Barriers and recommendations for harm reduction services among people living with HIV in Manitoba, Canada: a qualitative study.

Introduction: In 2022, the province of Manitoba, Canada, recorded its highest increases in substance-related deaths and new HIV diagnoses. The COVID-19 pandemic exacerbated access barriers to harm reduction services across the country. Given the intertwined relationship between HIV and injection substance use, we sought to better understand People Living with HIV's (PLHIV) access barriers to harm reduction services, and recommendations for improved care. Methods: This qualitative study was co-designed by and co-executed with people with lived experiences in HIV and substance use. The data collection process encompassed a semi-structured in-depth qualitative interview with PLHIV followed by three quantitative questionnaires and was conducted between October 2022 and May 2023 in HIV clinics. Descriptive statistics were performed to illustrate substance use practices, and we employed reflexive thematic analysis to generate themes and explain shared patterns of meaning across participants in relation to our research question. Results: We developed two themes to explain the qualitative data: (1) Discussion: PLHIV who use substances face many hurdles when seeking harm reduction and health services. It is essential to implement new strategies centred on the lives of PLHIV who use substances to address the unprecedented rates of HIV diagnoses, health-related harms, and substance-related deaths.