Social and structural determinants of injection drug use-associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

Injection drug use can lead to bacterial and fungal infections, which are becoming more common. These infections are influenced by the social environments in which people inject drugs and how they receive treatment. In this study, we systematically collected and analyzed information from 26 qualitative studies conducted between 2000 and 2021 to understand these factors better. We found that two main things affect the risk of infection. The first is the "social production of risk," which means that larger factors like the availability of clean drugs and safe places to inject, as well as healthcare policies and access to harm reduction programs, all contribute to infection risk. For example, when drugs are of poor quality and do not dissolve, they can lead to infections. Additionally, unsafe spaces for injecting, influenced by law enforcement and unstable housing, also play a role. Difficulties in accessing healthcare and harm reduction services can deter people from seeking treatment, further increasing their risk. The second factor is "practices of care among people who use drugs." This means that people who inject drugs often have strategies to protect themselves from infections. Some of these involve helping each other (mutual care) and taking care of themselves (self-care). For instance, they may share sterile equipment or help each other inject safely. However, these protective measures can sometimes lead to other health risks, like the transmission of HIV. In conclusion, the risk of bacterial and fungal infections among people who inject drugs is influenced by social and structural factors that can be changed, such as improving drug quality, providing safer places for injection, and making healthcare and harm reduction services more accessible. People who inject drugs try to protect themselves and their community, but they often face obstacles in doing so.