Downtown Eastside Research Articles

“They talk about it like it's an overdose crisis when in fact it's basically genocide”: The experiences of Indigenous peoples who use illicit drugs in Vancouver's Downtown Eastside neighbourhood

Indigenous Peoples who use illicit drugs (IPWUID) are disproportionately represented among toxic drug poisoning deaths in Canada. These drug-related harms are framed by the historical and ongoing trauma related to settler colonialism and are acutely visible in Vancouver, Canada's Downtown Eastside - a low-income neighbourhood that is an epicenter of the drug poisoning crisis and characterized by entrenched poverty, substance use, violence, and homelessness. This study was undertaken to examine the experiences and perspectives of IPWUID in the Downtown Eastside regarding the drug poisoning crisis and the responsiveness of harm reduction programs within the context of settler colonialism. Indigenous-led qualitative interviews were conducted with 16 IPWUID recruited by Indigenous peer researchers. Indigenous ways of knowing were embedded throughout the entire research design to ensure research was culturally congruent. Interview transcripts were analyzed thematically and interpreted by drawing on concepts of social violence and racial capitalism. Our analysis reviewed three key themes that centered the experiences of IPWUID in Vancouver's Downtown Eastside in relation to the drug poisoning crisis: (1) that the drug poisoning crisis is understood as a form of genocide toward Indigenous Peoples; (2) that the crisis is experienced within the context of pervasive distrust and adversarial relationships with police rooted in structurally racist experiences of place-based policing practices; and (3) that there is a desire for culturally-safe harm reduction care with Indigenous representation, cultural integration, and that addresses inequities and injustice stemming from colonialism and structural racism. Findings demonstrate how responses to the drug poisoning crisis among IPWUID need to respond to social and materials conditions perpetuated by colonialism and racial capitalism, while also centering IPWUID through the development and implementation of Indigenous-led and culturally safe harm reduction approaches.

“The wrong side of the desk”: Material and Discursive Struggle in Bud Osborn’s Downtown Eastside

Abstract Bud Osborn (1947-2014) was an American poet and activist who arrived in Vancouver, Canada in 1986. He landed in Vancouver’s oldest neighbourhood, the Downtown Eastside (DTES), while struggling with heroin addiction. The DTES is a complex and politically active neighbourhood and site of intersecting social crises. Osborn would spend the remainder of his life capturing this community in his poetry, which is often understood solely through activism for harm reduction and against gentrification. In this article, I engage with his poetry to understand the politics which motivate his activism. This exploration will include a variety of textual mediums, voices, and analytic perspectives to capture the complex politics contained in his words. I believe that by reading his words we can examine his complicated self-positionality as a PWUD (people who use drugs) and a member of the lumpenproletariat who occupied sociocultural spaces that often excluded those from his social standing. This examination shows how he constitutes the DTES as a space of material and discursive struggle. What emerges from this examination is how his poetic resistance at the level of the signifier intertwines with his street-level resistance. That is, how the act of writing and reading poetry can be an act of defiance.

The Garden and Its Walls

This essay examines the Dr. Sun Yat-Sen Classical Chinese Garden in Vancouver through a sociocultural lens. Positioned in Chinatown within Vancouver’s Downtown Eastside (DTES), the garden is the first authentic Ming Dynasty-style scholar’s garden outside of China. Operating as both a public park managed by the Vancouver Park Board, as well as a paid garden managed by a nonprofit organization, the garden symbolizes an intersection of Canadian and Chinese cultures, offering a distinctive lens for analyzing cultural interplay. The concepts of the «contact zone» as well as assemblage theory are central to understanding the garden’s role in facilitating cross-cultural dialogues. Influenced by scholars like James Clifford and Mary Louise Pratt, the garden serves as a physical and conceptual space where cultures converge, fostering interpersonal dialogue among visitors of varied backgrounds. Philipp Schorch’s expansion of the contact zone to museum spaces offers a framework for analyzing the garden as representing Chinese culture in Vancouver as well as tying the garden to its locality. The analysis of the garden extends beyond its own confines and over its walls, exposing and exploring the complex relationship the garden has to its surrounding space, the DTES, and Chinatown.

