Still “at risk”: An examination of how street-involved young people understand, experience, and engage with “harm reduction” in Vancouver’s inner city

Abstract

Background Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the ‘street drug scene’, understood, experienced and engaged with harm reduction. Methods Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17–28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants’ understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. Results Young peoples’ ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples’ broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver’s Downtown Eastside) strongly determined access to services. Conclusions In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples’ multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances.

Association between water, sanitation, general hygiene and oral hygiene practices of street-involved young people in Southwest Nigeria

“…SIYP are adolescents and young persons who come to the street and engage in the street economy as a source of labor [10]. They also engage in high-risk behaviors [11] and have emergency health needs [12]. In Nigeria, the risk for sexually transmitted infection, HIV infection and sexual exploitation are increased in SIYP [13][14][15][16].…”

Association Between Water, Sanitation, General Hygiene And Oral Hygiene Practices Of Street Involved Young People In Southwest Nigeria

“…SIYP are adolescents and young persons who come to the street and engage in the street economy as a source of labour [10]. They also engage in high-risk behaviours [11] and have emergency health needs [12]. In Nigeria, the risk for sexually transmitted infection, HIV infection and sexual exploitation are increased in SIYP [13][14][15][16].…”

Addressing the problem of sterile drug injecting supply acquisition for people who inject drugs.

“…People who use drugs engaging in harm reduction programs have a general understanding of the public and personal health benefits these programs promote, and are supportive of them (Bozinoff, Small, Long, DeBeck, & Fast, 2017;Otiashvili et al, 2019).…”

“…Through harm reduction practices such as syringe exchange programs (SEP), also known as needle exchange programs and syringe service programs, participants are educated on best practices for reducing the risk of infection and other harms, and provided with sterile injecting supplies. Despite provision of free sterile injecting supplies and education, there exists some degree of syringe re-use or sharing among SEP participants Bozinoff, Small, Long, DeBeck, & Fast, 2017;Ksobiech, 2006 This risky sharing and re-use of supply behavior occurs within all PWID communities. Ksobiech (2006) conducted a meta-analysis demonstrating syringe sharing behaviors were reduced among SEP participants compared to those who do not participate, but the prevalence of syringe sharing was not reported in this analysis.…”