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

项目摘要/摘要 在持续的新冠肺炎疫情中，洛杉矶县的无房人口激增。 在这一群体中，有吸毒的人(PWUD)--这是一个患病风险显著增加的社区 经血液传播的感染，如艾滋病毒和丙型肝炎、皮肤和软组织感染以及其他健康脆弱性 与街头生活的日常暴力有关。洛杉矶县2020年的数据估计，有 物质使用障碍占无房人口总数的32%。无住房的PWUD将受到 在公共安全和卫生设施以及敌对住房方面经常流离失所和受害 居民。另一方面，广泛的公共卫生服务，包括注射器交换计划，药物 治疗中心、街头医疗、住房外展计划和住房在最近几年得到实施 几年来，由于新冠肺炎大流行，疫情急剧扩张。这些风险环境特征， 再加上街头生活的不确定性和不可预测性，可能会导致总体幸福感下降- 在这个人群中的存在和本体论安全。这项工作的总体目标是记录这些 特征(即公共安全/卫生努力、公共卫生和住房努力以及当地利益集团)的影响 加利福尼亚州洛杉矶的无住房PWUD。这项研究的第一个目的是探索如何与公众互动 安全机构和敌对的邻里居民在其中形成了本体论安全感 第二个目标将审查与公共卫生机构(即无家可归者)的互动 服务、住房、注射器交换)和积极分子影响了同样的结果。 为了阐明这些联系，本研究将使用补充方法。首先，在他作为 作为减少危害用品的独立提供者，并作为当地互助组织的成员， 将使用符合扩展案例方法的直接参与者观察来参与人种学 接近。同时，将以滚雪球抽样的方式招募30名无住房的PWUD，参与- 长时间的半结构化面试。这两种方法的利用是关键--正在进行的人种学将突出 无房残疾人的现状及其与公共安全和公共卫生组织的关系， 虽然访谈将阐明这些互动如何影响安全感和幸福感，以更好地 了解健康的社会决定因素。田野笔记和正式访谈中的民族志数据分析 数据将在社区咨询委员会的指导下进行，该委员会的成员将来自 社区和当地利益攸关方组织。包括一辆驾驶室与私人投资公司的承诺一致 到社区参与的参与式方法。将使用ATLAS.TI 8软件对数据进行分析 包装，并将以归纳和演绎定性技术为特色。最终结果将构成 的博士论文，并将提交给CAB以及社区成员和其他 利益攸关方，以便为他们今后与这一群体的工作提供信息。

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.