Beyond individual factors: a critical ethnographic account of urban residential fire risks, experiences, and responses in single-room occupancy (SRO) housing

BackgroundBurn injuries are a significant public health concern, closely linked to housing conditions and socioeconomic status. Residents in socioeconomically deprived neighbourhoods are at increased risk of exposure to hazards due to older and poorer housing conditions and limited access to fire protection measures. Individual behaviours such as substance use, smoking, and hoarding are often highlighted as primary causes of residential fires, overshadowing the broader socioeconomic and structural factors that also play a significant role in housing safety. This paper explores the correlation between inadequate housing conditions and heightened fire risks leading to burn injuries, focusing on the contextual factors shaping everyday urban fire risks, experiences, and responses of residents living in Single-Room Occupancy (SRO) housing in Vancouver’s Downtown East Side (DTES) and staff working in the fire, health, housing (social and private), and non-profit sectors.MethodsAs part of an ongoing ethnographic study, we partnered with the Vancouver Fire Rescue Services (VFRS) to conduct participant observations in private, non-profit, and government-owned SROs, modular homes, and a temporary shelter. This paper synthesizes insights from participant observations from the first author’s self-reflexive journals, including informal conversations with approximately fifty-nine individuals such as SRO tenants, SRO managers/caretakers, health workers, burn survivors, municipal staff, not-for-profit staff, and firefighters.ResultsUrgent housing-related issues contributing to inequitable everyday urban fire risks were identified, such as structural deficiencies in SRO buildings and systems, inadequate waste management and storage, and inequitable approaches to addressing hoarding. Additionally, disparities in access to information and the interaction between interpersonal and structural stigmas were significant factors, underscoring the pressing need for intervention.ConclusionCommunities like DTES, facing precarious housing conditions, disadvantaged neighbourhoods, and complex health and social challenges, necessitate a comprehensive and holistic approach to fire prevention and safety. Recognizing the interplay between housing instability, mental and physical health issues, unregulated toxic drug supply, drug criminalization, and structural inequities allows practitioners from various sectors to develop contextually driven fire prevention strategies. This multifaceted approach transcends individual-level behaviour change and is crucial for addressing the complex issues contributing to fire risks in underserved communities.

A case study of the DULF compassion club and fulfillment centre—A logical step forward in harm reduction

In 2022, the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre emerged as a groundbreaking initiative and research endeavor aimed at addressing the alarming rise in overdose deaths within Vancouverʼs Downtown Eastside. As the first of its kind, this pioneering model operated as a non-profit, low-barrier, and non-medicalized approach to regulating the volatility of the content of the illicit drug market in order to prevent overdose deaths. Going beyond traditional overdose prevention methods, the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre not only provided supervised consumption services, but also supplied rigorously tested cocaine, heroin, and methamphetamine at cost to club members. This intrinsic case study offers a unique perspective on the operation of Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre, delving into its inception, development, implementation, and the challenges it faced in its operation. Ultimately, the insights garnered from the Drug User Liberation Frontʼs Compassion Club and Fulfillment Centre hold significant value for others interested in establishing similar programs or exploring de-medicalized approaches regulating substances in order to prevent overdose deaths.

The impact of the COVID-19 pandemic on HIV treatment gap lengths and viremia among people living with HIV British Columbia, Canada, during the COVID-19 pandemic: Are we ready for the next pandemic?

