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Sample demographics are comparable to those of PWID represented in UK surveillance data ( Doran et al., 2020). This paper draws on mixed method data generated for the Care & Prevent study with 455 PWID, many of whom report rough sleeping and injecting-related hospitalisation, to explore the dynamics of medical care seeking and avoidance among the most marginalised. UK surveillance data demonstrate increases in mortality, morbidity and health system burden associated with injecting-related infections ( Public Health England, 2019), but provide little insight into the contextual and social relations informing health harm risk and treatment access. Translation of cultural safety principles to care for people who inject drugs in hospital settings offers transformative potential to reduce serious health harms among this population.ĭeaths among the intersecting populations of people who inject drugs (PWID) and those made homeless in the United Kingdom (UK) have risen exponentially over the past decade ( ONS, 2019a, 2019b).

In a context of everyday violence and marginalisation, avoidance of medical care can have a protective impetus. For many severe physical pain and debility were normalised, incorporated into the day to day. Qualitative accounts emphasise engagement with the medical system as a ‘last resort’, with admission to hospital in a critical or a “near death” condition common. Survey participants report an extensive history of rough sleeping (78%) injecting-related bacterial infections (65%) and related hospitalisation (30%). This paper focuses on qualitative findings, analysed thematically and contextualised in relation to the broader survey sample. Participants were recruited though drug treatment services and homeless hostels in London from October 2017–June 2019. The mixed methods Care & Prevent study generated survey data with 455 PWID and in-depth qualitative interviews with a subsample (n = 36).

In this context, it is crucial to explore how poverty, multi-morbidity and care delay interplay in exacerbating vulnerability to mortality among an aging population of people who use illicit drugs. In the United Kingdom, increases in premature mortality among the intersecting populations of people made homeless and people who inject drugs map onto the implementation and solidification of fiscal austerity policies over the past decade, rather than drug market fluctuations and trends as in North America.

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