{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:16:59Z","timestamp":1758586619952,"version":"3.44.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["EG5-179453"],"award-info":[{"award-number":["EG5-179453"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In 2022, the province of Manitoba, Canada, recorded its highest increases in substance-related deaths and new HIV diagnoses. The COVID-19 pandemic exacerbated access barriers to harm reduction services across the country. Given the intertwined relationship between HIV and injection substance use, we sought to better understand People Living with HIV\u2019s (PLHIV) access barriers to harm reduction services, and recommendations for improved care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This qualitative study was co-designed by and co-executed with people with lived experiences in HIV and substance use. The data collection process encompassed a semi-structured in-depth qualitative interview with PLHIV followed by three quantitative questionnaires and was conducted between October 2022 and May 2023 in HIV clinics. Descriptive statistics were performed to illustrate substance use practices, and we employed reflexive thematic analysis to generate themes and explain shared patterns of meaning across participants in relation to our research question.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We developed two themes to explain the qualitative data: (1) <jats:italic>knowledge about and availability of harm reduction services<\/jats:italic>, and (2) <jats:italic>safer substance use and supervised consumption sites<\/jats:italic>. In the first theme, participants described being aware of the different harm reduction services in their community, but recounted several access barriers limiting service uptake, including restrictive service times and limited mobile services. These limitations increased participants\u2019 likelihood of sharing injecting equipment, and produced stress and anxiety about lacking access to safe supplies. In the second theme, participants discussed what they consider \u201csafe\u201d spaces for using substances, highlighting the importance of autonomy and privacy where they can use without fear of stigma and interference. Thus, to make substance use safer in Manitoba, participants advocated for the implementation of supervised consumption sites to ensure the availability of non-judgmental spaces where they can find and use safe injecting supplies, trained staff, and connections to health and social supports.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>PLHIV who use substances face many hurdles when seeking harm reduction and health services. It is essential to implement new strategies centred on the lives of PLHIV who use substances to address the unprecedented rates of HIV diagnoses, health-related harms, and substance-related deaths.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1636409","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:28:41Z","timestamp":1758518921000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and recommendations for harm reduction services among people living with HIV in Manitoba, Canada: a qualitative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Enrique","family":"Villacis-Alvarez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Maier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Haworth-Brockman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Pashe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Baliddawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikki","family":"Daniels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Murdock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Russell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Dan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freda","family":"Woodhouse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susie","family":"Cusson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marj","family":"Schenkels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Kasper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren J.","family":"MacKenzie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurie","family":"Ireland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Templeton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Keynan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zulma Vanessa","family":"Rueda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref1","year":"2025"},{"key":"ref2","year":"2022"},{"key":"ref3","year":"2022"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/j.lana.2024.100805","article-title":"Sex differences in houselessness, injection drug use, and mental health conditions among people newly diagnosed with HIV in Manitoba, Canada from 2018 to 2021: a retrospective cohort study","volume":"36","author":"Sharp","year":"2024","journal-title":"Lancet Reg Health \u2013 Am"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"100433","DOI":"10.1016\/j.ijregi.2024.100433","article-title":"Sexually transmitted and blood-borne infections by sex, methamphetamine use, and houselessness before, at, and after HIV diagnosis in Manitoba, Canada","volume":"13","author":"Sorokopud-Jones","year":"2024","journal-title":"IJID Reg"},{"key":"ref6","year":"2022"},{"key":"ref7","year":"2021"},{"key":"ref8","year":"2010"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S118","DOI":"10.1016\/j.amepre.2021.05.044","article-title":"Syringe services programs\u2019 role in ending the HIV epidemic in the U.S.: why we cannot do it without them","volume":"61","author":"Broz","year":"2021","journal-title":"Am J Prev Med"},{"key":"ref10","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"287","DOI":"10.3390\/tropicalmed9120287","article-title":"Gender and intersecting barriers and facilitators to access the HIV cascade of care in Manitoba, Canada, before and during Covid-19 pandemic: a qualitative study","volume":"9","author":"Villacis-Alvarez","year":"2024","journal-title":"Trop Med Infect Dis"},{"key":"ref12","first-page":"13","article-title":"A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the Sava Syndemic","volume":"28","author":"Singer","year":"2000","journal-title":"Free Inq Creat Soc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1016\/j.socscimed.2004.12.024","article-title":"The social structural production of HIV risk among injecting drug users","volume":"61","author":"Rhodes","year":"2005","journal-title":"Soc