The SARS-CoV-2 (COVID-19) pandemic has impacted the care of people living with HIV (PLWH). This study aims to characterize the impact of the pandemic on the length of HIV treatment gap lengths and viral loads among people living with HIV (PLWH) in British Columbia (BC), Canada, with a focus on Downtown Eastside (DTES), which is one of the most impoverished neighbourhoods in Canada. We analyzed data from the HIV/AIDS Drug Treatment Program from January 2019 to February 2022. The study had three phases: Pre-COVID, Early-COVID, and Late-COVID. We compared results for individuals residing in DTES, those not residing in DTES, and those with no fixed address. Treatment gap lengths and viral loads were analyzed using a zero-inflated negative binomial model and a two-part model, respectively, adjusting for demographic factors. Among the 8982 individuals, 93% were non-DTES residents, 6% were DTES residents, and 1% had no fixed address during each phase. DTES residents were more likely to be female, with Indigenous Ancestry, and have a history of injection drug use. Initially, the mean number of viral load measurements decreased for all PLWH during the Early-COVID, then remained constant. Treatment gap lengths increased for all three groups during Early-COVID. However, by Late-COVID, those with no fixed address approached pre-COVID levels, while the other two groups did not reach Early-COVID levels. Viral loads improved across each phase from Pre- to Early- to Late-COVID among people residing and not residing in DTES, while those with no fixed address experienced consistently worsening levels. Despite pandemic disruptions, both DTES and non-DTES areas enhanced HIV control, whereas individuals with no fixed address encountered challenges. This study offers insights into healthcare system preparedness for delivering HIV care during future pandemics, emphasizing community-driven interventions with a particular consideration of housing stability.

Characterizing Use of Supervised Consumption Services among Street-involved Youth and Young Adults in the Context of an Overdose Crisis.

In response to an increase in overdose deaths, there was a rapid scale-up of supervised consumption services (SCS), including federally sanctioned SCS and low-barrier SCS known as overdose prevention sites (OPS), in Vancouver, Canada, beginning in December 2016. However, little is known about the use of such services among adolescents and young adults (AYA) in this context. We therefore sought to characterize factors associated with the use of federally sanctioned SCS and OPS among street-involved AYA who inject drugs in Vancouver during an overdose crisis. From December 2016 to March 2020, data were collected from a prospective cohort of street-involved AYA aged 14 to 26 at baseline. Using multivariable generalized estimating equation analyses, we identified factors associated with recent use of federally sanctioned SCS and OPS, respectively. Among 298 AYA who inject drugs, 172 (57.8%) and 149 (50.0%) reported using federally sanctioned SCS and OPS during the study period, respectively. In multivariable analyses, public injecting, negative police interactions, and residing or spending time ≥ weekly in the Downtown Eastside neighborhood were all positively associated with the use of federally sanctioned SCS and OPS, respectively. Additionally, ≥ daily unregulated opioid use and residential eviction were positively associated with federally sanctioned SCS use, while requiring help injecting was inversely associated. Self-identified female or non-binary gender was also positively associated with OPS use (all p < 0.05). Both federally sanctioned SCS and OPS successfully engaged AYA at heightened risk of adverse health outcomes. However, the lack of accommodation of AYA who require manual assistance with injecting at federally sanctioned SCS may be inhibiting service engagement.

“I'm just searching to get better”: Constructions of treatment citizenship on injectable opioid agonist treatment

BackgroundAs part of the response to Canada's worsening overdose crisis driven by a toxic, adulterated drug supply, there has been increased attention to and expansion of drug treatment, options, including injectable opioid agonist treatment (iOAT). iOAT typically involves the, witnessed daily injection of opioids under healthcare provider supervision. There is a robust, evidence base on iOAT; however, there has been less focus on how people engage with this; treatment outside of clinical trials. This paper examines how people engage with iOAT programs, in expanded treatment settings in Canada, focusing on how the broader socio-structural context, shapes patient subjectivities in treatment. MethodsThis study draws on critical ethnographic and community-based research approaches, conducted with people accessing four iOAT programs in Vancouver's Downtown Eastside; neighbourhood from May 2018 to November 2019. Data included in-depth baseline and followup, interviews and approximately 50 h of observation fieldwork conducted in one iOAT, program and with a subsample of participants in the surrounding neighbourhood. Analysis, leveraged the concepts of biological citizenship and structural vulnerability. ResultsThis analysis characterized three narrative frames—regular long-term engagers, pain, patients, and sporadic and short-term engagers—through in-depth case presentations of participants with distinct types of engagement with iOAT programs. Participants within these, narrative frames described a dominant form of iOAT citizenship, an autonomous patient who, regularly engages in treatment and avoids pleasure. However, structural vulnerabilities, including, homelessness and housing instability, entrenched poverty, criminal-legal system engagement, and unmanaged pain, shaped the ability of participants to make claims to this normative model of citizenship. ConclusionThis study examined how structural vulnerabilities impact people's construction and ability to make iOAT citizenship claims. Findings point to the need for changes within and outside of iOAT programs, such as lower threshold treatment models, improved social services (e.g., secure housing), and pain management support.

