This project utilized an interdisciplinary approach to explore what harm and harm reduction meant during intersecting public health emergencies, the opioid crisis and the coronavirus pandemic. Using thematic and historical analysis, I analyzed interviews with frontline workers, news coverage, and municipal government documents to understand how people conceptualized the opioid crisis during coronavirus (and vice versa). On the whole, I found that harm reduction was a central aspect of the efforts against the opioid crisis in Hamilton. However, there were discrepancies in how it was practiced and understood. Generally, harm reduction was presented in municipal government documents as a medical intervention that involved, for example, the provision of new needles and naloxone kits to prevent disease and death. Such a practice was indeed important to address the unique harms at the intersection of COVID and the opioid crisis. However, to frontline workers and activists, harm reduction was a much broader term: it included services that were crucial to daily life, such as food and washrooms; the right to safe housing; and broader social and structural interventions, such as the decriminalization of opioid use. The context of the coronavirus pandemic, which exposed people who use opioids to unique harms, exacerbated the disparity between these definitions: harm reduction was simultaneously presented as a narrow, medical practice and a broad, political intervention. / Thesis / Master of Arts (MA)

Les personnes en situation d’itinérance (PSI) font face à plusieurs défis pour (sur)vivre dans l’espace public dont la judiciarisation, la criminalisation (Bellot et Sylvestre, 2017), les demandes de déplacements et la saisie de matériels (Herring, 2019) qui se manifestent aussi dans les espaces de soins (Dej, 2020). D’ailleurs, les intervenant.e.s de première ligne en itinérance opèrent avec des tensions complexes dans le cadre de leur travail, iels doivent assurer le bien-être de leurs usager.ère.s et répondre à des tâches de contrôle, en négociant leur mandat avec d’autres organisations telles que la police (Stuart, 2016). Les crises ont pour effet d’exacerber la discrétion individuelle des travailleur.euse.s en première ligne, soutenant les collaborations, mais aussi les résistances dans la rue (Brodkin, 2021). Au Québec, la gestion de la COVID-19 a été qualifiée de « punitive » (Fortin et al., 2022), visant démesurément les quartiers pauvres et racisés (Luscombe et McClelland, 2020a). Bien que le profilage social est largement documenté à Montréal, jusqu’à maintenant peu de connaissances ont été produites quant aux conséquences des crises sur les organisations participant à la gouvernance de l’itinérance. Les travailleur.euse.s de première ligne ont largement été mobilisé.e.s, toutefois, peu de recherches se sont penchées sur leurs rôles (Alcadipani et al., 2020). Suite à 42 entretiens réalisés avec des intervenant.e.s de première ligne en itinérance, j’ai utilisé la méthodologie de contre-histoire pour confronter une narrative-maître de collaboration. Les entretiens suggèrent que les intervenant.e.s ont plutôt chercher à limiter les interactions avec la police alors que différentes crises convergent et vulnérabilisent leurs usager.ères. Iels ont mis en place différentes stratégies pour limiter ces interactions et assurer le bien-être des PSI. Autant lorsqu’iels limitent les interactions que lorsqu’iels en viennent à collaborer avec la police, les intervenant.e.s font face à des dilemmes plus complexes qui engendrent des conséquences amplifiées sur leurs usager.ère.s. Ces résultats permettent de discuter des conséquences de la crise sur leurs pratiques d’intervention et du contexte dans lequel opère cette gouvernance de l’itinérance. / People experiencing homelessness (PEH) face many challenges including judicialization, criminalization (Bellot & Sylvestre, 2017), banishment and seizures (Herring, 2019) while they survive in the streets. Studies show they also experience this punitive governance in spaces of care (Dej, 2020). Frontline workers (FW) have to work with complex tensions in the context of their work, they have to insure wellbeing of PEH, while also negotiating tasks of control alongside police public forces (Stuart, 2016). Scholars that study disasters and crisis help us appreciate how such exceptional times can exacerbate discretion bringing both collaboration but also resistance in the streets (Brodkin, 2021). In Quebec, the resolution of the pandemic has been qualified as ’’punitive’’ (Fortin et al., 2022) while some scholars found disproportionate patterns of control in poor and racialized neighbourhoods (Luscombe & McClelland, 2020a). The social profiling and punitive control of PEH has been widely documented and studied in Montreal, yet little is known about the impacts of the COVID-19 pandemic on key issues that matter to practitioners who have been widely mobilized (Alcadipani et al., 2020). Following 42 interviews realized with frontline workers in the homelessness sector, I used a counter-story methodology to challenge the master narrative of collaboration. Results suggest that FW rather limited their interactions with police officers in many amplified situations of overlapping crisis that marginalized their clients, bringing strategies to insure PEH wellbeing without relying on police interactions. Both, when they rely on or avoid police support, they faced more complex dilemmas that have amplified consequences for their clients. Finally, I discuss the impacts of the COVID-19 crisis on their practices considering the context in which takes place homelessness governance.

All governments aim to ensure better health and nutrition to children. The Rajasthan state (India) has implemented a unique frontline coordination model where Accredited Health Social Activist (ASHA) Sahyoginis are expected to support two other frontline workers (FLWs) i.e. the Anganwadi Workers from the Integrated Child Development Services and the Auxiliary Nurse Midwives from the Health department to improve child health. This thesis focuses on examining the existing coordination between the three groups of FLWs in Rajasthan by exploring FLWs' participation in child immunisation and Vitamin A supplementation (two common activities), service coverage and beneficiary's' knowledge (expected outcomes), and the challenges faced and areas that need improvement for better frontline coordination. A mixed methods design was used. Sixteen villages from two blocks (tribal and non-tribal) of Udaipur district (Rajasthan) were selected using multistage purposive sampling. The formative stage included 12 FLWs' in-depth interviews (IDIs) as well as a review of FLWs' job descriptions to understand the process and government expectations on their participation in routine childhood immunisation, polio camps, routine Vitamin A supplementation and Vitamin A campaigns. The next stage included data collection from the 16 selected villages i.e. structured questionnaire survey of FLWs (46), observations of Maternal and Child Health and Nutrition Day (16), review of FLWs' immunisation and Vitamin A registers (32) and a structured questionnaire survey of registered infants' mothers (321)-all to ascertain the actual participation of FLWs in these four activities and the outcomes. IDIs with FLWs (46) and FLWs' line managers (17) were conducted to understand their experience, issues and solutions for better frontline coordination. The participation of FLWs in three of the four activities (except Polio Camps) was found to be limited. The FLWs and their line managers were also dissatisfied with coordination between FLWs. Poor outcomes also indicated unsatisfactory coordination. Overall, frontline participation and outcomes were better in tribal than non-tribal villages. A variety of factors (i.e. personal, professional, organisational, and geo-socio-cultural) appeared to affect coordination between FLWs. Appropriate recruitment, training, monitoring and supervision and rewards to the FLWs along with greater political commitment for coordinated approached and addressing intra-departmental challenges are proposed to improve frontline coordination and child health in Rajasthan.