Background: This community-based participatory research study explored the impacts of the COVID-19 pandemic on drug use, and access to substance use/harm reduction services among Indigenous people living with HIV/AIDS in Saskatchewan and Manitoba.

Methods: The project was grounded in an Indigenized ethical space and utilized etuaptmumk/Two-Eyed Seeing to interweave Indigenous and Western ways of knowing, being and doing. Participants in Manitoba (n=24) and Saskatchewan (n=21) were recruited using printed flyers, community-based agencies, peers, and social media. Interviews focused on pandemic’s impacts on substance use and access to substance use programs/supports during the COVID-19 pandemic. Data were analyzed using thematic analyses.

Results: Participants described a variety of impacts of COVID-19 on their substance use, including relapses, increased drug use, and negative impacts of isolation on overdoses and mental health. Injection drug use increased during the pandemic, including the use of fentanyl products and crystal meth. Many participants reported reduced access to harm reduction supplies and interruption of substance use/detox programs and support services during the pandemic. Relapse to substance use during the pandemic occurred in a context of social isolation, co-occurring health issues, family grief and loss related to fatal drug overdoses, homelessness, food insecurity, and inadequate socio-economic resources. Participants also described a variety of ways they coped with the pandemic.

Conclusion: The COVID-19 pandemic in Manitoba and Saskatchewan was characterized by increased overdose risk, and other drug-related harms faced by this community. Reducing barriers to culturally safe healthcare, addressing housing and food insecurity, access to harm reduction, and expanding the response to the toxic drug and overdose crisis are urgently needed. Failure to urgently address the harm reduction needs of Indigenous people living with HIV and experiencing multiple intersecting vulnerabilities may intensify the existing health and social disparities of this group.

Contexte :
La crise des surdoses au Canada a été exacerbée par les mesures sanitaires venues enrayer la pandémie de COVID-19. Pour comprendre cela, nous nous sommes intéressées au vécu des personnes utilisatrices de drogue à injection au Québec pendant la crise de la COVID-19.

Méthodes :
Dans le cadre du programme multi-pays EPIC, des entrevues individuelles qualitatives semi-dirigées ont été conduites auprès de personnes utilisatrices de drogue au Québec entre août et novembre 2021. Le but de ces entrevues est de documenter le vécu de la crise de la COVID-19, ainsi que de connaître les besoins en matière d’aide communautaire ou sanitaire des personnes interrogées. Les entrevues ont été faites via la plateforme zoom. La partie audio a été enregistrée et retranscrite à l'écrit. L’analyse thématique du contenu a été assurée par deux chercheur·es.

Résultats :
11 personnes ont été interrogées. Le principal sujet de préoccupation abordé lors de ces entrevues est l’impact négatif des mesures sanitaires sur la crise des surdoses. Les participant·es ont notamment évoqué les mesures de couvre-feu et de confinement, qui les ont poussé·es à consommer à leur domicile, sans supervision. L’accès aux centres d’injection supervisés ou aux services communautaires d’analyse de drogue a été restreint ou empêché à cause de ces mesures. Les participant·es ont aussi indiqué avoir vécu un ralentissement ou une réduction dans la qualité des services de santé.

Conclusions :
Les réponses à ces entrevues ont mis en évidence la nécessité d'utiliser les structures communautaires pour les personnes utilisatrices de drogue et les effets néfastes en cas de restriction à l’accès à ces services. Ces témoignages permettent de mettre en lumière les vécus des personnes utilisatrices de drogue pendant cette pandémie et à identifier les besoins en matière de prévention et de réduction des méfaits pour cette population vulnérable au VIH.

Background: In Canada, people who use drugs (PWUD) experience the highest exposure to the hepatitis C virus (HCV). HCV treatment is essential for individual and population health; to achieve elimination, more people need to seek treatment. This project aimed to characterize PWUDs’ healthcare experiences across British Columbia, Canada, assess how these experiences affect their willingness to access healthcare, and to propose community-sourced solutions.

Methods: People with a history of drug use were recruited by peers to participate in one 1-2 hour semi-structured videoconference interview. Analysis of transcripts followed a deductive–inductive iterative process. Analysis, informed by peer knowledge, theories of stigma, and literature, was guided by Interpretive Description to identify themes.

Results: 25 PWUD described aspects of their healthcare experiences and reflected on seeking access to healthcare at different times in their lives. Many participants had poor healthcare relationships and experiences featuring dismissal, judgment, and personal blame. Many PWUD described being denied care for severe conditions including injury and post-surgical pain. Most attributed these experiences to stigma from individual healthcare workers, sometimes enabled by organizational policy. Many participants avoided healthcare, including HCV testing and other care, to reduce anticipated and enacted stigma. Some maintained strong healthcare relationships despite periods of homelessness, disordered substance use, or sex work. In good relationships participants felt their provider listened to them, concentrated on their needs, and was non-judgmental.