44 Cognitive Intraindividual Variability as a Predictor of Functional Outcomes in a Sample of Precariously Housed Individuals

Objective:Precariously housed individuals are exposed to multiple adverse factors negatively impacting neurocognitive functioning. Additionally, this population is subjected to poor life outcomes, such as impaired psychosocial functioning. Neurocognitive functioning plays an important role in psychosocial functioning and may be especially critical for precariously housed individuals who face numerous barriers in their daily lives. However, few studies have explicitly examined the cognitive determinants of functional outcomes in this population. Cognitive intraindividual variability (IIV) involves the study of within-person differences in neurocognitive functioning and has been used as marker of frontal system pathology. Increased IIV has been associated with worse cognitive performance, cognitive decline, and poorer everyday functioning. Hence, IIV may add to the predictive utility of commonly used neuropsychological measures and may serve as an emergent predictor of poor outcomes in at-risk populations. The objective of the current study was to examine IIV as a unique index of the neurocognitive contributions to functional outcomes within a large sample of precariously housed individuals. It was hypothesized that greater IIV would be associated with poorer current (i.e., baseline) and long-term (i.e., up to 12 years) psychosocial functioning.Participants and Methods:Four hundred and thirty-seven adults were recruited from single-room occupancy hotels located in the Downtown Eastside of Vancouver, Canada (Mage = 44 years, 78% male) between November 2008 and November 2021. Baseline neurocognitive functioning was assessed at study enrolment. Scores from the Social and Occupational Functioning Assessment Scale (SOFAS), the Role Functioning Scale (RFS), the physical component score (PCS) and the mental component score (MCS) of the 36-Item Short Form Survey Instrument were obtained at participants’ baseline assessments and at their last available follow-up assessment to represent baseline and long-term psychosocial functioning, respectively. Using an established formula, an index of IIV was derived using a battery of standardized tests that broadly assessed verbal learning and memory, sustained attention, mental flexibility, and cognitive control. A series of multiple linear regressions were conducted to predict baseline and long-term social and role functioning (average across SOFAS and RFS scores), and PCS and MCS scores from IIV. In each of the models, we also included common predictors of functioning, including a global cognitive composite score, age, and years of education.Results:The IIV index and the global composite score did not explain a significant proportion of the variance in baseline and long-term social and role functioning (p &gt; .05). However, IIV was a significant predictor of baseline (B = -3.84, p = .021) and long-term (B = -3.58, p = .037) PCS scores, but not MCS scores (p &gt; .05). The global composite score did not predict baseline or long-term PCS scores.Conclusions:IIV significantly predicted baseline and long-term physical functioning, but not mental functioning or social and role functioning, suggesting that IIV may be a sensitive marker for limitations in everyday functioning due to physical health problems in precariously housed individuals. Critically, the present study is the first to show that IIV may be a useful index for predicting poor long-term health-related outcomes in this population compared to traditional neuropsychological measures.

