The nexus between drug control and public health: a mixed-methods study investigating the impact of police enforcement activities on access and utilization of HIV prevention and treatment among women who inject drugs

Despite their increased risk of acquiring and transmitting HIV, people who inject drugs (PID) are among those with the least access to HIV prevention and treatment. Police enforcement activities have been shown to increase risk of HIV transmission and impede access to life-saving antiretroviral treatment (ART) among PID. Given that women comprise one-third of injectors globally but shoulder a disproportionate HIV burden, interventions must consider how gender shapes the application and impact of police enforcement on HIV outcomes. Women who inject drugs (WID) face multi-level interpersonal, social, and structural vulnerabilities that increase their risk of drug-related harm, but little is known about how police enforcement activities shape HIV risks and health adversity in general among WID. This project will contribute to HIV prevention and treatment expansion efforts by identifying whether gender modifies the link between police enforcement and HIV risk, prevention and treatment outcomes, elucidating how policing shapes key HIV outcomes, and quantifying the potential impact of eliminating punitive police enforcement practices on the expansion of ART among WID. This mixed-methods research will draw on pooled quantitative data from two studies I lead on as PI and co-PI: the Women Speak Out study, the largest representative dataset of WID in Southeast Asia, and the Jakarta Peer-Driven Intervention study, a community-led treatment intervention exploring determinants of HIV among PID. Additional original qualitative data will be collected from WID in urban sites in Indonesia. This study will be the first to explore how police enforcement activities shape access and utilization of HIV prevention and treatment in the region. Employing integrated knowledge translation, this study will shift the research field from identifying gender-related health disparities related to police enforcement towards informing appropriate interventions to reduce them.