Sci Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"442","DOI":"10.2174\/1570162X14666160324124736","article-title":"Mechanisms of HIV transcriptional regulation by drugs of abuse","volume":"14","author":"Tyagi","year":"2016","journal-title":"Curr HIV Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"116011","DOI":"10.1016\/j.taap.2022.116011","article-title":"Methamphetamine induces intestinal injury by altering gut microbiota and promoting inflammation in mice","volume":"443","author":"Wang","year":"2022","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"783121","DOI":"10.3389\/fmed.2022.783121","article-title":"Related effects of methamphetamine on the intestinal barrier via cytokines, and potential mechanisms by which methamphetamine may occur on the brain-gut Axis","volume":"9","author":"Li","year":"2022","journal-title":"Front Med"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/QAI.0000000000001643","article-title":"Brief report: recent methamphetamine use is associated with increased rectal mucosal inflammatory cytokines, regardless of HIV-1 Serostatus","volume":"78","author":"Fulcher","year":"1999","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.lfs.2010.10.002","article-title":"Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV","volume":"88","author":"Carrico","year":"2011","journal-title":"Life Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1007\/s10461-009-9631-1","article-title":"Syringe-mediated Syndemics","volume":"15","author":"Bulled","year":"2011","journal-title":"AIDS Behav"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1097\/QAI.0000000000002062","article-title":"Sharing of injection drug preparation equipment is associated with HIV infection: a cross-sectional study","volume":"81","author":"Ball","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/COH.0000000000000628","article-title":"What constitutes a syndemic? Methods, contexts, and framing from 2019","volume":"15","author":"Mendenhall","year":"2020","journal-title":"Curr Opin HIV AIDS"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e067813","DOI":"10.1136\/bmjopen-2022-067813","article-title":"Social and structural barriers and facilitators to HIV healthcare and harm reduction services for people experiencing syndemics in Manitoba: study protocol","volume":"13","author":"Rueda","year":"2023","journal-title":"BMJ Open"},{"key":"ref24","year":"2022"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/s0145-2134(02)00541-0","article-title":"Development and validation of a brief screening version of the Childhood Trauma Questionnaire","volume":"27","author":"Bernstein","year":"2003","journal-title":"Child Abuse Negl"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1176\/ps.2010.61.9.933","article-title":"Validating the empowerment scale with a multisite sample of consumers of mental health services","volume":"61","author":"Rogers","year":"2010","journal-title":"Psychiatr Serv Wash DC"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual Res Sport, Exerc Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1037\/qup0000196","article-title":"Conceptual and design thinking for thematic analysis","volume":"9","author":"Braun","year":"2022","journal-title":"Qual Psychol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.mcna.2021.08.006","article-title":"Infectious complications of injection drug use","volume":"106","author":"Marks","year":"2022","journal-title":"Med Clin North Am"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/j.annemergmed.2023.11.020","article-title":"Barriers and facilitators to harm reduction for opioid use disorder: a qualitative study of people with lived experience","volume":"83","author":"Westafer","year":"2024","journal-title":"Ann Emerg Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.drugpo.2018.03.026","article-title":"Safe and unsafe spaces: non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City","volume":"57","author":"Hunter","year":"2018","journal-title":"Int J Drug Policy"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.drugalcdep.2017.07.016","article-title":"Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: a longitudinal analysis","volume":"180","author":"Ickowicz","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"108868","DOI":"10.1016\/j.jsat.2022.108868","article-title":"Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran","volume":"143","author":"Khezri","year":"2022","journal-title":"J Subst Abus Treat"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.drugpo.2006.11.019","article-title":"Public injection settings in Vancouver: physical environment, social context and risk","volume":"18","author":"Small","year":"2007","journal-title":"Int J Drug Policy"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"102663","DOI":"10.1016\/j.drugpo.2020.102663","article-title":"Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs","volume":"77","author":"Trayner","year":"2020","journal-title":"Int J Drug Policy"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.amepre.2021.04.017","article-title":"Supervised injection facilities as harm reduction: a systematic review","volume":"61","author":"Levengood","year":"2021","journal-title":"Am J Prev Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e0227298","DOI":"10.1371\/journal.pone.0227298","article-title":"The effectiveness of substance use interventions for homeless and vulnerably housed persons: a systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder","volume":"15","author":"Magwood","year":"2020","journal-title":"PLoS One"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.drugalcdep.2014.10.012","article-title":"Supervised injection services: what has been demonstrated? A systematic literature review","volume":"145","author":"Potier","year":"2014","journal-title":"Drug Alcohol Depend"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12954-022-00609-5","article-title":"Supervised consumption site enables cost savings by avoiding emergency services: a cost analysis study","volume":"19","author":"Khair","year":"2022","journal-title":"Harm Reduct J"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1636409\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:28:43Z","timestamp":1758518923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1636409\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":40,"alternative-id":["10.3389\/fpubh.2025.1636409"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1636409","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]},"article-number":"1636409"}}