68 Neurocognitive Functioning and Symptoms of Psychosis in Precariously Housed Adults with Multimorbidity

Objective:In persons with severe psychiatric disorders, distinct neurocognitive profiles hold differential associations to positive, negative and disorganized symptom dimensions of psychosis. These patterns portend specific functional outcomes, treatment efficacy, and prognoses. Similar associations have not been established in multimorbid samples in which persons present with a complex array of psychiatric symptoms. The objective of this study was to (1) establish neurocognitive profiles in a multimorbid, marginalized sample and (2) investigate their pattern(s) of association with psychiatric symptom dimensions and psychosocial outcomes.Participants and Methods:Participants (n=370; Mage = 45 years; 74% male) were precariously housed, substance-using adults with multimorbidity, recruited from Single-Room Occupancy hotels and a community court within the Downtown Eastside of Vancouver, BC, Canada. Data were collected as part of a longitudinal examination consisting of annual, bi-annual, and monthly neurocognitive, psychosocial, and psychiatric assessments. Neurocognitive scores were combined into five cognitive domains (Attentional Control [AC]; Processing Speed [PS]; Fluid Reasoning [Problem Solving and Reversal Learning; Gf]; Encoding and Retrieval [ER]; and Decision Making [DM]) and submitted to a latent profile analysis. The resulting profiles capturing neurocognition were validated on sociodemographic and clinical variables. Finally, the profiles were compared across previously validated, population-distinct factors derived from the Positive and Negative Syndrome Scale (PANSS), as well as on measures of psychosocial functioning.Results:An optimal goodness-of-fit was reached for a three-profile model (BLRT=127.86, p=.01). Profile 1 (n=207, 55.9%) showed stronger neurocognition (all p&lt;.05), with a within-profile strength in Gf (p&lt;.001). With the exception of ER, Profile 2 (n=109, 29.5%) exhibited inferior neurocognition across all indicators compared to Profile 1 (all p &lt;.05); yet showed a relative, within-profile strength in Gf (p &lt; .01). Profile 3 (n=54, 14.6%) generally displayed comparable impairments to Profile 2. Additionally, their performance on Gf was remarkably low compared to Profiles 1 and 2 (p&lt;.001). Psychiatrically, compared to Profile 1, Profile 2 exhibited more positive/disorganized symptoms and general psychopathology, as well as higher total PANSS (all p &lt;.05), whereas Profile 3 showed the poorest insight/awareness (p&lt;.01). Profiles 2 and 3 had lower levels of adaptive functioning and work productivity compared to Profile 1 (all p&lt;.01).Conclusions:Three neurocognitive profiles were detected in a sample of precariously housed adults with multimorbidity: one profile of comparatively higher neurocognitive capacity, with less symptoms of psychosis and better psychosocial functioning; a second profile of comparatively poorer neurocognition and psychosocial functioning, with more symptoms of psychosis; and a third profile with a severe deficit in fluid reasoning and poor insight and awareness. Given their poor insight, the third profile may be comprised of particularly vulnerable persons at greater risk of unmet healthcare needs. Interventions to improve these individuals' understanding of their personal health risks might facilitate their capacity to access services. Conversely, individuals from Profile 2 may benefit from outreach programs focusing on medication access and adherence to address their symptoms of psychosis. In sum, our findings suggest that the confluence of neurocognition and psychiatric symptoms may implicate unique treatment approaches and outcomes in precariously-housed persons with multimorbid conditions.

Detection of multiple human enteropathogens in Norway rats (Rattus norvegicus) from an under-resourced neighborhood of Vancouver, British Columbia.

Urban Norway rats (Rattus norvegicus) can carry various human pathogens, and may be involved in pathogen propagation and transmission to humans. From January 31-August 14, 2021, a community outbreak of Shigella flexneri serotype 2a occurred among unhoused or poorly housed people in the Downtown Eastside neighborhood of Vancouver, British Columbia, Canada. The source could not be identified; however, patients reported contact with rats, and previous studies indicated transmission of rat-associated zoonotic pathogens among the unhoused or poorly housed residents of this neighborhood. The study objective was to determine if rats trapped in the outbreak area were carriers of Shigella spp. and other zoonotic enteric pathogens. From March 23-April 9, 2021, 22 rats were lethally trapped within the outbreak area. Colonic content was analyzed using the BioFire FilmArray Gastrointestinal (multiplex PCR) panel for human enteropathogens, which detected: Campylobacter spp. (9/22), Clostridioides difficile (3/22), Yersinia enterocolitica (5/22), Cryptosporidium spp. (8/22), Giardia duodenalis (5/22), Rotavirus A (1/22), enteroaggressive Escherichia coli (2/22), enteropathogenic E. coli (10/22), and Shigella spp. or enteroinvasive E. coli (EIEC) (3/22). An ipaH PCR assay was used for targeted detection of Shigella spp./EIEC, with five rats positive. Two samples contained insertion sites unique to S. flexneri isolated from the human outbreak. This study highlights the potential for rats to carry a broad range of human pathogens, and their possible role in pathogen maintenance and/or transmission.

