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

项目总结/摘要 在持续的COVID-19大流行期间，洛杉矶县的无家可归人口激增。 在这个群体中，有吸毒者（PWUD）-这是一个风险大大增加的群体。 血液传播感染，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 与街头日常生活中的暴力有关。洛杉矶县2020年的数据估计， 吸毒者占无住房总人口的32%。无居所的残疾人士 公共安全和卫生沿着敌对的住房， 居民另一方面，一系列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最近已经实施， 2019冠状病毒病疫情导致业务急剧扩张。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，可能会导致整体感觉下降， 存在和本体论的安全感这项工作的总体目标是记录这些 特点（即公共安全/卫生工作、公共卫生和住房工作以及地方利益集团）影响 在加利福尼亚州洛杉矶的无住房PWUD。本研究的第一个目的是探讨如何与公众互动 安全机构和敌对的社区居民塑造了本体安全感， 第二个目标将研究如何与公共卫生机构（即无家可归者） 服务，住房，注射器交换）和活动家影响这些相同的结果。 为了阐明这些关联，本研究将使用补充方法。首先，在他的角色中， 一个独立的减少伤害用品供应商，并作为当地互助组织的成员，PI 将采用与扩展案例法相一致的直接参与者观察进行民族志研究 approach.同时，30个无家可归的PWUD将被招募使用雪球抽样参加小时- 半结构化的面试。这两种方法的利用是关键-正在进行的民族志将突出 无居所残疾人士的现况，以及他们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， 了解健康的社会决定因素。对来自田野记录和正式访谈的民族志数据进行分析 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 社区和地方利益攸关方组织。纳入CAB符合PI的承诺 to community社区engaged参与式methods方法.将使用ATLAS.ti 8软件进行数据分析 包，并将采用归纳和演绎定性技术。最终结果将构成 PI的博士论文，并将提交给CAB以及社区成员和其他 为他们今后的工作提供信息。

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.