstein e Chuck Fortin chegaram a Bahia, Brasil, há apenas quatro meses do endurecimento de medidas repressivas estabelecidas pelo Ato Institucional, AI-5, pelo regime militar em 1968. Em suas respectivas favelas, eles trabalhavam sob a vigilância das autoridades policiais locais, que inibiam iniciativas de organização comunitária, e listavam motivos para justificar a prisão de Jack. Após férias na região amazônica e desinformados acerca da existência de uma busca policial em seu encalço, voltaram a Salvador onde Jack foi imediatamente forçado a sair do país antes que fosse aprisionado, ou coisa pior. Esta saga conta sobre seu exílio, conflitos e tensas negociações com os dirigentes do Corpo de Paz, e de seu retorno proibido, cruzando a fronteira do Brasil disfarçado para o casamento de Chuck. A narrativa descreve os desafios e os resultados modestos alcançados pelo desenvolvimento comunitário durante o regime militar. Ademais, sob circunstâncias mais favoráveis, ambos retornam ao Brasil, e por anos ainda podem sentir a sua presença.

High willingness to use overdose prevention sites among female sex workers in Baltimore, Maryland

BackgroundOverdose Prevention Sites (OPS) operate worldwide as spaces where people can consume previously purchased drugs under supervision, and are linked to reductions in HIV/HCV transmission and fatal overdoses. As the United States weighs their merits and legality, research is needed to estimate acceptability and use among populations at high risk for overdose. We examine willingness to use OPS among street-based female sex workers (FSW) with prevalent drug use and associated morbidities. MethodsWe describe self-reported willingness, barriers and conditions around use of a hypothetical OPS among 141 FSW engaged in active drug use in Baltimore City, and describe trends using Pearson’s χ2 and Fisher’s exact tests. ResultsMost women had history of overdose (55 %) and were likely to use OPS (77 %). Willingness was higher among women who: were sexual minorities (97 %;P=0.002),experienced homelessness (82 %;P=0.019), injected drugs (82 %;P=0.013), shared syringes (82 %;P=0.007), experienced sexual violence (92 %;P=0.045) or reported heroin use (83 %;P=0.039) in the past 3 months. Common anticipated barriers included transportation (45 %) and fear of arrest (41 %). ConclusionsThis study highlights a population of uniquely high-risk women who would benefit from an OPS integrated with other services. Conditions and barriers discussed are informative for planning and implementation.

Coupling law enforcement and community-based regulations in support of compliance with biodiversity conservation regulations

SummaryThe scope and scale of wildlife crimes around the world have risen in intensity and complexity, yet current enforcement strategies have often not delivered desired effects on illegal activities, even within protected areas. Tackling the array of illegal activities by emphasizing law enforcement above other options is challenging and potentially unsustainable. We explored the potential for social norms, community regulations and socioeconomic factors to promote compliance with wildlife laws by interviewing 334 respondents in 28 villages that share boundaries with protected areas in Nigeria. Using an anonymous direct questioning approach, we recorded a high prevalence of non-compliance behaviours in all studied communities. Injunctive norms (i.e., perceptions of acceptable behaviour within a social group) significantly predicted compliance, as respondents with no complicit friends or family members were more likely to comply with wildlife regulations. Perceived likelihood of community-level sanctions played a more salient role than the fear of arrest by rangers in influencing compliance. In addition, non-compliance increased with number of dependents, but reduced with average monthly household income. Our study demonstrates that clear knowledge of the social norms that drive local behaviour as well as the authorities that enforce them is integral to understanding the forces that drive community involvement and participation in conservation. Incorporating local communities in planning enforcement interventions may help protect threatened species and landscapes.

Policing Practices and Risk of HIV Infection Among People Who Inject Drugs.

Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.

A World of Distrust

In District of Columbia v. Wesby, the Supreme Court recently considered whether a prudent officer had probable cause to make warrantless arrests at a festive house party. While reactions from scholars of criminal law are beginning to emerge, this Essay is the first to conceive of the decision through the lens of property theory. In this regard, the Essay offers two principal claims. First, on interpretive grounds, it contends that Wesby generated a de facto reallocation of property interests by abolishing both (a) the right held by the general public to access without fear of arrest those properties to which they reasonably believe they are welcome, and (b) the correlative duty of titleholders to respect reasonably mistaken access until the mistake is revealed. Second, on normative grounds, it questions the justificatory nature of this shift from an allocation that vindicates trust one person has placed in another to an allocation that allows someone else to violate that trust. The Essay concludes that perceiving Wesby as a dispute over property interests not only will deepen the developing assessments of the decision by scholars of criminal law, but, more broadly, prompt reflection on matters across the property spectrum as to the oft-concealed implications that allocative choices regarding property interests bring to bear on our ability to trust one another in the marketplace and in myriad social settings.

