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Policy Reform to Shift the Health and Human Rights Environment for Vulnerable Groups: The Case of Kyrgyzstan's Instruction 417

Health and Human Rights, Vol. 14, No. 2, pp. 1-15, December 2012

Northeastern University School of Law Research Paper No. 122-2012

16 Pages Posted: 5 Jan 2013  

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences

Rachel Thomas

Open Society Foundations (OSF)

Marina Smelyanskaya

Open Society Foundations (OSF)

Irina Artamonova

University of California, San Diego (UCSD) - School of Medicine

Natalya Shumskaya

AIDS Foundation East-West

Aijan Dooronbekova

AIDS Foundation East-West

Aibek Mukambetov

Open Society Foundations (OSF) - Soros Foundation Kyrgyzstan

Heather Doyle

Open Society Foundations (OSF)

Rebecca Tolson

Open Society Foundations (OSF)

Date Written: December 21, 2012

Abstract

Background: Police activities shape behavior and health outcomes among drug users, sex workers, and other vulnerable groups. Interventions to change the policing of drug consumption and sex work in ways that facilitate public health programming and respect for human rights have included policy reforms, education, and litigation. In 2009, the Kyrgyz government promulgated “Instruction 417,” prohibiting police interference with “harm reduction” programs, re-enforcing citizen rights, addressing police occupational safety concerns, and institutionalizing police-public health collaboration.

Objectives/Methods: Although ample evidence points to gaps between intended and actual impact of policy and other structural interventions, there is little research on the impact of initiatives designed to align policing, health, and human rights. We conducted a police officer survey to assess links between Instruction 417 knowledge and legal and public health knowledge, attitudes towards harm reduction programs, and intended practices targeting vulnerable groups.

Results: In a 319-officer sample, 79% understood key due process regulations, 71.1% correctly characterized law on sex work, 54.3% understood syringe possession law, while only 44.4% reported familiarity with Instruction 417. Most (72.9%) expressed positive attitudes toward condom distribution, while only 56% viewed syringe access favorably. Almost half (44%) agreed that police should refer vulnerable groups to disease prevention programs, but only 20% reported doing so. In multivariate analysis, knowledge of Instruction 417 was associated with significantly better knowledge about (aOR=1.84, 95%CI: 1.12-3.00) and attitudes towards harm reduction programs (aOR=3.81, 95%CI:1.35-10.75), and knowledge of due process for the detention of sex workers (aOR=2.53, 95%CI:1.33-4.80). Younger, junior officers and those in rural areas may not be well-informed about the policy.

Discussion: While reflecting positively on Instruction 417 as a structural approach to aligning policing and public health, this analysis highlights gaps in policy dissemination and calls for further research to assess street-level impact of interventions on the health and human rights environment for vulnerable groups.

Suggested Citation

Beletsky, Leo and Thomas, Rachel and Smelyanskaya, Marina and Artamonova, Irina and Shumskaya, Natalya and Dooronbekova, Aijan and Mukambetov, Aibek and Doyle, Heather and Tolson, Rebecca, Policy Reform to Shift the Health and Human Rights Environment for Vulnerable Groups: The Case of Kyrgyzstan's Instruction 417 (December 21, 2012). Health and Human Rights, Vol. 14, No. 2, pp. 1-15, December 2012; Northeastern University School of Law Research Paper No. 122-2012. Available at SSRN: https://ssrn.com/abstract=2192474

Leo Beletsky (Contact Author)

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences ( email )

416 Huntington Avenue
Boston, MA 02115
United States
617-373-5540 (Phone)

Rachel Thomas

Open Society Foundations (OSF) ( email )

224 West 57th Street
New York, NY 10019
United States

Marina Smelyanskaya

Open Society Foundations (OSF) ( email )

224 West 57th Street
New York, NY 10019
United States

Irina Artamonova

University of California, San Diego (UCSD) - School of Medicine ( email )

9500 Gilman Drive
MC 0507
La Jolla, CA 92093
United States

Natalya Shumskaya

AIDS Foundation East-West ( email )

P.O. Box 75752
Amsterdam
Netherlands

Aijan Dooronbekova

AIDS Foundation East-West ( email )

P.O. Box 75752
Amsterdam
Netherlands

Aibek Mukambetov

Open Society Foundations (OSF) - Soros Foundation Kyrgyzstan ( email )

55A, Logvinenko St.
Bishkek, 720040
Kyrgyzstan

Heather Doyle

Open Society Foundations (OSF) ( email )

224 West 57th Street
New York, NY 10019
United States

Rebecca Tolson

Open Society Foundations (OSF) ( email )

224 West 57th Street
New York, NY 10019
United States

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