“Especially Being Homeless, They Just Think You’re Infected with COVID or Something”: A Qualitative Exploration of the COVID-19 Pandemic’s Impact on People Experiencing Homelessness With a History of Injection Drug Use in Baltimore, Maryland

Abstract

People experiencing homelessness with a substance use disorder are a highly structurally vulnerable population, facing a unique burden of compounding stigma, discrimination, and adverse health outcomes. Evidence remains mixed on best practices for housing interventions designed to meet the needs of this population. Ten people with a history of injection drug use experiencing homelessness during the COVID-19 pandemic were interviewed between July 2021 and February 2022 in Baltimore, Maryland. Thematic analysis was used to characterize the pandemic’s impact on their resource access, housing, and substance use. Participants highlighted substantial challenges resulting from structural changes during the pandemic, including limits on income-generating opportunities and resource access, and increases in experiences of stigma and discrimination. However, several individuals reported decreased substance use in response to changes to their housing status, with those placed in secure housing attributing their decreased use to this change. These accounts can help guide housing and social support interventions best suited to meet the unique needs of people experiencing homelessness with substance use disorders.

Keywords:

• Homelessness
• people who inject drugs
• COVID-19
• housing access

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute on Drug Abuse [U01-DA036297, R01-DA053136, F31DA054849 to EUP], the National Institute of Allergy and Infectious Diseases [T32AI102623 to EUP] and the Johns Hopkins University Center for AIDS Research [P30-AI094189], The funding sources had no role in the analysis and interpretation of the data, writing of the report, or decision to submit the article for publication.

Notes on contributors

Abigail K. Winiker

Abigail K. Winiker is a PhD candidate in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, where she also completed an MSPH. Her work focuses on the design and implementation of harm reduction-based behavioral interventions targeting vulnerable populations, including people who inject drugs. Her current research explores the intersections of trauma and violence with mental health and substance use outcomes, as well as the moderating role of resilience.

Eshan U. Patel

Eshan U. Patel, PhD received his doctorate from the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. He is an epidemiologist who primarily conducts research on the epidemiology, detection, prevention and control of infectious diseases, including HIV, viral hepatitis, other sexually transmitted infections, and COVID-19. He is particularly interested in using research to understand and address social determinants of infectious disease transmission and prevention among key populations such as people who inject drugs.

Becky L. Genberg

Becky L. Genberg, PhD, MPH is an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is an epidemiologist who uses research to understand and intervene on the social determinants of health behaviors and outcomes related to infectious disease and substance use.

Jennifer Ching

Jennifer Ching, MSPH completed her MSPH in the Johns Hopkins Bloomberg School of Public Health in the Department of International Health. She is currently serving in the Peace Corps in Botswana.

Catherine Schluth

Catherine Schluth, BS is currently pursuing a master of science (ScM) in infectious disease epidemiology at Johns Hopkins Bloomberg School of Public Health. Her intended focus for her graduate thesis and subsequent research career is HIV/AIDS among key populations such as adolescent girls and young women, sex workers, transgender people, and people who inject drugs. She has engaged in several years of research in infectious disease epidemiology.

Shruti H. Mehta

Shruti H. Mehta, PhD, MPH is a professor of epidemiology and Vice Chair for Research and Administration in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is an epidemiologist whose primary research interests include working with hard-to-reach populations to understand the epidemiology, natural and treated history of HIV, hepatitis C virus (HCV) and HIV/HCV co-infection. She has a special interest in identifying and overcoming barriers to care and treatment of HIV and hepatitis C virus among people who inject drugs and men who have sex with men as well as their sexual partners in both Baltimore and international settings.

Gregory D. Kirk

Gregory D. Kirk, MD, PhD, MPH is a professor of epidemiology and Vice Dean for Research at the Johns Hopkins Bloomberg School of Public Health. He is a physician-scientist and epidemiologist whose primary research focuses on understanding the natural history of viral infections, particularly HIV and the hepatitis viruses, in both domestic and international settings.

Suzanne M. Grieb

Suzanne M. Grieb, PhD is an assistant professor in the Center for Child and Community Health Research (CCHR) in the Johns Hopkins School of Medicine and holds a joint faculty appointment in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health (JHSPH). Her research focuses on utilizing community-engaged research to develop and implement interventions that address social determinants of sexually transmitted infections (STIs) among minority and underserved populations.