Structural interventions for HIV prevention, such as needle and syringe exchange programs (henceforth referred to as SEPs), are well documented for their success in mitigating the impact of the HIV epidemic among persons who inject drugs (PWID). Expanded access to sterile injection equipment has led to decreased needle sharing among injectors and reduced HIV incidence in many locales. The public health literature documents the public health utility of SEPs, yet policies have been implemented in several localities that restrict the areas where they may legally operate.
In 2000, the District of Columbia (DC) government passed the 1000 Foot Rule (§48-1121), prohibiting the distribution of “any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school)”. No research has explored its impact on the availability of land space that is legal for syringe exchange services. A similar deficit exists in the public health literature pertaining to the spatial relationship (i.e., walking distance via sidewalks) between where DC substance users live and access syringe exchange services.
This research examines the relationship between the locations of PWID home residences and the locations where PWID accessed SEP services, and how the 1000 Foot Rule affects the land space in DC where SEPs may legally operate to provide harm reduction services to PWID. This research had 3 primary methodological components: (1) to use data from the DC-GIS and DC Master Address Repository systems to measure longitudinal changes in the amount of legal SEP operational space in DC due to the application of the 1000 Foot Rule, (2) to conduct a series of hot spot mapping analyses of IDU-related arrests to identify statistically significant clusters/areas of potential IDU risk environments and to quantify the overlay between these areas and school buffer zones, and (3) to conduct distance estimation analyses to quantify one measure of SEP access (i.e., walking distance via sidewalks between home residence and SEP exchange site) and its associated changes over time among DC PWID and to evaluate how this measure of SEP access may predict engagement at the SEPs.
The results of this research suggest the 1000 Foot Rule may negatively affect SEP program access in that its application causes a large proportion of the land space in DC to be ineligible for legal SEP operations. A majority of the land space in areas of greatest need for SEP services were ineligible for legal SEP operations. Further, the majority of IDU-related arrests occurred within 1000 feet of schools. The data suggest that the mean walking distance between PWID home residence and the location where persons accessed SEP services ranged from 2.03 to 4.13 miles over the study period (1996-2010 and 2014). This descriptive analysis may provide a foundation for future research that explores how the 1000 Foot Rule affects PWIDs’ actual access to harm reduction services in the District.
|Advisor:||Ruiz, Monica S.|
|Commitee:||Jones, Jeff, Roess, Amira, Turner, Monique M.|
|School:||The George Washington University|
|School Location:||United States -- District of Columbia|
|Source:||DAI-B 77/01(E), Dissertation Abstracts International|
|Subjects:||Public health, Epidemiology|
|Keywords:||District of Columbia, HIV prevention, Needle exchange programs, Policy analysis, Structural interventions, Substance use, Syringe access|
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