Danya Fast

Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study

BackgroundStreet-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among street-involved youth in Vancouver, Canada.MethodsQualitative interviews with street youth who inject drugs elicited descriptions of the adoption of injection as a route of administration. Interviewees were recruited from the At-Risk Youth Study (ARYS), a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Audio recorded interviews were transcribed verbatim and a thematic analysis was conducted.Results26 youth aged 16 to 26 participated in this study, including 12 females. Among study participants the first injection episode frequently featured another drug user who facilitated the initiation of injecting. Youth narratives indicate that the transition into injecting is influenced by social interactions with drug using peers and evolving perceptions of injecting, and rejecting identification as an injector was important among youth who did not continue to inject. It appears that social conventions discouraging initiating young drug users into injection exist among established injectors, although this ethic is often ignored.ConclusionThe importance of social relationships with other drug users within the adoption of injection drug use highlights the potential of social interventions to prevent injection initiation. Additionally, developing strategies to engage current injectors who are likely to initiate youth into injection could also benefit prevention efforts.

Drug-related risks among street youth in two neighborhoods in a Canadian setting

We compared drug-related behaviors, including initiation of drug use, among street youth residing in two adjacent neighborhoods in Vancouver. One neighborhood, the Downtown Eastside (DTES), features a large open-air illicit drug market. In multivariate analysis, having a primary illicit income source (adjusted odds ratio [AOR]=2.64, 95% confidence interval [CI]: 1.16-6.02) and recent injection heroin use (AOR=4.25, 95% CI: 1.26-14.29) were positively associated with DTES residence, while recent non-injection crystal methamphetamine use (AOR: 0.39, 95% CI: 0.16-0.94) was negatively associated with DTES residence. In univariate analysis, dealing drugs (odds ratio [OR]=5.43, 95% CI: 1.24-23.82) was positively associated with initiating methamphetamine use in the DTS compared to the DTES. These results demonstrate the importance of considering neighborhood variation when developing interventions aimed at reducing drug-related harms among street-involved youth at various levels of street entrenchment.

Pathways to criminalization for street-involved youth who use illicit substances

Abstract Illicit drug use and homelessness among street-involved young people remain community and public health concerns, in part because of their association with ‘public disorder’, as well as increased encounters between youth, police, the criminal justice system, and the associated health-related harms. In the public imagination, illicit drug use, homelessness, and police encounters (including incarceration) are often understood as problems rooted in individual biographies. In general, there has been a lack of attention to the larger historical, institutional, and social-spatial contexts that converge across time, to increase young people’s risk of coming into contact with police and the criminal justice system. Drawing from a longitudinal ethnography with street-involved young people who use illicit drugs in Vancouver, Canada, we highlight two qualitative case studies that illustrate some of the ‘pathways’ to criminalization among this population. Specifically, these case studies reflect the complex linkages between child apprehension, foster care, homelessness, illicit substance use, and incarceration (juvenile detention and prison) across time. Our findings highlight the role of state interventions in perpetuating the marginalization that occurs across young people’s lives, in ways that increase their vulnerability to police and criminal justice encounters.

Perceptions of a drug prevention public service announcement campaign among street-involved youth in Vancouver, Canada : a qualitative study

BackgroundDue to the popularity of public service announcements (PSAs), as well as the broader health and social harms associated with illicit drug use, this study sought to investigate how drug prevention messages found in the Government of Canada’s DrugsNot4Me campaign were understood, experienced, and engaged with among a group of street-involved young people in Vancouver, Canada.MethodsQualitative interviews were conducted with 25 individuals enrolled in the At-Risk Youth Study, and a thematic analysis was conducted.ResultsFindings indicate that the campaign’s messages neither resonated with “at-risk youth”, nor provided information or resources for support. In some cases, the messaging exacerbated the social suffering experienced by these individuals.ConclusionsThis study underscores the importance of rigorous evaluation of PSAs and the need to consider diverting funds allocated to drug prevention campaigns to social services that can meaningfully address the structural drivers of drug-related harms among vulnerable youth populations.

“Getting out of downtown”: a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene

BackgroundUrban drug “scenes” have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths’ drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner-city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences.MethodsBetween 2008 and 2016, we draw on 150 semi-structured interviews with 75 street-entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between.ResultsYouth described that, in order to successfully exit Vancouver’s inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves – both physically and socially – from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth’s capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low-threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption.ConclusionsPolicies and programming interventions that can facilitate young people’s efforts to reduce engagement with Vancouver’s inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, ‘low threshold’ addiction treatment services, as well as access to supportive housing outside of the scene.

Criminalization of HIV non-disclosure: Narratives from young men living in Vancouver, Canada

Background Previous research has identified the impacts of legal frameworks that criminalize HIV non-disclosure among people living with HIV (e.g., elevated stigma and violence). However, far less is known about the perspectives or experiences of people–particularly, men–who are HIV-seronegative or who are unaware of their status. The objective of this paper is to describe the health and social risks that young men perceive to be associated with an HIV diagnosis in the context of Canada’s current legal framework pertaining to HIV non-disclosure. Methods We analyzed data from 100 in-depth interviews (2013–2016) conducted with 85 young men ages 18–30 in Vancouver on the topic of the criminalization of HIV non-disclosure. Results Our analysis revealed two dominant narratives in relation to HIV criminalization: (a) interrogation and (b) justification. An interrogation narrative problematized the moral permissibility of criminalizing HIV non-disclosure. In this narrative, Canada’s HIV non-disclosure legal framework was characterized as creating unjust barriers to HIV testing uptake, as well as impeding access to and reducing retention in care for those living with HIV. Conversely, a justification narrative featured a surprising number of references to HIV as a “death sentence”, despite effective treatments being universally available in Canada. However, most of those who presented the justification narrative asserted that the criminalization of HIV non-disclosure was morally justified in light of the perceived negative stigma-related impacts of HIV (e.g., discrimination; being ostracized from sex or romantic partners, friends, family). The justification narrative often reflected a belief that the legal framework provides both punishment and deterrence, which were perceived to supersede any barriers to care for both HIV-positive and -negative individuals. Conclusion Public education regarding contemporary medical advances in HIV may help contest lay understandings of HIV as a “death sentence”, which is particularly relevant to destabilizing justification narratives. However, significant strengthening of HIV stigma-reduction efforts will be needed to move society away from narratives that attempt to justify Canada’s current HIV non-disclosure legal framework.

Secure care: more harm than good

KEY POINTS Many who overdose on drugs in British Columbia are youth under the age of 19 years,[1][1] and calls for “secure care” legislation have intensified. Secure care legislation would legitimize the detention and forced care of youth who are deemed to be at immediate risk of serious