Still "At Risk": An Examination of How Street-Involved Young People Understand, Experience, and Engage With "Harm Reduction" in Vancouver's Inner City

Background: Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. In order to understand why young people in this setting continue to experience drug related harms despite an intensive public health response, we examined how young people understood, experienced and engaged with harm reduction in the context of drug scene involvement and marginalization.Methods: Twelve semi-structured interviews were conducted in 2013 with thirteen young people (ages 17-28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants' understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed.Results: Young peoples’ understandings of and ideas about harm reduction were diverse and expansive. Many young people articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples’ broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempts to access addiction treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver's Downtown Eastside) strongly determined access to services.Conclusions: In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples’ multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances.