Advancing Health Equity by Understanding and Addressing Systemic, Structural and Institutional factors that reinforce stigma in Harm Reduction and Sexually Transmitted and Blood Borne Infections (STBBI) Prevention in New Brunswick
Purpose:
The Department of Health (DoH), in collaboration with ResearchNB, is opening a competition (independently peer-reviewed) to provide funds for research to examine systemic, structural, and institutional factors that reinforce stigma and discrimination against people who use substances. The research will analyze how these factors differ across provincial populations, settings, and policy-making partners, and how they shape funding decisions, service availability, and the uptake of harm reduction and STBBI prevention supports.
The findings will help provincial partners design and evaluate interventions, policies, and practices that promote inclusion, dignity, and access; reduce stigma; and advance health equity.
Background
Stigma can be defined as the negative attitudes and prejudices that cause people with a particular difference or challenge such as substance use, STBBIs, the colour of their skin, etc., to be labelled, stereotyped, and feared. When organizations embed stigma in their policies, programming and decision making, whether intentional or not, this is referred to as structural stigma.
Stigma does not operate in isolation—it intersects with other determinants of health such as access to health care; employment; housing; education; rural isolation; race, gender, and colonial histories, resulting in layered inequities. This can translate into:
- Limited or delayed access to appropriate prevention;
- Misattribution of complex issues to stigmatized identity;
- Inappropriate resource allocation to stigmatized areas;
- Fear of criminalization; and
- Lack of research and evidence- based best practices.
For many, these experiences of stigma create fear, avoidance of care, and further marginalization.
Addressing stigma from a public health and health equity perspective requires shifting focus from individual attitudes to structural change. This includes examining how policy, health systems, and community narratives perpetuate exclusion, and identifying interventions that promote safety, dignity, and inclusion.
Building on existing provincial surveillance data (e.g., substance use, STBBI trends), this project will generate insights that inform equitable, stigma-free public health practice and community engagement in New Brunswick.
Supporting data highlights the urgency:
- Declining naloxone response rates and persistent opioid-related deaths suggest stigma may inhibit help-seeking and harm reduction engagement.
- Continued transmission of STBBIs underscores the importance of tackling the social and structural factors that contribute to risk.
This work will create a baseline for future provincial action plans and evaluation of stigma-reduction initiatives within harm reduction and STBBI prevention work.
Supporting Statistics and Evidence
- Substance Use and Naloxone Response Decline:
- “The rate of individuals responding to naloxone in Q1 2025 has declined compared to 2024” (new-brunswick-substance-surveillance-report-2025-q1 (2).pdf).
- The use of take home naloxones kits continues to rise, however the response rate is declining. Stigma would have some suggest that naloxone does not work and is a waste of taxpayer dollars, when in fact the illicit drug supply is evolving and opioids require more doses of naloxone and initiatives such as drug checking due to the combinations being used.
- Apparent Opioid and Substance Use Toxicity Deaths:
- Apparent opioid toxicity deaths involving fentanyl currently account for 44% of accidental deaths (new-brunswick-substance-surveillance-report-2025-q1 (2).pdf).
- Stigma associated with opioid toxicity may prevent individuals or communities from engaging with harm reduction services and instead find them using alone and dying due to overdose when naloxone administration and a call for help in a timely manner.
- STBBI Reporting in 2023 (Chlamydia, Gonorrhea, HIV/AIDS):
- Chlamydia remains the most reported STBBI, with rates slightly declining since 2022 (Annual-report-CDC-branch-2023.pdf, page 40).
- HIV cases reflect continued challenges in prevention, awareness, and treatment access, exacerbated by stigma in at-risk populations.
Project Requirement:
Using a health equity lens, researchers will:
- Analyze how intersecting stigmas (e.g., substance use, STBBIs, gender, Indigeneity, sexuality, poverty, rurality) shape availability, experiences, and outcomes in harm reduction and STBBI supports.
- Examine and identify structural and systemic factors that contribute to stigma within healthcare settings, community organizations, and broader policy environments. This may include provincial legislation, guidelines from provincial regulatory bodies, etc.)
- Engage individuals with lived and living experience in all stages of the research design, data collection, and knowledge translation to ensure findings reflect real-world contexts.
