Search

AbstractBackgroundMethodsFindingsConclusionThe COVID-19 pandemic exacerbated the US overdose crisis and disproportionately impacted unstably housed people who use drugs. Measures to address the pandemic within the context of crisis produced differential effects, particularly among people who use drugs. Examining how unstably housed people who use drugs adapted to shifting risk environments is imperative to responding to future crises.Rapid ethnographic data was collected from June 2020 to April 2021 in Rhode Island. Data include in-depth interviews with 39 unstably housed people who use drugs and approximately 50 hours of fieldwork.COVID-related service disruptions and policing of public space (e.g. city curfews) reinforced participants’ marginality and increased surveillance. This heightened visibility disrupted participants’ socio-spatial patterns as they were regularly relocated and faced increased risk of arrest due to public drug use and housing instability. Participants regularly weighed overdose risk reduction against COVID-19 exposure and risk of arrest, which increased harm.Findings demonstrate how COVID-related public health measures intersected with participants’ socio-spatial and drug use patterns in ways that increased overdose risk. Drawing on health equity approaches when responding to crisis situations is critical to address intersecting inequities faced by unstably housed people who use drugs. [ABSTRACT FROM AUTHOR]

Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside – one of Canada's overdose epicenters – this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations. [ABSTRACT FROM AUTHOR]

Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada - a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants' service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants' structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants' subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP. Keywords: HIV/AIDS; integrated service model; treatment as prevention; structural vulnerability; qualitative; Canada, Introduction The negative impact of social-structural inequities, such as poverty, homelessness and drug criminalization on HIV treatment and care among people living with HIV (PLHIV) who use drugs is well [...]