Policing space in the overdose crisis: A rapid ethnographic study of the impact of law enforcement practices on the effectiveness of overdose prevention sites

North America is in the midst of an overdose crisis. In some of the hardest hit areas of Canada, local responses have included the implementation of low-threshold drug consumption facilities, termed Overdose Prevention Sites (OPS). In Vancouver, Canada the crisis and response occur in an urban terrain that is simultaneously impacted by a housing crisis in which formerly ‘undesirable’ areas are rapidly gentrifying, leading to demands to more closely police areas at the epicenter of the overdose crisis. We examined the intersection of street-level policing and gentrification and how these practices re/made space in and around OPS in Vancouver's Downtown Eastside neighborhood. Between December 2016 and October 2017, qualitative interviews were conducted with 72 people who use drugs (PWUD) and over 200 h of ethnographic fieldwork were undertaken at OPS and surrounding areas. Data were analyzed thematically and interpreted by drawing on structural vulnerability and elements of social geography. While OPS were established within existing social-spatial practices of PWUD, gentrification strategies and associated police tactics created barriers to OPS services. Participants highlighted how fear of arrest and police engagement necessitated responding to overdoses alone, rather than engaging emergency services. Routine policing near OPS and the enforcement of area restrictions and warrant searches, often deterred participants from accessing particular sites. Further documented was an increase in the number of police present in the neighborhood the week of, and the week proceeding, the disbursement of income assistance cheques. Our findings demonstrate how some law enforcement practices, driven in part by ongoing gentrification efforts and buttressed by multiple forms of criminalization present in the lives of PWUD, limited access to needed overdose-related services. Moving away from place-based policing practices, including those driven by gentrification, will be necessary so as to not undermine the effectiveness of life-saving public health interventions amid an overdose crisis.

I could take the judgment if you could just provide the service: non-prescription syringe purchase experience at Arizona pharmacies, 2018

BackgroundCommunity pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in all but two states. However, people who inject drugs (PWID) face significant barriers accessing sterile syringes, particularly in states without laws allowing syringe services programming. To our knowledge, no recent studies of pharmacy-based syringe purchase experience have been conducted in communities that are both rural and urban, and none in the Southwestern US. This study seeks to understand the experience of retail pharmacy syringe purchase in Arizona by PWID.MethodsAn interview study was conducted between August and December 2018 with 37 people living in 3 rural and 2 urban Arizona counties who identified as current or former users of injection drugs. Coding was both a priori and emergent, focusing on syringe access through pharmacies, pharmacy experiences generally, experiences of stigma, and recommendations for harm reduction services delivered by pharmacies.ResultsAll participants reported being refused syringe purchase at pharmacies. Six themes emerged about syringe purchase: (1) experience of stigma and judgment by pharmacy staff, (2) feelings of internalized stigma, (3) inconsistent sales outcomes at the same pharmacy or pharmacy chain, (4) pharmacies as last resort for syringes, (5) fear of arrest for syringe possession, and (6) health risks resulting from syringe refusal.ConclusionsNon-prescription syringe sales in community pharmacies are a missed opportunity to improve the health of PWID by reducing syringe sharing and reuse. Yet, current pharmacy syringe sales refusal and stigmatization by staff suggest that pharmacy-level interventions will be necessary to impact pharmacy practice. Lack of access to sterile syringes reinforces health risk behaviors among PWID. Retail syringe sales at pharmacies remain an important, yet barrier-laden, element of a comprehensive public health response to reduce HIV and hepatitis C among PWID. Future studies should test multilevel evidence-based interventions to decrease staff discrimination and stigma and increase syringe sales.

The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK

Background: Recent UK ‘hostile environment’ immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing ‘hostile environment’-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its ‘hostile environment’ policies and address their negative health impacts.

The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK.

Background: Recent UK 'hostile environment' immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing 'hostile environment'-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its 'hostile environment' policies and address their negative health impacts.