Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas.

OBJECTIVE To understand associations of punitive policies to the population prevalence of injection drug users and to HIV seroprevalence among injectors. DESIGN AND METHODS A lagged-cross-sectional analysis of metropolitan statistical area data. Estimates of drug injectors per capita and of HIV seroprevalence among injectors in 89 large US metropolitan areas were regressed on three measures of legal repressiveness (hard drug arrests per capita; police employees per capita; and corrections expenditures per capita) controlling for other metropolitan area characteristics. RESULTS No legal repressiveness measures were associated with injectors per capita; all three measures of legal repressiveness were positively associated with HIV prevalence among injectors. CONCLUSIONS These findings suggest that legal repressiveness may have little deterrent effect on drug injection and may have a high cost in terms of HIV and perhaps other diseases among injectors and their partners--and that alternative methods of maintaining social order should be investigated.