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Research on a Vulnerable Neighborhood—The Vancouver Downtown Eastside from 2001 to 2011

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Abstract

The Downtown Eastside (DTES) of Vancouver is the subject of considerable research due to high rates of drug use, poverty, crime, infectious disease, and mental illness. This paper first presents a brief background to the DTES and then presents a survey of literature addressing the issues in this area from 2001 to 2011. The literature surveyed includes a range of publications such as those from peer-reviewed journals and the grey literature of reports and dissertations. This survey investigates the themes and outcomes of the extant literature and highlights the notable lack of research on mental health in the DTES.

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Authors and Affiliations

  1. St. Paul’s Hospital, Centre for Health Evaluation and Outcome Sciences (CHÉOS), 588-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada

    Isabelle Aube Linden, Marissa Y. Mar & Michael Krausz

  2. Sauder School of Business, University of British Columbia, 2053 Main Mall, Vancouver, BC, V6T 1Z2, Canada

    Gregory R. Werker

  3. City Council, City of Vancouver, Vancouver City Hall, 453 West 12th Ave, Vancouver, BC, V5Y 1V4, Canada

    Kerry Jang

  4. Department of Psychiatry, UBC Hospital, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada

    Kerry Jang & Michael Krausz

  5. School of Population and Public Health, University of British Columbia, James Mather Building, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada

    Michael Krausz

Authors
  1. Isabelle Aube Linden
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  2. Marissa Y. Mar
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  3. Gregory R. Werker
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  4. Kerry Jang
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  5. Michael Krausz
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Corresponding author

Correspondence to Isabelle Aube Linden.

Appendix: Body of Literature (Chronologically Ordered)

Appendix: Body of Literature (Chronologically Ordered)

Peer-Reviewed Journal Articles

1. Kendall T, Morris C, Braitstein P. Constrained choices and HIV-positive women accessing. Canadian Woman Studies. 2001;21(2):96–102.

2. Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS, Montaner JSG, O’Shaughnessy MV, Schechter MT. Unsafe injection practices in a cohort of injection drug users in Vancouver: Could safer injecting rooms help? Canadian Medical Association Journal. 2001;165(4):405–410.

3. Patrick DM, Rekart ML, Jolly A et al. Heterosexual outbreak of infectious syphilis: epidemiological and ethnographic analysis and implications for control. Sexually Transmitted Infections. 2002;78:i164-69.

4. Wood E, Tyndall MW, Spittal PM et al. Needle exchange and diff iculty with needle access during an ongoing HIV epidemic. International Journal of Drug Policy. 2002;13:95–102.

5. Benoit C, Carroll D, Chaudhry M. In search of a healing place: Aboriginal women in Vancouver’s Downtown Eastside. Social Science and Medicine. 2003;56:821–833.

6. Kerr T, Wood E, Small D, Palepu A, Tyndall MW. Potential use of safer injecting facilities among drug users in Vancouver’s Downtown Eastside. Canadian Medical Association Journal. 2003;169(8):759–763.

7. Kerr T, Oleson M, Wood E. Harm reduction activism: A case study of an unsanctioned user-run safe injection site. Canadian HIV/AIDS Policy & Law Review. 2004;9(2):13–19.

8. Kerr T, Wood E, Grafstein E et al. High rates of primary care and emergency department use among injection drug users in Vancouver. Journal of Public Health. 2004;27(1):62–66.

9. Miller CL, Wood E, Spittal PM et al. The future face of coinfection. Journal of Acquired Immune Deficiency Syndromes. 2004;36(2):743–749.

10. Weatherill SA, Buxton JA, Daly PC. Immunization programs in non-traditional settings. Canadian Journal of Public Health. 2004;95(2):133–137.

11. Wood E, Kerr T, Small W et al. Changes in public order after opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal. 2004;171(7):731–734.

12. Wood E, Spittal P, Small W et al. Displacement of Canada’s largest public illicit drug market in response to a police crackdown. Canadian Medical Association Journal. 2004;170(10):1551–1556.

13. Gurstein P, Small D. From housing to home: Reflexive management for those deemed hard to house. Housing Studies. 2005;20(5):717–735.

14. Janssen PA, Demorest LC, Whynot EM. Acupuncture for substance abuse treatment. Journal of Urban Health. 2005;82(2):285–295.