R1 (Resident Advocacy Project) Flexible and Enhanced Learning with our RICHER Partners: Reciprocal Partnerships between Medical Students and Equity-Deserving Communities to Promote Vaccine Access and Teach Health Advocacy

Abstract Rationale and Objectives The University of British Columbia provides medical students in years 1, 2, and 4 with protected time to explore the CanMEDs competencies in student-directed service, education, and research through the Flexible and Enhanced Learning (FLEX) program. Six FLEX students in the past three years have engaged in reciprocal partnerships with the Responsive, Intersectoral Community Child Health Education and Research group (RICHER). RICHER is a consortium of interdisciplinary healthcare providers, resource centres, and community members working across sectors and systems who serve equity-deserving children, youth, and families in Vancouver’s inner-city. Students develop leadership, health advocacy, and collaboration competencies through mentorship and co-learning with the RICHER team and community partners. For example, students have partnered to promote and amplify vaccine equity, knowledge of children’s and youth’s rights, food security, and social-emotional learning. Project Description For each FLEX project, community members identify local priorities. They conduct needs assessments and environmental scans. Students complete project proposals, ethics board and grant applications, and elicit iterative community feedback. Students collect data and communicate findings to stakeholders, including community members and RICHER clinicians. RICHER further amplifies community voices by sharing FLEX project results with local and provincial decision-makers, resulting in policy change and resource mobilization. Projects are evaluated qualitatively by stakeholders. For example, during the COVID-19 lockdown, many inner-city families faced barriers accessing COVID vaccines. The Downtown Eastside neighbourhood had some of the lowest vaccination rates in the province. Outcomes FLEX students surveyed 122 community members and found that 89 (73%) community members experienced a significant barrier to accessing COVID vaccines, such as: no access to technology or ID required to register or book an appointment, no access to transportation to a vaccine clinic, or trauma associated with accessing healthcare or injections. The RICHER team was able to respond to these findings by authoring a letter to the local health authority, who mobilized a pop-up vaccine clinic at an accessible, local community centre using the principles of brokered trust. Discussion/Future Directions This vaccine equity project has set a precedence for accessible care and created a model for future vaccine clinics to provide protection against viruses like influenza. FLEX students and hospital staff learned from Indigenous Elders and community members how to use the medicine wheel in the context of wholistic healthcare. As health advocates, FLEX students learned to ask, “who are we not seeing and why?” and learned how to write motivational letters to changemakers.

Storytelling and the Healing Power of Photography: Rita Leistner’s My Space Project

The aim of the article is to analyze the artistic, social project titled My Space. Stories from Inside the Downtown Eastside Vancouver, created by Canadian photographer Rita Leistner. Through her photographs and interviews, the artist presents the everyday life of a group of drug and alcohol addicted residents of Astoria and Balmoral hotels. The article is based on photographs taken by Leistner and the statements of project participants – both acquired from the artist’s Webpage. Bearing in mind Leistner’s intentions, we tend to present her story in the storytelling narrative. We treat that approach as a useful tool for qualitative data analysis as well as insightful framework to represent a story. This approach has worked well so far in the study of culture and art. Thus, we focus on the content and a form of a story while uncovering its threads looking at it from different dimensions interpreted through the prism of individuals to whom the story relates. We look at the way in which the space occupied by the heroes of the story is being photographed by Leistner, who creates a medium allowing the narrative to connect the present with the past and the future. That medium plays an important role in building a community.

