Research Location: BC Centre for Excellence in HIV/AIDS

Illicit drug use is a major public health concern in British Columbia, most notably the high rates of HIV and Hepatitis C transmission among injection drug users. Additionally, in Vancouver and elsewhere in British Columbia, there is concern regarding escalating rates of crystal methamphetamine (CM) use. The prevalence of CM use is rising internationally, and has been associated with unsafe sexual and injecting practices among specific subpopulations at risk for HIV. However, the potential associations between CM use and sexual and injection-related risk behaviour among marginalized populations in Vancouver have not been thoroughly investigated. Brandon Marshall was previously funded by MSFHR for his Master’s work studying the interactions between drug use and sexual risk behaviour among street youth in Vancouver. He is now continuing his examination of a number of social, environmental, and structural factors that predict frequent CM use and subsequent health-related harms among young injection drug users. He hypothesizes that social disadvantage, impoverished living conditions, frequent exposure to law enforcement, and poor access to health and harm reduction services will be associated with higher frequency and intensity of CM use. This research will help inform evidence-based public health policy and interventions for marginalized populations. Marshall’s findings may be used to develop strategies that seek to reduce the harms associated with CM use, prevent further transmission of HIV and Hepatitis C, and provide better support for youth and injection drug users who are already infected.

Street youth often carry a heavy burden: trauma, sexual and physical violence, lack of education, homelessness, and mental illness all contribute to the difficulties that many young street people face. Studies have shown that street youth are also one of the groups at most risk of progressing from non-injection drug use to injection drug use, including crystal methamphetamine use. Because they often engage in high-risk sexual activities and drug use, street youth are also particularly susceptible to being infected with and spreading blood-borne diseases like HIV and Hepatitis C. Young women in this group, some of whom are involved in the sex trade, are at particularly high risk of contracting these diseases. Health authorities in Vancouver have recognized this problem and responded by expanding and decentralizing needle exchange programs that target street youth. However, little is currently known about the effect that these programs have had on the risk behaviours and drug use patterns of street-based youth. Given that street youth who inject are often hard to reach, there are concerns that this population may not have adequate access to critical HIV prevention programs such as needle exchange. Daniel Werb is investigating the factors associated with syringe sharing among street youth, such as crystal methamphetamine use, unstable housing, involvement in sex trade work, historical sexual abuse, and depression. He will also investigate the reach of youth-oriented needle exchange programs in Vancouver and determine their effectiveness in harm reduction. Werb’s findings will help health authorities understand this at-risk population better, and contribute to the development of effective programs that support the health of street youth who inject drugs.

It is estimated that 269,000 Canadians have injected drugs in the past year; statistics reveal that almost 20 per cent of all newly-recorded HIV infections are associated with injection drug use. High risk behaviours associated with injection drug use have made injection drug user populations especially vulnerable to HIV infection. This is particularly evident in Vancouver’s Downtown Eastside, which has experienced an explosive HIV epidemic among local injection drug users. For several years, this neighbourhood has felt the effects of new developments squeezing out older, low-income housing. This ongoing revitalization of Canada’s poorest postal code will soon be coupled with the upcoming 2010 Olympics. It is also expected that targeted policy interventions will be initiated to reduce the appearance of public disorder, particularly open illicit drug scenes. The implications for current residents are significant. The coming years have the potential to bring a massive displacement of injection drug users out of the Downtown Eastside, away from where most of their health and social services are currently situated. Kora DeBeck is monitoring how public policy changes related to urban revitalization affect risky behaviours and health among injection drug users. She is analyzing data from established cohort studies, which currently follow more than 2,000 injection drug users. Not only will DeBeck’s work help local policy makers respond to changing health service needs within Vancouver, it will also inform other cities experiencing similar urban transitions.

Injection drug use has significant health consequences, including high rates of HIV and hepatitis C transmission. These problems have been exacerbated in recent years by the use of crystal methamphetamine (commonly called crystal meth), particularly in BC. Methamphetamine use is becoming increasingly common among marginalized youth, particularly those whose social and economic environment is the street. It is estimated there are between 45,000 to 150,000 street-involved youth in Canada, most of whom live in the large urban centres of Toronto, Montreal and Vancouver. Illicit drug use and unsafe sexual practices, including unprotected sex and sex trade work, increase susceptibility to HIV infection among street-involved youth. Brandon Marshall is one of the few researchers investigating the relationship between illicit drug use and sexual risk behaviours among street-involved youth. Using data collected from the B.C. Centre for Excellence in HIV/AIDS At-Risk Youth Study, he will examine how different social, structural, and environmental factors impact sexual practices. Specific factors include the age of first sexual experience, sexual orientation, illicit drug use, sexual relationships with older partners, access to health services, and involvement in the Downtown Eastside community of Vancouver, where drug use and poverty are prominent. This research will improve our understanding of illicit drug use and sexual activity in marginalized youth and will play an important role in developing sexual health education and prevention programs for youth at-risk.