15. Kerr T, Marsh D, Li K, Montaner J, Wood E. Factors associated with methadone maintenance therapy among a cohort of polysubstance using injection drug users in Vancouver. Drug and Alcohol Dependence. 2005;80:329–335.

16. Kerr T, Oleson M, Tyndall MW, Montaner J, Wood E. A description of a peer-run supervised injection site for injection drug users. Journal of Urban Health. 2005;82(2):267–275.

17. Kerr T, Tyndall M, Li, K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. The Lancet. 2005;366(9482):316–318.

18. Marshall SK, Charles G, Hare J, Ponzetti JJ, Stokl M. Sheway’s services for substance using pregnant and parenting women: Evaluating the outcomes for infants. Canadian Journal of Community Mental Health. 2005;24(1):19–33.

19. Shannon K, Bright V, Duddy J, Tyndall MW. Access and utilization of HIV treatment and services among women sex workers in Vancouver’s Downtown Eastside. International Journal of Drug Policy. 2006;17:107–114.

20. Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America’s first supervised injection facility. Drug and Alcohol Dependence. 2005;83(3):193–198.

21. Wood E, Tyndall M, Li K et al. Do supervised injecting facilities attract higher-risk injection drug users? American Journal of Preventive Medicine. 2005;29(2):126–130.

22. Wood E, Tyndall M, Stoltz J et al. Safer injecting education for HIV prevention within a medically supervised safer injecting facility. International Journal of Drug Policy. 2005;16:281–284.

23. Kerr T, Stoltz J, Tyndall M, Li K, Zhang R, Montaner J, Wood E. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. British Medical Journal. 2006;332(7535):220–222.

24. Kerr T, Tyndall M, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Drug Policy. 2006;17:436–441.

25. Grebely J, Raffa J, Lai C, Krajden M, Tyndall MW. Hepatitis C virus reinfection in injection drug users. Journal of Gastroenterology and Hepatology. 2007;22:1519–1525.

26. Small W, Kerr T, Charette J, Schechter MT, Spittal PM. Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation. International Journal of Drug Policy. 2006;17:85–95.

27. Shannon K, Ishida T, Lai C, Tyndall MW. The impact of unregulated single room occupancy hotels on the health status of illicit drug users in Vancouver. International Journal of Drug Policy. 2006;17:107–114.

28. Spittal PM, Hogg RS, Li, K et al. Drastic elevations in mortality among female injection drug users in a Canadian setting. AIDS Care. 2006;18(2):101–108.

29. Tyndall MW, Wood E, Zhang R, Lai C, Montaner JSG, Kerr T. HIV seroprevalence among participants at a medically supervised injection facility in Vancouver, Canada: Implications for prevention, care and treatment. Harm Reduction Journal. 2006:3(36):36–40.

30. Wood E, Tyndall M, Lai C, Montaner JSG, Kerr T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Substance Abuse Treatment, Prevention and Policy. 2006;1(13):13–16.

31. Wood E, Tyndall M, Qui Z, Zhang R, Montaner JSG, Kerr T. Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. American Journal of Public Health. 2006;96(5):770–773.

32. Kerr T, Small W, Moore D, Wood E. A micro-environmental intervention to reduce harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. International Journal of Drug Policy. 2007;18:37–45.

33. Grebely J, Genoway K, Khara M et al. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepaititis C virus infection. International Journal of Drug Policy. 2007;18:437–443.

34. Grebely J, Raffa J, Meagher C et al. Directly observed therapy for the treatment of hepatitis C virus infection in current and former injection drug users. Journal of Gastroenterology and Hepatology. 2007;22:1519–1525.

35. Maas B, Fairbairn N, Kerr T et al. Neighborhood and HIV infection among IDU: Place of residence independently predicts HIV infection among a cohort of injection drug users. Health and Place. 2007;13:432–439.

36. Maberley DA, Hollands H, Chang A, Adilman S, Chakraborti B, Kliever G. The prevalence of low vision and blindness in a Canadian inner city. Eye. 2007;21:528–533.

37. Ogilvie G, Krajden M, Maginley J et al. Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women. Canadian Medical Association Journal. 2007;1777(5):480–483.

38. Poh CF, Hislop G, Currie B, Lee R. Oral cancer screening in a high-risk underserved community—Vancouver Downtown Eastside. Journal of Health Care for the Poor and Underserved. 2007;18:767–778.

