Background: Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among streetinvolved youth in Vancouver, Canada.

We undertook this qualitative study to examine young people's understandings of the physical and social landscape of the downtown drug scene in Vancouver, Canada. In-depth interviews were conducted with 38 young people ranging from 16 to 26 years of age. Using the concept of symbolic violence, we describe how one downtown neighborhood in particular powerfully symbolizes 'risk' among local youth, and how the idea of this neighborhood (and what happens when young people go there) informs experiences of marginalization in society's hierarchies. We also discuss the complex role played by social networks in transcending the geographical and conceptual boundaries between distinct downtown drug-using neighborhoods. Finally, we emphasize that young people's spatial tactics within this downtown landscape -the everyday movements they employ in order to maximize their safety -must be understood in the context of everyday violence and profound social suffering.

Recent research has highlighted the ways in which social structural processes and physical environments operate to push young drug users towards risk. We undertook this study in order to explore how young people who were currently street-entrenched characterized and understood their initiation into the local drug scene in downtown Vancouver, Canada. Semi-structured qualitative interviews were conducted with 38 individuals recruited from a cohort of young drug users known as the At-Risk Youth Study (ARYS). Participant narratives reflected an understanding among young people that they are simultaneously pulled and pushed towards the local scene. Push factors were understood as circumstances that propelled young people towards this setting, in some cases because of proximity to it from a very early age, and in other cases because of adverse situations experienced elsewhere and the need to find a new place to live that was both affordable and safe. Interwoven with accounts of how youth were pushed towards the local scene were stories that emphasized a high degree of autonomy and the factors that initially attracted them to this scene, including a desire for excitement, independence and belonging. Once young people were more permanently based in downtown Vancouver, participants identified several factors that accelerated their entrenchment in this locale, including increasingly ‘problematic’ drug use, an intensified need to generate income, experiences of chronic homelessness, and unstable social relationships. Our findings stress the need for early intervention with youth, before they are initiated into the social networks and processes that rapidly propel young people towards risk within these contexts. Once initiation has occurred, the boundary between safety and risk quickly becomes difficult to navigate, and young people become highly vulnerable to numerous harms.

Background: Unsafe injection practices are prevalent among injection drug users (IDU) and have resulted in numerous forms of drug-related harm including HIV/HCV transmission and other bacterial and viral infections. North America's first supervised injection facility (SIF) was established in Vancouver in order to address injection-related harms among IDU. This study sought to examine injection drug users' experiences receiving safer injecting education in the context of a SIF.

In Canada, approximately 150,000 youth live on the street. Street-involvement and homelessness have been associated with various health risks, including increased substance use, blood-borne infections, and sexually transmitted diseases. We undertook a qualitative study to better understand the social and structural barriers street-involved youth who use illicit drugs encounter when seeking housing. We conducted 38 semi-structured interviews with street-involved youth in Vancouver, Canada from May to October 2008. Interviewees were recruited from the At-risk Youth Study (ARYS) cohort, which follows youth aged 14 to 26 who have experience with illicit drug use. All interviews were thematically analyzed, with particular emphasis on participants' perspectives regarding their housing situation and their experiences seeking housing. Many streetinvolved youth reported feeling unsupported in their efforts to find housing. For the majority of youth, existing abstinence-focused shelters did not constitute a viable option and, as a result, many felt excluded from these facilities. Many youth identified inflexible shelter rules and a lack of privacy as outweighing the benefits of sleeping indoors. Single-room occupancy hotels (SROs) were reported to be the only affordable housing options, since many landlords would not to rent to youth on welfare. Many youth reported resisting moving to SROs as they viewed them as unsafe and as giving up hope for a return to mainstream society. The findings of the present study shed light on the social and structural barriers street-involved youth face in attaining housing and challenge the popular view of youth homelessness constituting a life-style choice. Our findings point to the need for housing strategies that include safe, low threshold, harm reduction focused housing options for youth who engage in illicit substance use.