Listening is Action: A Soundwalk with Hildegard Westerkamp

In the sound documentary Listening is Action, the composer Hildegard Westerkamp engages in a conversation with Luis Velasco-Pufleau at her home in the city of Vancouver, which is situated on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations. She talks us through her first field recordings and her soundwalking practice, her work at the Vancouver Co-operative Radio, and her participation in the World Soundscape Project, all of which started or took place in the 1970s. Furthermore, she takes us on soundwalks at places she used to go and record more than thirty years ago, such as those now called Kitsilano Beach and Vancouver’s Downtown Eastside, and that constitute the sources for her soundscape works A Walk Through the City (1981) and Kits Beach Soundwalk (1989). This sound documentary is an invitation to listen more attentively to the multiple voices that inhabit our environments in order to imagine new, plural, and unforeseen realities. The sound work Listening is Action is enhanced by a written commentary in which Luis Velasco-Pufleau explores the radical relationality of listening and the connection between Westerkamp’s thinking with the work of Pauline Oliveros and Hannah Arendt. Finally, he engages with critical listening positionality in order to reflect on some of the limits and contradictions present in the sound documentary.

Understanding the relationship between the spatial configuration and the crime rate of Downtown Eastside in Vancouver, Canada

As one of Vancouver's oldest neighbourhoods and the historical heart of the city, Downtown Eastside (DTES) has been home to many low-income residents and has been challenged by factors such as high crime rates, drug use, unemployment, housing issues, and loss of businesses in the community. Although a variety of studies have explored the causes and effects of DTES's social dilemma and indicated that crimes are closely related to the spatial configuration of the underlying street network, how DTES's underlying street network affects the spatial distribution of different types of crime remains unclear. Focusing on the relationship between the street network and the crime rate of DTES, the authors make three hypotheses regarding the connections between the street network of DTES and the distribution patterns of crimes, and employ the space syntax methods to analyse the street network of DTES and test the hypotheses. The results indicate that the spatial configuration of street network can be helpful in explaining where different crimes may occur, thus providing a spatial perspective to figure out approaches to addressing DTES's social issues. At last, this paper, combining spatial and social perspectives, puts forward strategies for making DTES a more liveable place, and is likely to work as a reference for academics and practitioners to further understand gentrification and urbanisation related issues.

“It's no foundation, there's no stabilization, you're just scattered”: A qualitative study of the institutional circuit of recently-evicted people who use drugs

People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities (e.g., drug prohibition, discriminatory housing policies), and prejudicial or illegal evictions are common. In Vancouver, Canada, evictions have proliferated in the Downtown Eastside, a historically low-income neighbourhood with high rates of drug use and housing instability, resulting in many PWUD being evicted into homelessness. This study characterizes housing trajectories of recently-evicted PWUD through the lens of the institutional circuit of homelessness, and explores how wider contexts of structural vulnerability shape experiences within this. Qualitative interviews were conducted with PWUD recently evicted in the Downtown Eastside (<60 days). Peer research assistants recruited 58 PWUD through outreach activities. All PWUD participated in baseline interviews on the causes and contexts of evictions. Follow-up interviews were completed with 41 participants 3–6 months later, focusing on longer-term impacts of eviction, including housing trajectories. Most participants were evicted into homelessness, remaining so at follow-up. Participants described patterns of residential instability consisting of frequent cycling between shelters, streets, and kin-based networks. While participants normalized this cycling as characteristic of their marginalized social positions, narratives revealed how the demands of the institutional circuit deepened vulnerabilities and prolonged experiences of homelessness. Experiences were framed by participants' (in)ability to navigate survival needs (e.g., shelter, drug use), with tensions and trade-offs between needs increasing participants' and their peers' risks of harms. Constructions of agency further shaped experiences; accounts highlighted tensions between the control inherent to indoor spaces and participants’ need for autonomy. Findings demonstrate how the demands of the institutional circuit foregrounded structural vulnerabilities to perpetuate cycles of instability. Interventions that address survival needs and preserve agency will be necessary to mitigate risks within the institutional circuit, in tandem with upstream interventions that target housing vulnerability and broader social-structural conditions (e.g., poverty, affordability) that entrap recently-evicted PWUD in the institutional circuit.

