Harm Reduction Policing

Objective of the study. To assess the prioritization of key and vulnerable populations (KVP) for TB. Material and methods. The material for this analytical study was the data from the Cochrane Library when searching for the key words "key and vulnerable populations for tuberculosis" in Russian and "key and vulnerable group population on tuberculosis" in English. The data prioritization consisted of assigning points to Objective of the study. To assess the prioritization of key and vulnerable populations (KVP) for TB. Material and methods. The material for this analytical study was the data from the Cochrane Library when searching for the key words "key and vulnerable populations for tuberculosis" in Russian and "key and vulnerable group population on tuberculosis" in English. The data prioritization consisted of assigning points to each group based on the number of references to this KVP group for TB in published works. Results of the study. Eight KVPs for TB were prioritized based on the use and results of the study, where more points were obtained (from 40 to 57 points). This priority list included population groups - people living with HIV, persons in custody and deprived of liberty, labor migrants, people who use drugs, people with chronic lung diseases (COPD), patients with diabetes, people with mental disorders and people who were in close contact with a patient with active pulmonary TB, who were selected as priority KVPs for TB. The specified KVPs for TB with a cumulative risk of 57-40 points were classified as high-priority risk groups. Groups with a cumulative risk of 29-24 points were classified as a medium-risk group for developing tuberculosis and included: healthcare workers, people with untreated lung changes detected during chest X-ray, outreach and social workers involved in the TB program, as well as personnel working in places of detention. Screening among other KVPs for TB, according to publications, was not systematic. Conclusions. Among the 22 risk groups of the KVPs for TB, the high-priority group included people living with HIV, persons in custody and deprived of liberty, labor migrants, people who use drugs, patients with COPD, patients with diabetes, people with mental disorders and people who were in close contact with a patient with active pulmonary TB. Keywords. Tuberculosis, key and vulnerable populations, publication analysis, Cochrane Library.

The few perceptual–cognitive expertise and deception studies in the domain of law enforcement have yet to examine perceptual–cognitive expertise differences of police trainees and police officers. The current study uses methods from the perceptual–cognitive expertise and deception models. Participants watched temporally occluded videos of actors honestly drawing a weapon and deceptively drawing a non-weapon from a concealed location on their body. Participants determined if the actor was holding a weapon or a non-weapon. Using signal-detection metrics—sensitivity and response bias—we did not find evidence of perceptual–cognitive expertise; performance measures did not differ significantly between police trainees and experienced officers. However, consistent with the hypotheses, we did find that both police trainees and police officers became more sensitive in identifying the object as occlusion points progressed. Additionally, we found that across police trainees and police officers, their response bias became more liberal (i.e., more likely to identify the object as a weapon) as occlusion points progressed. This information has potential impacts for law enforcement practices and additional research.

Adolescents in sub-Saharan Africa continue to face a high burden of HIV, with adolescent girls and young women disproportionately affected. Yet despite major investments in HIV education, testing, condoms, and biomedical prevention such as PrEP, reductions in new infections remain slow in countries like Kenya and Nigeria. This viewpoint argues that current prevention strategies overlook the social realities that shape adolescent decision-making. Drawing on Bicchieri’s Social Norms Theory and field experience, we highlight how visible sanctions tied to pregnancy, reputation, and respectability guide protection choices more than biomedical logic. For many adolescents, discreet hormonal contraception allows girls to avoid public shame, while boys often avoid condoms because being seen purchasing them signals sexual activity and attracts moral judgment. These gendered pressures reduce dual protection even when knowledge and access exist, and fragmented HIV and reproductive health services reinforce the divide. Health systems often deepen this pattern when adolescents feel judged or questioned by providers. Effective HIV prevention requires confronting these normative pressures and integrating youth-friendly reproductive and HIV services. Prevention becomes stronger when it aligns with how adolescents interpret risk, dignity, and responsibility within their social environments rather than focusing on biomedical solutions alone.

