Grant: CIHR Fellowship

In the context of growing opioid misuse in Canada, a critical public health priority is to prevent - rather then simply respond to - the transition of individuals into injection drug use (IDU), given its many harms. As IDU is a socially communicable phenomenon, efforts must focus on preventing the involvement of people who currently inject drugs (PWID) in initiating others. As North American PWID disproportionately identify as sexual or gender minorities, and up to one-third are estimated to be female, such interventions must consider how gender and sexuality shape IDU initiation events. Both women as well as sexual and gender minorities (SGM) face structural and interpersonal vulnerabilities that increase their risk of drug-related harms once they begin injecting, but little is known about how this social context contributes to IDU initiation. This project will contribute to preventing IDU initiation among women and SGM by identifying how gender and sexuality shape initiation events, and how gender dynamics impact the effectiveness of health system interventions to reduce the risk that PWID initiate others into IDU. This mixed-methods research will draw on quantitative and qualitative data from Preventing Injecting by Modifying Existing Responses, a five-year multi-site study pooling data from four observational cohorts of people who inject drugs in Canada, the United States, Mexico, and France. Additional original qualitative data will be collected from SGM who inject drugs in the Tijuana-San Diego border region. This study will be the first to examine pathways to IDU for SGM. Employing integrated knowledge translation, this study will move the research field from identifying gender and sexual orientation disparities related to injection drug use towards intervening to reduce them. It will also help to ensure that the prevention benefits of current and emerging injection prevention interventions are fully realized for Canadians of diverse genders and sexualities.