- Develop practical, evidence-informed recommendations for reducing stigma and promoting health equity within harm reduction and STBBI programs.
- Co-create education and communication tools (e.g., “language matters” guidance, anti-stigma toolkits, media recommendations) to reshape the views of policy makers; shift community narratives; and promote person-first, non-judgmental public health messaging.
- Propose a framework to measure stigma reduction and health equity outcomes over time. Include provincial-level and community-level indicators.
Deliverables must include:
- A comprehensive final report with actionable, evidence-based recommendations for policy and program adaptation.
- At least one knowledge translation product co-developed with community partners (e.g., toolkit, workshop materials, or communication guide).
- Clear strategies for integrating findings into ongoing Public Health Branch and community-based initiatives related to harm reduction and STBBI prevention initiatives.
Supporting Resources
- 2025 New Brunswick Substance Use Harms Report:
- 2023 CD Annual Report
- Dismantling Structural Stigma In health care
- Stigma as a local process
Eligibility Criteria:
- Must have research and/or evaluation experience in one or more of the following areas: Determinants of Health, Population Health.
- Must hold a university faculty appointment or equivalent at a New Brunswick university or Institution.
- Must be a Canadian citizen, permanent resident, or actively pursuing such status.
- Must not have received funding from, or affiliation with, the alcohol, tobacco, vaping product, cannabis, opioid, gambling, ultra-processed food, sugar-sweetened beverage, or fossil fuel industries, (or subsidiaries), within the past ten years.
- Applicants may, and are encouraged to, involve community organizations, additional researchers (in New Brunswick or in other provinces/territories) to enhance the depth and scope of the project, provided all are free from conflict of interest (i.e., are not named in another application).
Eligible Expenses:
All expenses are deemed eligible apart from paying compensation of the award recipient, overhead / indirect costs or any retroactive expenses.
Application Procedure:
Applications for this fund are only accepted through the ResearchNB application portal and are evaluated against the evaluation criteria for this fund.
Prior to peer review, the Department of Health will conduct an initial eligibility screening. Applications that are deemed out of scope at this stage may be declined and will not proceed with the peer review process.
Award Duration and Reporting:
Recipients will be asked to meet virtually with the Department for a kick-off meeting, regular check-in meeting during the project and for a close-out meeting.
Project is expected to be completed within 12 months of receiving the Notice of Decision letter. A final report shall be submitted through the portal 90 days from the end of the project. These reports are to be completed via the application portal.
Fund Manager: Vy Cung (vy@researchnb.ca)
Application Form:
Evaluation Criteria:
Public Health Research Fund
Advancing Health Equity by Understanding and Addressing Systemic, Structural and Institutional factors that reinforce stigma in Harm Reduction and Sexually Transmitted and Blood Borne Infections (STBBI) Prevention in New Brunswick
Purpose:
The Department of Health (DoH), in collaboration with ResearchNB, is opening a competition (independently peer-reviewed) to provide funds for research to examine systemic, structural, and institutional factors that reinforce stigma and discrimination against people who use substances. The research will analyze how these factors differ across provincial populations, settings, and policy-making partners, and how they shape funding decisions, service availability, and the uptake of harm reduction and STBBI prevention supports.
The findings will help provincial partners design and evaluate interventions, policies, and practices that promote inclusion, dignity, and access; reduce stigma; and advance health equity.
Background
Stigma can be defined as the negative attitudes and prejudices that cause people with a particular difference or challenge such as substance use, STBBIs, the colour of their skin, etc., to be labelled, stereotyped, and feared. When organizations embed stigma in their policies, programming and decision making, whether intentional or not, this is referred to as structural stigma.
Stigma does not operate in isolation—it intersects with other determinants of health such as access to health care; employment; housing; education; rural isolation; race, gender, and colonial histories, resulting in layered inequities. This can translate into:
- Limited or delayed access to appropriate prevention;
- Misattribution of complex issues to stigmatized identity;
- Inappropriate resource allocation to stigmatized areas;
- Fear of criminalization; and
- Lack of research and evidence- based best practices.
For many, these experiences of stigma create fear, avoidance of care, and further marginalization.