Black gay, bisexual, and other men who have sex with men (BMSM) in the US South are disproportionately impacted by HIV. We adapted Project Strength Through Youth Livin’ Empowered (STYLE) to create STYLE 2.0 to assist young BMSM link and remain engaged in HIV care. The multi-component intervention included (1) health care navigators to facilitate linkage and engagement activities, (2) motivational interviewing by a behavioral health provider, and (3) a mobile app to reduce stigma and social isolation. We enrolled 66 BMSM from North and South Carolina in the 12-month intervention and analyzed longitudinal data to assess service utilization, dose, and delivery characteristics while also examining changes in HIV care continuum outcomes. We examined associations between intervention characteristics and HIV care continuum outcomes using logistic regression. We found that all HIV outcomes improved from baseline to 12-month follow-up, including receipt of HIV care (78.8–84.9%), retention in HIV care (75.9–87.7%), being prescribed antiretroviral therapy (ART) (96.8–98.5%), and achieving viral suppression (82.3–90.8%), although none were statistically significant. In multi-variable analyses, participants with more encounters categorized as food bank were more likely to report being prescribed ART [odds ratio (OR): 41.65; 95% confidence interval (CI): 2.72–637.74]. Clients with more referral to care encounters were less likely to have been prescribed ART (OR: 0.02; 95% CI: <0.001–0.42) and be virally suppressed (OR: 0.39; 95% CI: 0.18–0.84). Findings suggest that an integrated approach to HIV and behavioral health services may help BMSM living with HIV overcome structural and social barriers to HIV care.

Special police, as an important force of prevention, control and disposal in public security departments, has been paid much attention. This paper mainly discusses the high quality training of special police. Faced with the current new situation of police law enforcement, the direction of training special police in police academies is how to become a leader in the special police force and how to develop better in the future. This paper holds that, in the new situation, facing the new challenges faced by the reform of recruitment system and law enforcement at the grass-roots level, the key to the training of special police in public security colleges is to build the trainees with core competitiveness facing the front line of public security. At the same time, abandon the shackles of the traditional training mode of special police, build a "one specialty and multi-abilities, two ends of development, three tracks go hand in hand, one plus five training" mode, and open up a new situation of innovative training of special police.

Police Leadership as Practice applies a leadership-as-practice approach (emphasising leader-employee relationships) to law enforcement. This book provides a progressive and collaborative leadership text for students of law enforcement, as well as insights into leadership dynamics in all organisations for students and researchers of business and management. The police leadership-as-practice perspective provides a holistic understanding of leadership in the police, identifying factors that inhibit and promote learning. It refers to four main components as dynamic and continuously evolving processes: Strategies: social mission and organisation, along with strategies as practice Community: organisational and police culture, identity and belonging, community of practice and competencies Participation: sense-making and discretion; power and politics Activities: learning as practice, change and change management as practice Practical and enriched with case studies, examples and best practice, the textbook is also rigorously research based. Authored by a professor of business and management with specialist knowledge in police leadership, it brings the cutting edge of leadership thinking to the practicalities of policing. It is essential reading for those engaged with policing, leadership roles, and management.

Stigma and judgment by health workers toward people living with HIV (PLHIV) and key populations can undermine the uptake of HIV services. In 2014, we recruited health workers delivering HIV services from 21 urban communities in South Africa and Zambia participating in the first year of the HPTN 071 (PopART) cluster-randomized trial. We analyzed self-reported levels of stigma and judgment toward (1) PLHIV, (2) women who sell sex, (3) men who have sex with men (MSM), and (4) young women who become pregnant before marriage. Using logistic regression, we compared responses between three health worker cadres and explored risk factors for stigmatizing attitudes. Highest levels of stigma and judgment were in relation to women who sell sex and MSM, especially in Zambia. Heath workers did not generally think that clients should be denied services, although this was reported slightly more commonly by community health workers. Higher education levels were associated with lower judgmental beliefs, whereas higher perceptions of coworker stigmatizing behaviors toward PLHIV and each key population were associated with holding judgmental beliefs. Training experience was not associated with judgmental attitudes for any of the key populations. Our findings confirm a high prevalence of judgmental attitudes toward key population groups but lower levels in relation to PLHIV, among all cadres of health workers in both countries. Planning and implementing targeted stigma reduction interventions within health settings are critical to meet the needs of vulnerable populations that face more stigmatizing attitudes from health workers.

