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SETTING: The Inuit community of Rigolet experiences greater rates of self-reported acute gastrointestinal illness (AGI) compared to southern Canada. INTERVENTION: A whiteboard video tool was collaboratively developed by Rigolet youth, community members, the research team and key regional stakeholders to share public health recommendations for reducing the risk of AGI. The video debuted in Rigolet at a community event in August 2016 and was later provided online for community members and local and regional health departments. Interviews and focus group discussions were used to evaluate the ability of the video to communicate public health information to community members in Rigolet. OUTCOMES: Community and government viewers reported that the whiteboard video was novel and engaging. Evaluation participants believed the video was suitable for promoting Inuit health because of the use of locally relevant visuals and narrative, which reflect Inuit art and storytelling traditions. Furthermore, participants indicated that the video co-development process was critical to ensuring community relevance of the video. Short-term outcome results suggest the video can reinforce health knowledge and potentially encourage behavioural change. IMPLICATIONS: The results suggest this whiteboard video was an effective tool to share information and could increase intention to change behaviours to reduce the risk of AGI in Rigolet. While tools like the whiteboard video are gaining popularity, the participatory approach was used to develop the video, and its use in an Inuit context illustrates its innovation and novelty. This tool may be a useful health promotion tool among Indigenous communities in Canada.

OBJECTIVES: Private security guards are increasingly regulating public space, including areas within urban drug scenes. We examined the prevalence and correlates of encounters with security guards among people who inject drugs (PWID) in Vancouver, Canada. METHODS: Data were derived from two prospective cohort studies of PWID collected between December 2005 and May 2014. We used multivariable generalized estimating equations to identify factors associated with reporting encounters with private security guards. RESULTS: Among 1714 participants, 616 (35.9%) reported encounters with security guards over the study period. In multivariable analyses, factors independently and positively associated with security guard encounters included: unstable housing (adjusted odds ratio [AOR]=1.27); daily non-injection crack use (AOR=1.35); daily methamphetamine use (AOR=1.40); street-based income generation (AOR=1.58); incarceration (AOR=1.45); experiencing violence (AOR=1.90); non-fatal overdose (AOR=1.31); syringe sharing (AOR=1.45); public injection (AOR=1.68); and inability to access addiction treatment (AOR=1.60) (all pCONCLUSION: Security guard exposure was independently associated with various measures of vulnerability and drug-related harm. These findings highlight the need for regulatory reforms and broader structural interventions to reduce harm among PWID in this setting. Language: en

There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver's inner city. Using Indigenous methodologies, a community research team comprised of APWUID/A led the study design, data collection and analysis. Peer-facilitated talking circles explored community members' experiences accessing healthcare services and patient-provider encounters. Using an intersectionality framework, our research demonstrated how healthcare inequalities among Aboriginal peoples are perpetuated by systemic racism and discrimination. Stigmatizing racial stereotypes were perceived to negatively influence individual attitudes and clinical practice. Participants' experiences of medical dismissal often resulted in disengagement from care or delay in care. The findings suggest healthcare providers must understand the structural and historical forces that influence racial disparities in healthcare and personal attitudes in clinical practice. Adequate clinical protocols for pain management within the context of illicit substance use are urgently needed. The valuation of Aboriginal peoples and cultures within healthcare is paramount to addressing the health gap between Aboriginal and non-Aboriginal Canadians.

Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards’ potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD’s access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.

Nicole Markwick , Ryan McNeil , Solanna Anderson , Will Small , Thomas Kerr * a British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 – 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada b School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada c Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada

People who inject drugs (IDU) face unique systemic, social and individual barriers to conventional HIV voluntary counselling and testing (VCT) programmes. Peer-delivered approaches represent a possible alternative to improve rates of testing among this population.Cross-sectional data from a prospective cohort of IDU in Vancouver, Canada, were collected between December 2011 and May 2012. Bivariate statistics and multivariate logistic regression were used to identify the prevalence of and factors associated with willingness to receive peer-delivered VCT.Of 600 individuals, 51.5% indicated willingness to receive peer-delivered pretest counselling, 40.7% to receive peer-delivered rapid HIV testing and 42.8% to receive peer-delivered post-test counselling. Multivariate analyses found significant positive associations between willingness for pretest counselling and having used Vancouver's supervised injection facility, Insite, or being a member of VANDU (a local drug user organisation) (all p0.05). Daily crack smoking and having used Insite were positively associated with willingness to receive peer-delivered HIV testing (p0.05). Willingness to receive peer-delivered post-test counselling was positively associated with male gender, daily crack smoking, having used Insite and being a member of VANDU (p0.05).While not universally acceptable, peer-delivered VCT approaches may improve access to HIV testing among IDU.