Nadine Caron

Background: Urban Indigenous Peoples who use drugs (IPWUD) were more likely to face multiple harms from COVID-19 pandemic restrictions in British Columbia. Canada’s history of racist medical experimentation resulted in a rational skepticism of health interventions for many Indigenous Peoples. This study focuses on the experiences of IPWUD during COVID-19 to inform public health practices and improve vaccine acceptance and uptake.Methods: Mixed methods were used to understand IPWUD experiences during COVID-19, including vaccine acceptance and uptake as part of the Cedar Project COVID-19 Study. Data were gathered using in-depth qualitative interviews and a questionnaire administered at two distinct time points. Emerging themes informed the direction of quantitative analysis of survey data, where we explored correlates of vaccine uptake, and integrated qualitative data to understand vaccine acceptability.Results: Data were collected between February 2021-December 2022. N=212 participants were enrolled at baseline, and N=127 completed the end of study questionnaire. Nineteen semi-structured interviews were conducted in Vancouver (n=9) and Prince George (n=10). Four themes were identified from qualitative interviews that describe the enduring impacts of colonialism on stress; cycles of isolation and crisis; fear and trauma-driven distrust; and resilience and connection. Perceived vaccine effectiveness (aOR=5.30 95% CI = 1.34, 20.93), historic trauma (aOR = 5.25 95% CI = 1.27, 21.76), age (aOR = 1.10 95% CI = 1.02, 1.19), and being a woman (aOR = 0.26 95%CI = 0.07, 0.94) were significantly associated with vaccination. Women engaged in sex work during COVID-19 were significantly less likely to get vaccinated (aOR = 0.14 95% CI = 0.02, 0.91). Medical distrust, misinformation, and past experiences challenged vaccine acceptance. Many participants experienced barriers to vaccination and challenges accessing services, and those who were unsure about getting vaccinated had the lowest vaccination rate by the end of study. Conclusion: This study connects and contextualizes experiences during the pandemic, and perceptions and uptake of the COVID-19 vaccine, through the significant roles of age, gender, vaccine perceptions, historic trauma, stability and basic hygiene, and sex work. Institutions should consider cultural and historical contexts surrounding vaccine uptake, emphasize relationship building, and prioritize Indigenous women in public health practices.

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