Using photovoice to understand experiences of opioid use among sexual and gender minority youth in Vancouver, Canada

Homes of substance: Drugs and the making of home/lessness for 2S/LGBTQ+ youth

Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual minority (2S/LGBTQ+) youth between the ages of 14 and 29 experience inequities in homelessness and substance use. Research in this area has explored substance use as a determinant of homelessness and/or as a coping mechanism, yet far less attention has been directed to the potentially generative role of drugs in this marginalizing context. This community-based photovoice study leverages data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth experiencing homelessness and unstable housing to examine how drugs shape their practices and contexts of homemaking. Analysis followed a reflexive thematic approach and was informed theoretically by perspectives on home- and place-making, a momentum-stagnation analytical frame, and a narcofeminist ethics of care. This framing centred attention on the possibilities of what drugs can do for 2S/LGBTQ+ youth in terms of shaping selves, homes, and worlds while homeless. We inductively derived three themes: (i) chasing comforts, (ii) striking down stagnation, and (iii) producing precarity. 2S/LGBTQ+ youth consumed substances in chasing comforts including warmth, relief, and a sense of clarity and being more at ease within the context of homelessness and social and material inequity. Their substance use was also a means for striking down stagnation and engendering momentum as they worked to carve out better homes and futures for themselves. Youth frequently drew attention to the temporality and limits of these benefits, however, cautioning that drugs could also turn to producing new forms of precarity that limited what they expected and experienced as possible with respect to their homemaking projects. Findings highlight the generative potential of drugs in the making of home/lessness and provide critical direction for policy and service delivery, including for supports to further consider and attend to the social contexts, meanings, and effects of 2S/LGBTQ+ youths' substance use in connection with homelessness.

2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study

BACKGROUND

Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.

METHODS

This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness. Employing constructionist narrative analysis, two storylines were inductively derived from participant-produced photographs and photovoice interviews with 32 2S/LGBTQ+ youth in Vancouver, Canada.

RESULTS

Taking refuge narratives centered on 2S/LGBTQ+ youths' use of substances to cope with intersecting hardships and minority stressors they had faced growing up, and when transitioning to homelessness. From playing into precarity narratives focused on the shifting possibilities and tensions of what sexualized crystal methamphetamine use can surface for 2S/LGBTQ+ youth in terms of facilitating connection and release and simultaneously invoking discomforts, including eviction from their family home.

CONCLUSIONS

These narratives can usefully be anticipated and recognized to better understand and address the social contexts in which 2S/LGBTQ+ youth experience substance use and associated harms, especially homelessness. They affirm the need for tailored supports for 2S/LGBTQ+ youth who use drugs in the lead-up to and after becoming homeless, including the provision of care that better recognizes youths' pursuits of becoming and belonging in the context of marginalization, and that takes a harm reduction approach to addressing the role of substance use in these pursuits.

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care.

METHODS

We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.

RESULTS

Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures.

CONCLUSIONS

LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Hyper-invisibility and visual scrutiny: reflections from photo-narrative research with transgender young persons

In recent years, photo-narrative methods have gained popularity as a feminist decolonial research approach. Located within the broader category of participatory action research, photovoice is committed to the democratisation of the research process. It aims to centre previously excluded knowledges and problematises what is considered ‘legitimate’ ways of knowing within the social sciences. As such, photovoice has been utilised across a wide range of studies that are aligned with a social justice agenda. Arising are questions around the burden of representation that is placed on participants; what it means for stories of marginalisation to be put ‘on display’; and the risk involved in disclosing personal experiences when there is a power differential between storyteller and audience. By highlighting complications encountered when conducting a photo-narrative project with transgender young persons in Cape Town, South Africa, this methodologically reflexive paper contributes to this conversation. We explore the nuances and complexities that arose when using a methodology that relies heavily on visual data, on a community that experiences intense visual scrutiny daily. As a result, the research focused on participants’ narratives of invisibility and hypervisibility as presented in the data, thus bringing a reflexive stance and interrogation to assumptions of the approach often taken for granted.