ABSTRACTHIV epidemic control requires improving access and uptake of HIV services by key populations (KPs). In Zambia, the behaviors of female sex workers (FSWs), men who have sex with men (MSM), and people of who use drugs (PWUD) are criminalized, and little information exists about their HIV/STI service use. Using a quality of care (QOC) framework, we compared barriers to and opportunities for HIV/STI service access and uptake among the three KPs. We conducted in-depth interviews and focus group discussions with 314 KP members between July 2013 and September 2015 in eight districts. Poorer QOC was received at public health facilities compared to private, NGOs and traditional healers. Stigma and discrimination, confidentiality, and legal prosecution were barriers to service use and more salient among MSM than FSWs and PWUD. Invasive facility policies were barriers and more prominent among FSWs than MSM and PWUD. Service unavailability was of equally high salience among MSM and PWUD than FSWs. Comfort in the clinic and perceived treatment effectiveness were facilitators for all three KPs. The health care experiences of KPs are not monolithic; HIV/STI service improvement strategies should address the concerns and be tailored to the needs of each key population.

Thailand is facing major mental health challenges due to a constellation of factors including rapid socio-economic changes and pressures on vulnerable populations. These cause many Thais to experience stress, anxiety, depression, isolation and suicidal ideation. Mental health is a public health priority; yet, mental health and psycho- social support services (MHPSS) are failing to meet some specific basic needs in mental health promotion, prevention and responsive care. MHPSS efficacy is limited by significant gaps in addressing the mental health needs of four overlapping key populations: LGBTQI+, sex workers, migrant workers and drug users. Adolescents and youth from these are a particular concern. Currently, these key populations are effectively excluded from the National Plan for Mental Health (2018-2037). Because they are at higher risk of HIV exposure, the deficit in MHPSS is detrimental to epidemic control and ending AIDS by 2030. To better understand the mental health needs of the four abovementioned key populations, we conducted a rapid situation analysis of mental health issues that they experience. We used an analytical framework to investigate the salient factors shaping their mental health in terms of four social domains. These are as follows: i) the family and home; ii) the school; iii) the workplace; and iv) the community. We also conducted a rapid assessment of MHPSS in relation to access and uptake of services by the four key populations. Data were obtained through qualitative research involving key informant interviews enhanced by a literature review of mental health among key populations in Thailand.

BackgroundDespite achievements in the HIV response, social and structural barriers impede access to HIV services for key populations (KP) including men who have sex with men (MSM), transgender women (TGW), and people who inject drugs (PWID). This may be worsened by the COVID-19 pandemic or future pandemic threats. We explored the impact of COVID-19 on HIV services and sexual and substance use behaviors among MSM/TGW and PWID in Zambia as part of a formative assessment for two biobehavioral surveys.MethodsFrom November-December 2020, 3 focus groups and 15 in-depth interviews (IDIs) with KP were conducted in Lusaka, Livingstone, Ndola, Solwezi, and Kitwe, Zambia. Overall, 45 PWID and 60 MSM/TGW participated in IDIs and 70 PWID and 89 MSM/TGW participated in focus groups. Qualitative data were analyzed using framework matrices according to deductive themes outlined in interview guides.ResultsKP reported barriers to HIV testing and HIV treatment due to COVID-19-related disruptions and fear of SARS-CoV-2 exposure at the health facility. MSM/TGW participants reported limited supply of condoms and lubricants at health facilities; limited access to condoms led to increased engagements in condomless sex. Restrictions in movement and closure of meet-up spots due to COVID-19 impeded opportunities to meet sex partners for MSM/TGW and clients for those who sold sex. COVID-19 restrictions led to unemployment and loss of income as well as to shortages and increased price of drugs, needles, and syringes for PWID. Due to COVID-19 economic effects, PWID reported increased needle-sharing and re-use of needles.ConclusionsParticipants experienced barriers accessing HIV services due to COVID-19 and PWID attributed unsafe needle use and sharing to loss of income and lack of affordable needles during pandemic-related restrictions. To maintain gains in the HIV response in this context, strengthening harm reduction strategies and improvements in access to HIV services are necessary.

