BACKGROUND: While the drug-related risks and harms associated with being unhoused have been previously identified, little is known about the drug-related impacts of displacement from housing. This qualitative and community-based participatory research study explores drug use patterns and risks among people living with HIV (PLHIV) displaced from housing in the West End and the Downtown Eastside neighbourhoods of Vancouver, British Columbia. METHODS: Between May 2023 and June 2024, semi-structured interviews (n = 29) and participant observations (n = 6) were conducted with PLHIV who use drugs displaced within the last six months from housing in the West End and/or the Downtown Eastside. Data were analyzed thematically and interpreted by drawing on the intersectional risk environment framework. Two illustrative cases that exemplified broader themes across the data were selected to better contextualize participants' experiences of displacement and drug use. RESULTS: Participants positioned drug use as critical to managing their health and survival needs, which were amplified by displacement. Coupled with increased drug use, participants experienced reduced access to safer environments for drug use and changes to their risk environment in ways that exacerbated their post-displacement overdose risk. Cases rendered visible how this was particularly true for participants experiencing intersecting oppressions based on race, ethnicity, gender, sexual orientation, and class. CONCLUSION: This study advances our understanding of displacement and its impacts on drug use patterns and risks across and within diverse communities of PLHIV. Our findings underscore the urgent need for housing and urban policies to complement harm reduction efforts. We call for participatory planning approaches that foster genuine collaboration between policymakers and marginalized communities to co-create housing and urban policies that are responsive to the needs of those most affected.
Chayama et al. (Wed,) studied this question.