Restrictive Syringe Access Laws and their Effects on HIV Rates
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Date
2022-05
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Publisher
The Ohio State University
Abstract
To prevent the spread of HIV among people who inject drugs, governments may implement Syringe Exchange Programs (SEPs/SSPs) that provide sterile syringes to reduce the prevalence of high-risk injection behaviors. In the United States, there is a patchwork of varying state laws that govern the operation of SEPs. Using a difference-in-difference analytical framework, I estimate the causal effect of changes in state-level legal frameworks governing syringe access on county-level new HIV case rates. This analysis includes laws that allow SEPs to operate or restrict their operations. I further investigate how the legal frameworks affect HIV rates in small and large counties. The results show that allowing for SEP operation at the state level is associated with a decrease in the reported county-level HIV rate. In those counties that allow for SEPs, increasing the restrictiveness of the laws governing how they can operate appears to also lower the reported HIV rate; however, this result is complicated by extending this investigation specifically to counties containing SEPs. Finally, the reduction in HIV rates associated with law changes that allow for SEPs to open appear to be exclusively concentrated in counties with populations below the national median. Public policy changes that influence how people who use drugs access sterile syringes can influence HIV outcomes.
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Keywords
HIV, Syringe Exchange, Legal Epidemiology, Difference in Difference