"A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada.

BACKGROUND: The harmful use of alcohol is one of the leading health risk factors for people's health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada. METHODS: Community based participatory research approach and qualitative methods-including semi-structured interviews and focus groups-were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. RESULTS: Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants' alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal's wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. CONCLUSIONS: Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users' engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.

Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal.

BACKGROUND: The distribution of safer crack-smoking equipment has been implemented in several Canadian cities to reduce potential health risks such as transmission of blood borne viruses (BBV). Little is known about the perspectives of persons who smoke crack (PWSC) on sharing crack-smoking materials or using in settings where safer crack-smoking equipment is provided. This paper presents data from the perspective of PWSC in Montréal on their experiences of, and rationales for, sharing crack-smoking equipment, in light of the risks of BBV transmission. METHODS: This qualitative study is based on analyses of BBV risk behaviours among people who use cocaine. Thirty-two semi-structured interviews were conducted in low-threshold community centres for persons who use drugs. Twenty-six interviewees who used cocaine also smoked crack, and constitute a subsample for analyses. Interview transcripts were coded inductively and analyzed thematically from a symbolic interactionist perspective. RESULTS: Participants demonstrated personal agency by adopting strategies to minimise sharing of smoking equipment. These included being firm in refusal to share, smoking alone, and keeping an extra pipe to give to others. Nonetheless, sharing seemed to be commonplace and was attributed to contextual and personal factors. These were linked to the social dynamics among smokers; economic reasons such as wanting to keep the accumulated crack resin; practical reasons such as lacking own smoking equipment; being ashamed to purchase or acquire crack pipes; fatalism; poor personal agency; and ambivalence or scepticism towards BBV transmission risks. CONCLUSION: To reinforce harm reduction for PWSC, interventions aimed at reducing barriers to safer smoking practices should be developed at both structural and individual levels.

Re-envisioning global agricultural trade: time for a paradigm shift to ensure food security and population health in low-income countries.

In this commentary, we use examples from West Africa to highlight how the liberalization of global agricultural trade exacerbates population health inequalities by threatening the livelihoods and food security of communities in low-income settings. We highlight the exploitative nature of trade agreements with West African countries demonstrating how these agreements disincentivize local agricultural investment and take jobs away from small-scale farmers. Further, we link agricultural trade liberalization to increased food insecurity, malnutrition, and exposure to environmental contaminants. Finally, we propose a paradigm shift that advocates for food sovereignty and the right to food.