“I’m Trying to Be There for My Kids”: A Needs Analysis of Fathers Who Experience Health Inequities in Vancouver, Canada

To better understand the needs of fathers who experience health inequities, we individually interviewed fathers, mothers, and service providers about their perspectives of supports for men in Vancouver’s Downtown Eastside, one of the most disadvantaged groups in Canada. Using a gender lens, thematic analysis of transcribed interviews with three cohorts revealed the following themes: “we need a He-way”: Fathers arguing for men-friendly services; “I had to do all the hard work”: Mothers identifying relational impacts of fathers’ barriers to services; “there is nothing out there for them”: Service providers acknowledging the lack of father-focused programs. Findings highlight the need for, and challenges to creating accessible, gender specific, father focused programs and services to best support men and families within the complex contexts of experiencing significant health inequities. This work illustrates how gender-based analyses can guide strategies for health promotion programs that will ultimately support fathers, mothers, and their families.

(Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada.

Overdose Prevention Sites (OPS) are low-barrier services where people may use illicit drugs under the monitoring of staff trained to provide life-saving care in the event of an overdose. In British Columbia (BC), Canada, OPS have been rapidly scaled-up as a community-based response to the overdose crisis and are staffed primarily by community members who are also people who use drugs (PWUD). While it is known that PWUD perform vital roles in OPS and other community-based overdose interventions, the expertise and expert knowledge of PWUD in this work remains under-theorised. This study draws on 20 months of ethnographic fieldwork in Vancouver, BC (July 2018 to March 2020), to explore how OPS responders who are PWUD developed and enacted expertise in overdose response. Ethnographic fieldwork focused on four OPS located in Vancouver's Downtown Eastside (DTES) and Downtown South neighbourhoods. Methods included 100 hours of observation in the sites and surrounding areas, three site-specific focus groups with OPS responders (n=20), and semi-structured interviews with OPS responders (n=14) and service users (n=23). Data was analysed with the aim of characterizing the knowledge underpinning responders' expertise, and the arrangements which allow for the formation and enactment of expertise. We found that OPS responders' expertise was grounded in experiential knowledge acquired through their positionality as PWUD and members of a broader community of activists engaged in mutual aid. Responders became skilled in overdose response through frequent practice and drew on their experiential and embodied knowledge of overdose to provide care that was both technically proficient and responsive to the broader needs of PWUD (e.g. protection from criminalization and stigmatizing treatment). Responders emphasized that the spatial arrangements of OPS supported the development of expertise by facilitating more specialized and comprehensive overdose care. OPS became sites of collective expertise around overdose management as responder teams developed shared understandings of overdose management, including processes for managing uncertainty, delegating team responsibilities, and sharing decision-making. This research re-situates theoretical understandings of expertise in community-based overdose response with implications for overdose prevention interventions. Findings underscore the experiential and embodied expertise of PWUD as community-based responders; the importance of supportive environments and team-based approaches for overdose response; and the benefits of community-driven training that extends beyond technical skills of overdose identification and naloxone administration.

Criminality and Inequity under Canada’s Legalization of Cannabis: A Study of Vancouver’s Downtown Eastside

Criminality and Inequity under Canada’s Legalization of Cannabis: A Study of Vancouver’s Downtown Eastside

Making moves: involved fathers experiences of Vancouver’s Downtown Eastside family walking program

ABSTRACT The relationship between physical activity and fatherhood in communities in which people experience marginalisation is not well understood in qualitative research. This is particularly the case in the Downtown Eastside (DTES) of Vancouver, Canada, where there are few services to meet the unique needs of fathers. To address these gaps, we developed Make a Move (MaM): A six-week family walking group pilot program for mothers, fathers, and their children who were living or accessing services in DTES. Informed by a community-based participatory research approach and intersectional poststructuralism, we conducted semi-structured interviews with nine fathers pre- and post-program to understand how their lived experiences as involved fathers in DTES shaped their participation in MAM. Our analysis revealed the ways that the men challenged dominant discourses related to masculinity, physical activity, and fathering, especially within the context of occupying marginalised and subordinate masculinities.