Grant: CIHR New Investigator

Socio-economic drivers of health risk are multi-dimensional and complex, and the broader socio-economic risk environment for marginalized people who use drugs (PWUD) has not been fully examined. Further, social and structural interventions to address these impacts are rare, as are examinations of how the socio-economic risk environment shapes research participation. My program of research will examine and develop strategies to mitigate the negative impacts of socio-economic risk on the health of marginalized PWUD across three interconnected lines of inquiry. First, using data from ongoing prospective cohorts of HIV-positive and HIV-negative PWUD, observational studies will examine the health impacts of key components of the socio-economic risk environment on health outcomes, including high-risk drug use; HIV and Hepatitis C-related outcomes, and mental illness. Second, I will implement social and structural intervention studies that test innovative strategies to mitigate the negative health impacts of socio-economic risk. Two RCTs will initiate this line of inquiry: (1) an RCT to test whether altering the distribution of social assistance decreases individual and community harm associated with escalations in drug use around the monthly distribution of social assistance; and (2) an RCT testing the efficacy of an intervention designed to expand access to low-threshold employment opportunities to improve employment uptake, drug use, HIV risk-behaviour and HIV treatment outcomes. Finally, to maximize the ethical and effective conduct of these and other RCTs, a third line of inquiry seeks to identify the individual, social and structural factors that affect recruitment, retention, and protocol adherence in addictions RCT research. This research innovates by linking observational, intervention and research participation studies to produce robust evidence for strategies to improve socio-economic security and health outcomes for people who use drugs.