Conclusions: Findings identified individual- (e.g., blaming), organizational- (flagging records), and systemic-level (society devaluing PWUD) issues impacting PWUDs’ healthcare access and quality. Good healthcare relationships can mitigate such issues, and can thrive despite active drug use or serious life struggles. Healthcare relationships strongly influence PWUDs’ healthcare decisions such as timely seeking of care, including HCV care. PWUD identified specific areas for clinicians to concentrate effort and techniques to create and maintain good relationships, e.g., trust-building and demonstrating respect.

Despite investments in the prevention and treatment of HIV, new infections continue to occur and a small but significant proportion of individuals living with HIV are not linked appropriately or retained in care. In Hamilton, Ontario, a rising proportion of new diagnoses occur in people who inject drugs. This group of patients experiences multiple barriers to accessing care and has traditionally been poorly served by the existing clinical infrastructure, particularly when they are affected by poverty and mental health diagnoses. We aim to evaluate a service delivery method which focuses on lowering barriers and providing a patient centred approach to care with the aim of increasing the number of individuals able to access the care they require. This program is different from other HIV clinics because it is housed in a community space (The AIDS Network, Hamilton ON), has weekly drop-in hours to see the doctor, and most patients with a concurrent opioid use disorder are also prescribed a safer supply of opioid medication to replace a toxic illicit opioid supply. This project is ongoing with 13 participants currently enrolled and more referred. At baseline, we conduct a survey with the participant then follow-up with chart review up to 18 months. We are also collecting qualitative data through semi-structured interviews then using reflexive thematic analysis to interpret. Thus far, we have retained all 13 patients in the study and most are adhering to their HIV treatment, resulting in undetectable and untransmissible HIV viral loads. Participants also report reduced cravings when they reach an individualized dose of a safer opioid supply which reduces their risk of overdose. The program’s preliminary findings show promise that integrating HIV care in a community setting with peer support, harm reduction supplies, and drop-in services for people who use drugs, will result in positive health outcomes.

Background
Ample international evidence demonstrates that prison syringe distribution programs result in a wide range of beneficial health outcomes, yet for decades Correctional Service Canada (CSC) refused to consider their implementation based on unfounded fears that doing so would lead to the proliferation of syringes behind bars and attacks against correctional officers. After a lawsuit by a former prisoner and four HIV organizations, the federal government announced in 2018 that it would introduce a “Prison Needle Exchange Program” (PNEP) in all federal prisons; however, as of 2022, the PNEP only exists in nine of 43 institutions.

Description
Four years after implementation, this study explored how the PNEP is operating by interviewing people formerly incarcerated in a federal prison with a PNEP. Between September 2021 and April 2022, the research team conducted 30 interviews across Canada.

Lessons learned
Research participants described pervasive drug use and routine sharing of injection equipment, indicating the urgent need for the program. Participants also described prison staff who are openly hostile towards people who use drugs, barriers to participating in a PNEP that requires multiple institutional approvals, and the risks of effectively ‘outing’ oneself as a person who uses drugs by participating in the program. People also discussed the lack of program confidentiality and privacy and increased surveillance as major deterrents.

Next steps
Research from other jurisdictions confirms the effectiveness of approaches to prison syringe distribution that respect confidentiality and do not rely on unnecessary surveillance. Disseminating equipment in secure kits to all people in prison upon request without a burdensome application process could ensure that PNEP participation is not recorded in individuals’ files. Access could be enhanced by diversifying how and how much equipment is distributed. As is the experience elsewhere, education and training are key to overcoming resistance and addressing stigma from prison staff.

Background: Supervised consumption services (SCS) are life-saving programs that reduce drug-related harms (e.g., overdose, HIV/HCV transmission) and provide support and connection for people who use drugs. Designing, delivering, and evaluating SCS in ways that are client-centred is crucial. Our community-based research group collaboratively developed a toolkit to help service providers and the organizations they work for in creating SCS that are client-focused and respond to client needs in respectful and empowering ways.

Methods: Between May-Aug 2021 we conducted semi-structured interviews (n=15) with clients who use drugs, of three Toronto-based HIV/AIDS organizations and two virtual focus groups with service providers (n=13) from these organizations. Questions focused on how to meaningfully evaluate SCS (e.g., what should be monitored to understand if SCS are operating successfully?) and what aspects of SCS are vital for clients/providers. We conducted follow-up interviews with clients (n=8) and an online survey with providers (n=25) to gather feedback and explore directions for outputs. Data were analysed using thematic analysis.

Results: We identified 12 characteristics of client-centred SCS and developed a supporting toolkit through ongoing engagement with our community advisory group and research team. The characteristics reflect client needs and priorities for SCS, which go beyond providing a space for safe consumption. For each characteristic, we provide: 1) questions to ask when designing and/or evaluating SCS; 2) tips to inform SCS design and operations; 3) tips for understanding and evaluating how well SCS reflect each characteristic. We use participant quotes to highlight important features of these interrelated characteristics.

Conclusions: This toolkit is not intended to be a comprehensive manual for designing and delivering SCS, since such guidelines exist. Rather, it can be an adjunct to existing resources that contributes to planning/implementation of new services and offers suggestions for reflection in evaluating delivery of existing SCS to ensure they are client-centred.