Impact of the Criminal Justice System on the HIV Risk of Urban Poor Women

Elise Riley, University of California, San Francisco
Social and Behavioral Sciences
Thematic Priority Area: Contextual, Cultural, and Structural Issues in HIV Prevention and Care
Innovative, Developmental, Exploratory Award (IDEA)

The management of populations at risk for incarceration is a crucial health policy issue for the State of California. Unstably housed, drug-using women are at high risk for both HIV infection and incarceration. While incarceration has been associated with HIV risk in the scientific literature, the impact of policing practices on HIV risk among women is under-researched. The proposed multi-methodological pilot study will provide a better understanding of how police activity influences drug and sex behaviors of impoverished women. We will explore (1) the specific contexts in which policing practices unintentionally contribute to HIV risk behavior and (2) the specific contexts in which policing practices are protective for HIV risk in this population.

Police presence in a neighborhood, direct interrogation, and arrest do disrupt and stop illegal activities. These disruptions can play a role in the HIV risk decision-making of unstably housed women, as illegal activities are forced to occur behind closed doors and in greater isolation. Yet, police presence in areas of high drug use can potentially reduce women’s HIV risks by aggressively targeting violence against women and drug-related violent crime. At the California State and local levels, public health advocates have argued that reform in criminal justice policies and practices would reduce HIV infection. Public safety and legal officials counter argue that sharp increases would occur in drug and sex-work related crime as a result of these reforms. Despite the recent vigorous public debate in the political sphere, the advocates and opponents have been unable to reference credible scientific evidence. The vacuum of data reveals the urgent need for evidence-based research assessing the impact of policing on the HIV risk of unstably housed, drug-using women in California.

We propose to conduct an ethnography which documents the “HIV risk environments” of unstably housed drug-using women, in specific relation to policing practices. HIV risk environment theory posits that physical, social, economic, legal, and policy factors influence socio-structural vulnerability to HIV. This approach contends that if HIV risk is socially produced, than so too are public health solutions to minimize it. Ethnographic research is well-suited to capture the contexts, social meanings and effects of illegal and high-risk practices that occur in drug-sex economies. We will select a sample of twenty women from a cohort study of unstably housed women in San Francisco (N=300). Year-long ethnographic research of women’s social and institutional relationships will reveal the contexts of HIV risk in relation to policing. Descriptive epidemiological data collected on sex and drug risk behaviors, arrest, incarceration, housing status, sex work and victimization will be triangulated with qualitative, ethnographic data to allow for multi-methodological analyses. The relationships between criminal law, policing policies and HIV risk is under active debate in California. The proposed study will offer objective information with which to facilitate dialogues with the CA State Office of AIDS, the CA Police Chief’s Association, community HIV prevention agencies, public health officials, and local legal and public safety officials. This study also offers a scientific model for ethnographic-epidemiological data triangulation and will provide pilot data for larger multi-methodological, comparative studies.