39. Small W, Rhodes T, Kerr T. Public injection settings in Vancouver: Physical environment, social context and risk. International Journal on Drug Policy. 2007;18:27–36.

40. Stotlz J, Wood E, Small W et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health. 2007;29(1):35–39.

41. Boyd S, Johnson J, Moffat B. Opportunities to learn and barriers to change: crack cocaine use in the Downtown Eastside of Vancouver. Harm Reduction Journal. 2008;5(34):34–45.

42. Grebely J, Genoway KA, Raffa JD et al. Barriers associated with the treatment of hepatitis C virus infection among illicit drug users. Drug and Alcohol Dependence. 2008;93:141–147.

43. Marshall BD, Fairbairn N, Li K, Wood E, Kerr T. Physical violence among a prospective cohort of injection drug users: a gender-focused approach. Drug and Alcohol Dependence. 97;2008:237–246.

44. Marshall BDL, Kerr T, Livingstone C et al. High Prevalence of HIV Infection Among Homeless and Street-involved Aboriginal Youth in a Canadian Setting. Harm Reduction Journal. 2008;5(35):35–39.

45. Rusch ML, Shoveller JA, Burgess S, Stancer K, Patrick DM, Tyndall MW. Demographics, sexual risk behaviours and uptake of screening for sexually transmitted infections among attendees of a weekly women-only community clinical program. Canadian Journal of Public Health. 2008;99(4):257–261.

46. Romney MG, Hull MW, Gustafson R et al. Large community outbreak of streptococcus pneumonia serotype 5 invasive infection an impoverished, urban population. Clinical Infectious Diseases. 2008;47:768–774.

47. Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T. Determinants of cutaneous injection-related infection care at a supervised injection facility. Annals of Epidemiology. 2009;19(6):404–409.

48. Lloyd-Smith E, Wood E, Li, K, Montaner JSG, Kerr T. Incidence and determinants of initiation into cocaine injection and correlates of frequent cocaine injectors. Drug and Alcohol Dependence. 2009;99:176–182.

49. Rachlis BS, Wood E, Zhang R, Montaner JSG, Kerr T. High rates of homelessness among a cohort of street-involved youth. Health Place. 2009;15(1):10–17.

50. Schuurman N, Cinnamon J, Crooks VA, Hameed SA. Pedestrian injury and the built environment: an environmental scan of hotspots. BMC Public Health. 2009;9:233–242.

51. Janssen PA, Gibson K, Bowen R, Spittal PM, Peterson KL. Peer support using a mobile access van promotes safety and harm reduction strategies among sex trade workers in Vancouver’s Downtown Eastside. Journal of Urban Health. 2009;86(5):804–809.

52. Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug and Alcohol Review. 2010;29:293–300.

53. Werb D, Kerr T, Fast D, Qi J, Montaner JSG, Wood E. Drug-related risks among street youth in two neighborhoods in a Canadian setting. Health and Place. 2010;16:1061–1067.

54. Marshall BDL, Wood E, Shoveller JA, Buxton JA, Montaner JSG, Kerr T. Individual, social and environmental factors associated with initiating methamphetamine injection: Implications for drug use and HIV prevention strategies. Prevention Science.2011;12(2):173–180.

Reports

1. Thomas L. Housing Services Report. Vancouver, BC: Vancouver Community Mental Health Services; 2002.

2. Howard T, Jackson M, Kerr T, Pacey K, Richardson J, Tyndall M. To Serve and Protect: A Report on Policing in Vancouver’s Downtown Eastside. Vancouver, BC: Pivot Legal Society; 2002.

3. BC Centre for Excellence in HIV/AIDS. Community Health and Safety Evaluation (CHASE) Annual Report. Vancouver, BC: BC Centre for Excellence in HIV/AIDS; 2003.

4. Coyne K. Fostering Change from Within: Downtown Eastside Crime Prevention/Community Development. Vancouver, BC: Strathcona Social and Community Research Group; 2004.

5. Babolet H, Cuddeford V, Jeffries F, Korstad H, Kubris S, Mark S, Miewald C, Moreland F. Vancouver Food System Assessment. Vancouver, BC: Western Economic Diversification Canada, 2004

6. BC Centre for Excellence in HIV/AIDS. Community Health and Safety Evaluation (CHASE) Final Report. Vancouver, BC: BC Centre for Excellence in HIV/AIDS; 2005.

