Grant: CIHR Fellowship

The increase in prescription opioid misuse and subsequent initiation of injection drug use (IDU) is a public health concern across North America (NA). IDU remains a key driver of the HIV epidemic in all three countries of NA. There is evidence that syringe distribution, supervised injection facilities and opioid substitution therapy are effective in preventing HIV transmission and may also decrease the initiation of other people into drug injection. Appropriate scale-up and expansion of such services varies across socioeconomic and geopolitical settings. It is therefore critical to have HIV services for people who inject drugs (PWID) tailored to respond to factors driving HIV transmission and injection initiation across diverse socioeconomic settings. The proposed project would therefore investigate the suite of available HIV services (i.e., testing, treatment, and prevention) for PWID in three different socioeconomic settings across NA: Tijuana, Mexico; San Diego, USA; and Vancouver, Canada. It will analyze how socio-structural services such as housing and access to welfare mediate HIV service uptake and HIV risk behaviors across settings. This project will also investigate the association between HIV service uptake and the risk that PWID initiate others into injection drug use. In addition, it will not only inform under-resourced settings on Canadian health policies but it will also inform efforts to optimize and scale up HIV services for underserved populations in low- and middle-income settings across North America that have been disproportionately impacted by IDU-driven HIV epidemics, including Mexico's northern border region as well as rural and remote indigenous communities in Canada.