Collateral Damage in the War on Drugs

This paper discusses whether two key War on Drugs policies, the criminalization of syringes and the disqualification of drug users from the Supplemental Security Income (SSI) program, are associated with injection-related human immunodeficiency virus (HIV) risk behaviors among injection drug users (IDUs). IDUs were interviewed regarding HIV risk behaviors, drug use, and criminal activities in six San Francisco Bay Area communities in 1996 and followed through 1997 (n = 1257). Multivariate analysis was conducted to examine the association between concern about arrest while carrying drug paraphernalia and injection-related risk behaviors. Regarding SSI, respondents were interviewed before (1996) and after (1997) drug and alcohol addicts were disqualified from SSI (n = 88). Bivariate analysis was conducted comparing IDUs who lost SSI benefits with those who retained benefits. Among our study sample, 32% of IDUs reported being concerned about possible arrest while carrying drug paraphernalia. In multivariate analysis, concerned IDUs were over one and one-half times more likely to share syringes than IDUs not concerned (adjusted odds ratio = 1.74; 95% confidence interval = 1.24, 2.44). Regarding SSI, 60% (53/88) of baseline SSI recipients had lost benefits by their follow-up interview. IDUs who lost benefits were more likely to participate in illegal activities (48 vs. 27%; P < 0.05), more likely to share syringes (17 vs. 0%; P < 0.05) and injected drugs on average more (43.8 vs. 36.4 per month; P < 0.03) than those who retained benefits. These data suggest that War on Drugs policies that deny injection equipment and federal income support to IDUs also increase their risk for HIV infection. These policies should be reconsidered.