Risk Environment Effects on Ontological Security Among People Who Use Drugs: An Ethnographic Study

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PROJECT SUMMARY/ABSTRACT Amidst the ongoing COVID-19 pandemic Los Angeles county has seen a surge in the unhoused population. Among this group are people who use drugs (PWUD) – a community at dramatically increased risk for bloodborne infection such as HIV and Hepatitis C, skin and soft tissue infections, and other health vulnerabilities related to the daily violence of life on the street. Los Angeles County data from 2020 estimate that people with substance use disorders account for 32% of the total unhoused population. Unhoused PWUD are subject to frequent displacement and victimization at the hands of public safety and sanitation along with hostile housed residents. On the other hand, a wide array of public health services including syringe exchange programs, drug treatment centers, street medicine, housing outreach programs, and housing have been implemented in recent years, with dramatic expansion occurring due to the COVID-19 pandemic. These risk environment features, coupled with the uncertain and unpredictable nature of street life, may lead to decreased feelings of overall well- being and ontological security among this population. The overall goal of this effort is to document how these features (i.e. public safety/sanitation efforts, public health and housing efforts, and local interest groups) impact unhoused PWUD in Los Angeles, CA. The first aim of this study is to explore how interactions with public safety agencies and hostile neighborhood residents shape feelings of ontological security among this community, while the second aim will examine how interactions with public health agencies (i.e. homeless services, housing, syringe exchanges) and activists impacts these same outcomes. In order to elucidate these associations, this study will use complementary methodologies. First, in his role as an independent provider of harm reduction supplies and as a member of a local mutual aid organization, the PI will engage in ethnography using direct participant observation consistent with the Extended Case Method approach. Simultaneously, 30 unhoused PWUD will be recruited using snowball sampling to partake in hour- long semi-structured interviews. The utilization of both approaches is key – ongoing ethnography will highlight the present situation of unhoused PWUD and their relationship to public safety and public health organizations, while interviews will illuminate how these interactions impact feelings of security and well-being, to better understand social determinants of health. Analysis of both ethnographic data from fieldnotes and formal interview data will be conducted with guidance from a Community Advisory Board whose members will be drawn from the community and local stakeholder organizations. The inclusion of a CAB is consistent with the PI’s commitment to community-engaged participatory methods. Analysis of the data will be done using the ATLAS.ti 8 software package and will feature both inductive and deductive qualitative techniques. Final results will form the core of the PI’s doctoral dissertation and will be presented to the CAB as well as community members and other stakeholders in order to inform their future work with this population.