Identification and retention of HIV-positive children in HIV services is essential to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition [loss to follow-up (LTFU) and death) of HIV-positive children from HIV services in low and middle-income countries (LMICs). We performed a comprehensive multidatabase search of original studies reporting retention/attrition data for HIV-positive children in LMICs through April 2016. Outcomes included LTFU, death, and overall attrition (LTFU + death) at intervals up to 60 months of follow-up. At least two authors determined study eligibility, performed data extraction, and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. We identified 3040 unique studies; 91 met eligibility criteria and were included in the analysis. This represents 147 129 HIV-positive children; most were from Africa (83%). LTFU definitions varied widely, with significant variability in outcomes across studies. Most attrition occurred in the first 6 months of follow-up, increasing to 23% by 36 months. HIV-positive children receiving antiretroviral therapy (ART) had significantly better retention in care than those not on ART. Studies that performed case-finding/tracing for those LTFU had better retention in care up to 24 months of follow-up. These findings underscore the high attrition of children from HIV services in LMICs. Early ART initiation and decentralized patient support services (e.g. tracing for those LTFU) have potential to improve retention in care. Implementation research and resources are urgently needed to improve retention among this vulnerable population.

BackgroundWith the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions.ObjectiveWe aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort.MethodsIn August 2018, 261 trained data collectors from 36 key population–led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President’s Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population–defining behaviors. Hotspots were visited by data collectors, and each hotspot’s name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots.ResultsA total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals.ConclusionsThe number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population–led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.

IntroductionAs oral pre‐exposure prophylaxis (PrEP) services scale up throughout sub‐Saharan Africa (SSA), clients continue to face challenges with sustained PrEP use. PrEP‐related stigma has been shown to influence engagement throughout the HIV PrEP care continuum throughout SSA. Validated quantitative measures of PrEP‐related stigma in SSA are of critical importance to better understand its impacts at each stage of the HIV PrEP care continuum. This study aimed to psychometrically evaluate a PrEP‐related stigma scale for use among key and vulnerable populations in the context of a Kenya national PrEP programme.MethodsAs part of a larger prospective cohort study nested within Kenya's Jilinde programme, this study used baseline data collected from 1135 participants between September 2018 and April 2020. We used exploratory factor analysis to evaluate the factor structure of a PrEP‐related stigma scale. We also assessed convergent construct validity of the PrEP‐Related Stigma Scale by testing for expected correlations with depression and uptake of HIV services. Finally, we examined the relationship between PrEP‐related stigma and key demographic, psychosocial and behavioural characteristics.ResultsWe identified four dimensions of PrEP‐related stigma: (1) interpersonal stigma, (2) PrEP norms, (3) negative self‐image and (4) disclosure concerns. The scale demonstrated strong internal consistency (α = 0.84), was positively correlated with depressive symptoms and negatively correlated with uptake of HIV services. Multivariable regression analysis demonstrated associations between PrEP‐related stigma and sex worker identity.ConclusionsThe adapted and validated PrEP‐Related Stigma Scale can enable programmes to quantify how PrEP‐related stigma and its dimensions may differentially impact outcomes on the HIV PrEP care continuum, evaluate stigma interventions and tailor programmes accordingly. Opportunities exist to validate the scale in other populations and explore further dimensions of PrEP‐related stigma.

Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini. The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services-including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management-alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust. Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.

Crowdsourcing is increasingly used to improve community engagement in HIV and sexual health research. In this scoping review, we reviewed studies using crowdsourcing approaches in HIV and sexual health research to identify strengths, opportunities for expansion, and limitations of such approaches. We searched CINAHL, Web of Science, Embase, and PubMed. Studies were included if they involved crowdsourcing activities, were in the field of HIV or sexual health, and described the methodology in sufficient detail. We conducted a qualitative synthesis of eligible articles. Our search strategy yielded 431 nonduplicate articles. After screening, 16 articles met the inclusion criteria, including 4 publications that described research from high-income countries, 7 from middle-income countries, 1 from a low-income country, and 4 that had a global focus. There were 4 categories of crowdsourcing: open contests, hackathons, open forums, and incident reporting systems. We identified common phases for data acquisition and dissemination: (1) preparation; (2) problem framing and crowd solicitation; (3) judging submissions; and (4) sharing selected submissions. Strengths of using crowdsourcing approaches include greater innovation due to crowd heterogeneity, encouragement of multisectoral collaboration, empowerment of vulnerable populations, cost-effectiveness, and relevance to local cultures and styles. Weaknesses among some methods include reliance on the internet, temporal transience, and difficulty in sustaining long-term community engagement. Crowdsourcing may be useful for HIV implementation research. Further research on crowdsourcing related to HIV and sexual health is needed.