7. City of Vancouver. Downtown Eastside Community Monitoring Report. Vancouver, BC: City of Vancouver; 2006.

8. Coyne and Associates Ltd. Ripples of Change: Community Capacity in Vancouver’s Downtown Eastside. Vancouver, BC: City of Vancouver; 2006.

9. Thomas L. Outcome evaluation: Mental health supported housing. Vancouver, BC: Vancouver Community Mental Health Services; 2006.

10. Alkenbrack B, Twiss D. Improvements…No Less Heroic. Vancouver, BC: Vancouver Coastal Health; 2007.

11. Buxton J. Vancouver Drug Use Epidemiology. Vancouver, BC: City of Vancouver; 2007.

12. City of Vancouver. 2007 Survey of Low-Income Housing in the Downtown Core. Vancouver, BC: City of Vancouver; 2007.

13. Dodson B, Gurr S. The Downtown Eastside Case Coordination Project: Moving Hard to Employ Individuals from Welfare to Opportunity. Vancouver, BC: Social Research and Demonstration Corporation; 2008.

14. Wilson-Bates F. Lost in Transition: How a Lack of Capacity in the Mental Health System is Failing Vancouver’s Mentally Ill and Draining Police Resources. Vancouver, BC: Vancouver Police Department, 2008.

15. Miewald C. Food Security and Housing in Vancouver’s Downtown Eastside. Vancouver, BC: Simon Fraser University; 2009.

16. Salmon A, Livingston A. “Me, I’m living it”: The primary health care experiences of women who use drugs in Vancouver’s downtown eastside. Vancouver, BC: University of British Columbia, Centre for Excellence for Women’s Health, Women’s Health Research Institute; 2009.

17. Swanson J, Pederson W. Still Losing Hotel Rooms: Hotel Survey and Report. Vancouver, BC: CCAP; 2009.

18. Li J. Downtown Eastside (DTES) Kitchen Tables: A Community Led Food Action Plan. Vancouver, BC: Potluck Café Society, DTES Neighbourhood House; 2010.

19. Pederson W, Swanson J. Pushed Out: Escalating Rents in the Downtown Eastside. Vancouver, BC: CCAP; 2010.

20. Vancouver Area Network of Drug Users. “We’re All Pedestrians”: Final Report of the Downtown Eastside Pedestrian Safety Project. Vancouver, BC: VANDU; 2010.

Dissertations

1. Braitstein P. Sexual Violence Among a Cohort of Injection Drug Users. [dissertation]. Vancouver, BC: Department of Health Care and Epidemiology, University of British Columbia; 2001.

2. Miller CL. Risk Factors and Determinants of HIV and Hepatitis C Prevalence and Incidence Among a Cohort of Young Injection Drug Users. [dissertation]. Vancouver, BC: Department of Individual Interdisciplinary Graduate Studies, University of British Columbia; 2002.

3. Piaseczna MA. [dissertation]. Methadone Dosing in Vancouver, BC: The Distribution of Prescribed Doses, predictors of Dose and Dose-Associated Behaviour. Vancouver, BC: Department of Health Care and Epidemiology, University of British Columbia; 2003.

4. Heed K. [dissertation]. Profiling the Street-Level Drug Trafficker on Vancouver’s Downtown Eastside. Burnaby, BC: School of Criminology, Simon Fraser University; 2001.

5. Chavoshi N, Spittal P, Richardson C, Schecter M, Joseph K, Moniruzzaman AKM. [dissertation]. The Cedar Project: A comparison of Sexual Vulnerabilities of Young Aboriginal People Surviving Drug Use and Sex Work in Prince George and Vancouver, BC. Vancouver, BC: Department of Health Care and Epidemiology, University of British Columbia; 2006.

6. Compton M. [dissertation]. “I’d be Dead Without it” Persons Living with HIV/AIDS Describe the Impact of Adequate Housing on Their Health and Health Practices. Vancouver, BC: School of Social Work, University of British Columbia; 2006.

7. Pakula B. [dissertation]. Access to Cervical Cancer Screening among First Nations Women and Other Vulnerable Populations in Vancouver’s Downtown Eastside. Burnaby, BC: School of Public Policy, Simon Fraser University; 2006.

8. Raffa JD. [dissertation]. Longitudinal Analyses of Medication Adherence Data in HIV-Infected Illicit Drug Users. Vancouver, BC: Statistics, University of British Columbia; 2006.

