Negotiating place and gendered violence in Canada's largest open drug scene

Abstract

Background Vancouver’s Downtown Eastside is home to Canada’s largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and ‘marginal men’ (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite. Methods Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants’ spatial practices. Results Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into “dangerous” drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income. Conclusion Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection services, to minimize violence and potential drug-related risks among these highly-vulnerable PWID.

Residential eviction and exposure to violence among people who inject drugs in Vancouver, Canada

“…Exposure to violence among PWID has also been linked to an increased likelihood of engaging in unsafe injection practices, including syringe sharing, as well as drug-related harms such as overdose (Braitstein et al, 2003). Further, recent qualitative research suggests that experiencing violence may impede access to harm reduction services among those who occupy marginal positions within drug economies, such as women and people with disabilities, by constraining the geographic scope of their activities (McNeil, Shannon, Shaver, Kerr & Small, 2014). …”

“…This framework describes how social, structural and environmental factors interact at macro- and micro-environmental levels to shape the health of PWID (Rhodes, 2002; Rhodes et al, 2012). The purpose of the Risk Environment framework is not to provide a comprehensive classification system for the complex, multifaceted aspects of the risk environment of PWID, but to instead shift attention away from the level of the individual to facilitate recognition and understanding of the role of environmental influences on health and risk (Goldenberg et al, 2011; McNeil et al, 2014; Richardson et al, 2013). Although first applied in the study of the risk of HIV acquisition (Rhodes, 2002), this framework has recently been extended to describe how contextual factors interact at various levels of influence to shape susceptibility to violence among PWID (Lorvick et al, 2014; Marshall et al, 2008).…”

“…For instance, several qualitative studies have elucidated how female PWID are often relegated to subordinate roles in street-based drug scene hierarchies, thereby increasing their vulnerability to violence (Epele, 2002; Maher & Daly, 1996; McNeil et al, 2014; Miller, Kerr, Strathdee, Li & Wood, 2007). Additionally, other quantitative studies have demonstrated how experiences of violence may vary by sex or gender.…”

“We need somewhere to smoke crack”: An ethnographic study of an unsanctioned safer smoking room in Vancouver, Canada

“…The organization currently operates within a storefront location in the Downtown Eastside that serves as a drop-in for people who use drugs, and is an authorized harm reduction supply distribution site of the British Columbia Centres for Disease Control. Its supervised injection room was opened to increase responsiveness to the needs of its members, who are sometimes unable to access Insite due to operating procedures imposed on this facility by the federal government (e.g., prohibitions of assisted injections) (McNeil et al, 2014a), and perceptions of safety in the area immediately surrounding Insite (McNeil et al, 2014b). VANDU revised its harm reduction policy at that time to accommodate crack smoking and adapted a small washroom within its facility equipped with a ventilation system into a provisional SSR (n.b., while permitted, other drugs were rarely smoked within the facility).…”

Integrating place into research on drug use, drug users’ health, and drug policy

“…Kao et al (2014) applied geospatial methods to study the relationship of spatial access to outpatient drug treatment facilities to drug use and treatment utilization among Mexican Americans in Houston, Texas (USA) who are current or former heroin users. McNeil and colleagues (2014) expanded research on gender-based violence in drug scenes to include “marginal men” – that is, men who occupy a marginal position in the drug scene because of their income-generation strategies, age, disability, health status, social isolation, or drug use practices. They find that hegemonic masculinities operating in the drug scene in Vancouver (Canada’s) Downtown East Side shape marginal men’s (and women’s) experiences of violence, and that these experiences, in turn, influence the spatial practices of marginal men (and women) within the drug scene.…”