*Corresponding author: Margaret Erickson, e-mail: [email protected]
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Margaret Erickson, PhD, MPH, is a Research Associate, Centre for Gender and Sexual Health Equity, Vancouver, Canada. Andrea Krüsi, PhD, MSc, is a Research Scientist, Centre for Gender and Sexual Health Equity, and Assistant Professor, University of British Columbia, Vancouver, Canada. Kate Shannon, PhD, MPH, is a Director, Centre for Gender and Sexual Health Equity, and Professor, University of British Columbia, Vancouver, Canada. Melissa Braschel, MSc, is a Statistician and Database Manager, Centre for Gender and Sexual Health Equity, Vancouver, Canada. Candice Norris is a Community Engagement Associate, Centre for Gender and Sexual Health Equity, Vancouver, Canada. Jane Buxton, MBBS, MHSc, FRCPC, is a Professor, University of British Columbia, Vancouver, Canada. Ruth Elwood Martin, MD, FCFP, MPH, is a Clinical Professor, University of British Columbia, Vancouver, Canada. Kathleen Deering, PhD, MSc, Research Scientist, Centre for Gender and Sexual Health Equity, and Associate Professor, University of British Columbia, Vancouver, Canada.
1In Canada, this term refers to First Nations, Inuit, and Métis people.
2For the purpose of this article, we use the term “criminalized substance use” to highlight how criminalized environments lead to economic precarity, violence, and high-risk situations. Emphasizing the criminalized environment of drug use helps to elucidate how drug policy and laws surrounding personal use of illicit substances are harmful in the way that they further perpetuate the cycle of criminalization for marginalized populations (Canadian Drug Policy Coalition, 2021; Wood et al., 2010).
3Although recruitment for the cohort has always focused on women (inclusive of cis and trans women), we understand and acknowledge that gender is fluid over time and may have changed for some participants since joining the cohort at baseline.
4As described by educator Harlen Pruden (Pruden, 2019), Two-Spirit is “a way to organize Indigenous Peoples of Turtle Island [otherwise known as North America] who embody diverse sexualities, gender identities, roles, and/or expressions” (Institute of Gender and Health, 2020, p.1). In our study, only Indigenous participants were asked whether they identified as Two-Spirit.
5In line with previous published research drawing on SHAWNA data, “participants had the option of providing more than one response to questions on sexual orientation [and] gender identity … based on evidence that minority stress processes affect all members of gender minority communities relative to cisgender people (Tan et al., 2020)” (Zhang et al., 2021, p.100666) and members of sexual minority communities relative to heterosexual communities (Meyer & Frost, 2013). For analyses, we combined participants with any response that fell into the gender minority or sexual minority categories into one group, respectively, for each variable.
