Project 461389

British Columbia (BC) continues to grapple with an overdose epidemic that has largely been framed as a men's public health crisis. Little has been said regarding how women (transgender, Two-Spirit and non-binary inclusive) are impacted, or how they might be differently navigating overdose risk environments or access to life-saving health services. Despite the implementation of a range of overdose prevention interventions, rising death rates in BC render the overdose epidemic a pressing public health issue compounded by the COVID-19 pandemic. Some sub-populations of marginalized women are not fully benefiting from current interventions, illustrating the need to better examine why. Women, in dynamic relationship with race, class and sexuality, are disproportionately impacted by social violence, which shapes health and overdose risk as well as access to and uptake of overdose prevention interventions. Emerging evidence indicates that women are more negatively impacted by the COVID-19 pandemic than men, exacerbating existing health inequities. Building upon our extensive experience in examining risk, harm, and health care access among women who use drugs, we are requesting funds to support a 4-year qualitative study addressing the following objectives: 1. To examine how intersecting social, structural, and environmental forces (including COVID-19) produce violence, shape women's overdose risk environments and contribute to differential outcomes across drug-using populations; 2. To examine the implementation of interventions to address overdose and COVID-19 health crises, including policy recommendations and their impacts on health-related outcomes; 3. To explore the experiences of women who use drugs in: the mitigation of overdose-related risk during the COVID-19 pandemic; engagement with overdose- and COVID-19-focused interventions; as well as factors that facilitate or impede their meaningful engagement in these activities during dual public health emergencies.