摘要：Repeated measurements and mixed-effects models were used to analyze the effects of an intensive long-term street-level police intervention on syringe exchange program use. Utilization data for 9 months before and after the beginning of the intervention were analyzed. Use fell across all categories and time periods studied, with significant declines in use among total participants, male participants, and Black participants. Declines in use among Black and male participants were much more pronounced than decreases among White and female participants. Of the 1127 AIDS cases reported to the Philadelphia, Pa, Department of Health during 2001, approximately 39% were attributed to injection drug use, a higher percentage than for any other risk factor and 19% higher than the national average. 1, 2 Syringe exchange programs have been associated with decreased incidence of blood-borne disease infection and risky syringe-related behaviors among injection drug users (IDUs). 3– 6 A legal syringe exchange program has operated in Philadelphia since 1992. 7 For most of the population served by the syringe exchange program, it is the only accessible source for sterile syringes. On May 1, 2002, Philadelphia launched an intensive long-term street-level policing initiative that deployed uniformed officers to occupy targeted city corners around the clock to disrupt open-air drug markets. The police department targeted these corners because of the amount and severity of drug violence present. 8 Many of these targeted corners were near syringe exchange program sites, and many clients likely passed by these corners while traveling to the syringe exchange program. The syringe exchange program did not change locations, times, or staffing patterns during the study period (C. Cook, MSS, MLSP, written communication, January 23, 2003). The operation represents a change in police tactics from previous antidrug initiatives, by decreasing arrests in favor of “deterrence and dispersal” tactics to disrupt drug markets and by maintaining a persistent heavy police presence. 8 Narcotics arrests substantially decreased after the operation began, despite greatly increased police activity. 8 However, many instances of police harassment of syringe exchange program users have been reported by exchange staff since the operation began, and on at least 1 occasion, a syringe exchange program user was arrested for possessing syringes procured at the syringe exchange program. Plans are to continue this long-term operation as long as funding continues. Research has long shown that IDUs are sensitive to police activity while making decisions about injection. 9– 11 Concern about arrest or search may lead to failure to seek and carry sterile syringes, as well as more rapid and less hygienic injection, and may deter uptake of health and preventive services. 12– 17 Differences in exposure to street-level drug policing may contribute to sharp differences in the rate of injection-related HIV in Black and White people in the United States. 18