9. DeBeck K. [dissertation]. Public Injection Drug Use in Vancouver’s Downtown Eastside: Addressing Public Health and Public Order Concern. Burnaby, BC: School of Public Policy, Simon Fraser University; 2007.

10. Rachlis BS, Wood E, Graham D et al. [dissertation]. The Impact of Migration on Drug and HIV-Related Risk Behaviours Among Injection Drug Users: Evidence from the Vancouver Injection Drug Users Study. Vancouver, BC: Department of Health Care and Epidemiology, University of British Columbia; 2007.

11. Bungay VA. [dissertation]. Health Experiences of Women who are Street-involved and use Crack Cocaine: Inequity, Oppression, and Relations of Power in Vancouver’s Downtown Eastside. Vancouver, BC: School of Nursing, University of British Columbia; 2008.

12. Shannon K, Tyndall M, Kerr T. [dissertation]. The Social, Structural, and Environmental Production of HIV Transmission Risk Among Women in Survival Sex Work: Evidence from the Maka Project Partnership. Vancouver, BC: Department of Health Care and Epidemiology. University of British Columbia; 2008.

13. Zettel P. [dissertation]. Meeting People Where They are At: How Nurses, Using the Framework of Harm Reduction, Make Sense of Nursing Practice with People Who Use Drugs. Vancouver, BC: School of Nursing, University of British Columbia; 2008.

14. Barrieshee, A. [dissertation]. Hepatitis C Virus Infection/Re-infection in Illicit Drug Use. Vancouver, BC: School of Pharmacology and Therapeutics, University of British Columbia; 2009.

15. Bruce RR. [dissertation]. An Intersectional Analysis of Aboriginal Women in the Downtown Eastside and B.C.’s Income Assistance Policy. Burnaby, BC: Department of Political Science, Simon Fraser University, 2009.

16. Chambers CT. [dissertation]. Risk and Resiliency Factors Associated with Injection Drug use Among At-Risk Youth in Vancouver, British Columbia. Vancouver, BC: Department of Health Care and Epidemiology. University of British Columbia; 2009.

17. Clarkson A, Spittal P, Schechter M et al. [dissertation]. The Cedar project: Exploring the Health Related Correlates of Child Welfare and Incarceration among Youth Aboriginal People in Two Canadian Cities. Vancouver, BC: Department of Health Care and Epidemiology. University of British Columbia; 2009.

18. Johnston KM, Levy AR, Montaner JS et al. [dissertation] A New Method of Integrating Epidemiological and Health Services Modelling Techniques for Studying Infectious Diseases: An Example Using HIV/AIDS. Vancouver, BC: Department of Health Care and Epidemiology. University of British Columbia; 2009.

19. Stewart N, McCann E. [dissertation]. Placing Housing Policy: Plans, Challenges, and Advocacy in Vancouver’s Downtown Eastside. Burnaby, BC: Department of Geography, Simon Fraser University; 2009.

20. Su M. [dissertation]. Aboriginal Women’s Experiences Seeking Help in an Urban Emergency Department. Vancouver, BC: School of Nursing, University of British Columbia, 2009.

21. Tossonian HK, Conway B, DeVlaming S et al. [dissertation]. Treatment of HIV Infection in Injection Drug Users. Vancouver, BC: School of Pharmacology and Therapeutics, University of British Columbia; 2009.

22. White A. [dissertation]. Being Open: Exploring primary health care services for women who sell sex and do high risk drugs in Vancouver. Burnaby, BC: School of Public Health, Simon Fraser University; 2007.

23. Bright V. [dissertation]. Experiences of Women Diagnosed with HIV in the Downtown Eastside. Vancouver, BC: School of Social Work, University of British Columbia, 2010.

24. Small W. [dissertation]. Injection Setting and Drug-Related Harm in Vancouver, Canada. Vancouver, BC: Department of Health Care and Epidemiology. University of British Columbia;2010.

25. Wood RA. [dissertation]. Issues of Gender in Injection Drug Use: Examining Contextual Circumstances of Women’s First Injecting Expereince and Factors Associated with Treatment Engagement. Vancouver, BC: School of Nursing, University of British Columbia; 2010.

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Linden, I.A., Mar, M.Y., Werker, G.R. et al. Research on a Vulnerable Neighborhood—The Vancouver Downtown Eastside from 2001 to 2011. J Urban Health 90, 559–573 (2013). https://doi.org/10.1007/s11524-012-9771-x

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