Cohort profile: Walking for harm reduction through street engagement (WHiSE 2.0)

Indigenous people using substances experience health disparities that are compounded by systemic inequities shaped by colonialism. The WHiSE 2.0 study aims to describe substance use patterns and harm reduction approaches among Indigenous people who use drugs in Thunder Bay, Sudbury, and Sault Ste Marie. A community-based research approach was used and guided by Indigenous leadership. Eligible study participants self-identified as Indigenous, lived in the study regions, and used substances within the last 3 months. Participants completed an interviewer-administered 1-hour questionnaire. Descriptive statistics were conducted to summarize participant demographic and cultural characteristics, impacts of colonization, substance use and health behaviours, and harm reduction knowledge, stratified by city. A total of 356 participants were enrolled: 173 in Thunder Bay, 101 in Sault Ste. Marie, and 82 in Sudbury. Most identified as First Nations with 93.1% in Thunder Bay, 76.8% in Sudbury, and 75.2% in Sault Ste. Marie. The percentage of participants across all sites with precarious sleeping situations was high, with 39.0% sleeping on the street, 28.3% staying in a shelter, and 23.3% couch surfing as well as 41.9% staying at a family or friend's home. Across all sites, 43.3% of participants injected drugs, 31.5% ingested drugs, 92.1% smoked drugs, and 38.5% snorted or inhaled drugs. Importantly across all sites, 84.0% knew what harm reduction was, and 82.3% of respondents had ever had HIV screening test and 84.3% hepatitis C testing. Also, 71.3% of all participants engaged in ceremonies and 22.2% reported that cultural teachings affected their harm reduction practices. WHiSE 2.0 is the first prospective cohort study examining the harm reduction needs of Indigenous people using substances in northern Ontario. Through a culturally grounded, community-led study, urgent service gaps are highlighted and the importance of locally tailored harm reduction strategies rooted in Indigenous knowledge and leadership.