Proyecto ESCUDO: Harmonizing Law Enforcement and HIV Prevention through a Police Education Program

Funded by NIDA grant R01 DA039073, with additional support from the Open Society Foundations and the UCSD Center for AIDS Research.

PI: Steffanie Strathdee, Leo Beletsky

Proyecto ESCUDO re-aligns policing and public health.

  • Living with VIH/SIDA: Tijuana Stories -- HIV/SIDA: The Epidemic in Tijuana Episode 3
  • Our research has added to the emerging global evidence base showing that policing practices are key structural drivers of HIV vulnerability among people who inject drugs (PWID), sex workers, and other criminalized groups. Simply continuing to document these practices and their links to health risk and public health detriment is not enough. This is why our team has undertaken an action research approach focused on shifting police knowledge, attitudes and behaviors. Led by Dr. Steffanie Strathdee and Leo Beletsky, members of our binational team have developed and piloted a police education program (PEP) designed to align law enforcement and HIV prevention in Tijuana. This work has received support from the UCSD Center for AIDS Research and Open Society Foundation.

    Building on our successful partnership with Tijuana’s police academy and police department, we anticipate scaling up these initial efforts toward a longer-term evaluation of this program through Proyecto Escudo (Project Shield).  The aims of Proyecto Escudo are as follows: 1) To evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of occupational NSIs (primary outcome). 2) To evaluate PEP efficacy on changes in secondary outcomes:  i) knowledge of transmission, prevention and treatment of HIV and related infections; ii) attitudes towards PWID, sex workers and HIV-infected persons; iii) adverse behaviors that interfere with HIV prevention; iv) protective behaviors. 3) To assess potential mediating and moderating factors influencing PEP efficacy. Using a modified stepped-wedge design involving all active duty police officers in Tijuana, police mandated for periodic refresher training will be assigned to classes which receive one 3-hour PEP course over 2 years until the entire force is trained.  NSI incidence and geocoded arrest data will be assessed department-wide (Aim 1). A sub-cohort sample will be invited to undergo pre- and post-PEP surveys with semi-annual follow-up for 2 years to assess self-reported NSIs (Aim 1), attitudinal and behavior changes (Aim 2) and mediators/moderators (Aim 3). The PEP’s impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs followed through 2020 under separate funding. Proyecto Escudo will be the first trial to assess efficacy of a PEP on policing behaviors that place PWID and police at elevated risk of HIV and blood-borne infections. Findings are expected to help bring PEPs to scale in the growing number of countries where policing is a documented driver of HIV acquisition. 

    Costing analysis of a Police Education Program  
    This research project will be done in concert with a NIDA-funded police education program (PEP) in Tijuana, Mexico (PI: Strathdee, R01DA039073).  The PEP also serves as a structural HIV prevention intervention in light of evidence linking policing behaviors (i.e. arrest, syringe confiscation, harassment) as a driver of HIV infection among people who inject drugs. The cost and scalability of such an intervention will be an important consideration for policymakers in determining its acceptance and sustainability. Thus, the goals of this project are to:
    1) Collect cost data related to the PEP intervention
    2) Perform a cost analysis and assess changes in cost as the PEP was scaled up in Tijuana
    3) Calculate the budgetary impact of the PEP if scaled-up across the state of Baja California