Extra-legal policing strategies and HIV risk environment: accounts of people who inject drugs in Nigeria

This article reports on an exploratory qualitative study investigating extra-legal policing practices and HIV vulnerability among injecting drug users. It draws upon thematic analysis of interview accounts of 29 street-involved PWID, recruited through snowball sampling in Uyo, Nigeria. The data emphasized that policing is a structural mechanism perpetuating drug-related harms and social suffering in the lives of PWID. Policing strategies, including searches, violence and confiscation of sterile needles and syringes, reproduce an environment of fear that undermines risk reduction and contributes to HIV risk via injecting in risky settings and receptive syringe sharing. Accounts highlighted humiliations, labeling and other expressions of contempt as forms of 'moral policing', which reinforce stigma and sanction human rights violations. Extra-legal policing practices, including violence, extortion and sexual harassments, adversely affect health and well-being. This raises questions about the effectiveness and legitimacy of policing and highlights a social justice perspective that may contribute to the reduction of health inequalities for PWID. It also provides a social justice and human rights rationale for advocacy for policy reforms, safe injection sites, needle and syringe distribution, oral drug substitution programs and rights-based, public health-oriented policing that enable access to harm reduction services for PWID.