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We sought to synthesize qualitative studies of social\u2013structural factors influencing incidence and treatment of injecting\u2010related infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1\u2009January 2000 to 18\u2009February 2021. Informed by Rhodes\u2019 \u2018risk environment\u2019 framework, we performed thematic synthesis in three stages: (1) line\u2010by\u2010line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher\u2010order analytical themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We screened 4841 abstracts and included 26 qualitative studies on experiences of injecting\u2010related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro\u2010environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health\u2010care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted\u2010injecting and sharing sterile equipment; and (6) self\u2010care, including vein health and self\u2010treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Injecting\u2010related bacterial and fungal infections are shaped by modifiable social\u2013structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health\u2010care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16257","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T05:56:42Z","timestamp":1683871002000},"page":"1853-1877","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Social and structural determinants of injection drug use\u2010associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-5556","authenticated-orcid":false,"given":"Thomas D.","family":"Brothers","sequence":"first","affiliation":[{"name":"UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care University College London  London UK"},{"name":"Department of Medicine, Faculty of Medicine Dalhousie University  Halifax Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6406-0171","authenticated-orcid":false,"given":"Matthew","family":"Bonn","sequence":"additional","affiliation":[{"name":"Canadian Association of People who Use Drugs (CAPUD)  Dartmouth Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-7196","authenticated-orcid":false,"given":"Dan","family":"Lewer","sequence":"additional","affiliation":[{"name":"UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Comeau","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dalhousie University  Halifax Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inhwa","family":"Kim","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dalhousie University  Halifax Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7692-7150","authenticated-orcid":false,"given":"Duncan","family":"Webster","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Dalhousie University  Halifax Canada"},{"name":"Division of Infectious Diseases Saint John Regional Hospital  Saint John Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3549-6232","authenticated-orcid":false,"given":"Andrew","family":"Hayward","sequence":"additional","affiliation":[{"name":"UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8718-8226","authenticated-orcid":false,"given":"Magdalena","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-049924"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000928"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1278"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1038"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14892"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003247"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.03.166"},{"key":"e_1_2_9_9_1","first-page":"379","article-title":"Epidemiology, microbiology, and clinical outcomes among patients with intravenous drug use\u2010associated infective endocarditis in New Brunswick","volume":"2","author":"Mosseler K","year":"2020","journal-title":"Can J Cardiol Open"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2308.170439"},{"key":"e_1_2_9_11_1","article-title":"Increasing infectious endocarditis admissions among young people who inject drugs. 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