Addressing stigma from a public health and health equity perspective requires shifting focus from individual attitudes to structural change. This includes examining how policy, health systems, and community narratives perpetuate exclusion, and identifying interventions that promote safety, dignity, and inclusion.
Building on existing provincial surveillance data (e.g., substance use, STBBI trends), this project will generate insights that inform equitable, stigma-free public health practice and community engagement in New Brunswick.
Supporting data highlights the urgency:
- Declining naloxone response rates and persistent opioid-related deaths suggest stigma may inhibit help-seeking and harm reduction engagement.
- Continued transmission of STBBIs underscores the importance of tackling the social and structural factors that contribute to risk.
This work will create a baseline for future provincial action plans and evaluation of stigma-reduction initiatives within harm reduction and STBBI prevention work.
Supporting Statistics and Evidence
- Substance Use and Naloxone Response Decline:
- “The rate of individuals responding to naloxone in Q1 2025 has declined compared to 2024” (new-brunswick-substance-surveillance-report-2025-q1 (2).pdf).
- The use of take home naloxones kits continues to rise, however the response rate is declining. Stigma would have some suggest that naloxone does not work and is a waste of taxpayer dollars, when in fact the illicit drug supply is evolving and opioids require more doses of naloxone and initiatives such as drug checking due to the combinations being used.
- Apparent Opioid and Substance Use Toxicity Deaths:
- Apparent opioid toxicity deaths involving fentanyl currently account for 44% of accidental deaths (new-brunswick-substance-surveillance-report-2025-q1 (2).pdf).
- Stigma associated with opioid toxicity may prevent individuals or communities from engaging with harm reduction services and instead find them using alone and dying due to overdose when naloxone administration and a call for help in a timely manner.
- STBBI Reporting in 2023 (Chlamydia, Gonorrhea, HIV/AIDS):
- Chlamydia remains the most reported STBBI, with rates slightly declining since 2022 (Annual-report-CDC-branch-2023.pdf, page 40).
- HIV cases reflect continued challenges in prevention, awareness, and treatment access, exacerbated by stigma in at-risk populations.
Project Requirement:
Using a health equity lens, researchers will:
- Analyze how intersecting stigmas (e.g., substance use, STBBIs, gender, Indigeneity, sexuality, poverty, rurality) shape availability, experiences, and outcomes in harm reduction and STBBI supports.
- Examine and identify structural and systemic factors that contribute to stigma within healthcare settings, community organizations, and broader policy environments. This may include provincial legislation, guidelines from provincial regulatory bodies, etc.)
- Engage individuals with lived and living experience in all stages of the research design, data collection, and knowledge translation to ensure findings reflect real-world contexts.
- Develop practical, evidence-informed recommendations for reducing stigma and promoting health equity within harm reduction and STBBI programs.
- Co-create education and communication tools (e.g., “language matters” guidance, anti-stigma toolkits, media recommendations) to reshape the views of policy makers; shift community narratives; and promote person-first, non-judgmental public health messaging.
- Propose a framework to measure stigma reduction and health equity outcomes over time. Include provincial-level and community-level indicators.
Deliverables must include:
- A comprehensive final report with actionable, evidence-based recommendations for policy and program adaptation.
- At least one knowledge translation product co-developed with community partners (e.g., toolkit, workshop materials, or communication guide).
- Clear strategies for integrating findings into ongoing Public Health Branch and community-based initiatives related to harm reduction and STBBI prevention initiatives.
Supporting Resources
- 2025 New Brunswick Substance Use Harms Report:
- 2023 CD Annual Report
- Dismantling Structural Stigma In health care
- Stigma as a local process
Eligibility Criteria:
- Must have research and/or evaluation experience in one or more of the following areas: Determinants of Health, Population Health.
- Must hold a university faculty appointment or equivalent at a New Brunswick university or Institution.
- Must be a Canadian citizen, permanent resident, or actively pursuing such status.
- Must not have received funding from, or affiliation with, the alcohol, tobacco, vaping product, cannabis, opioid, gambling, ultra-processed food, sugar-sweetened beverage, or fossil fuel industries, (or subsidiaries), within the past ten years.
- Applicants may, and are encouraged to, involve community organizations, additional researchers (in New Brunswick or in other provinces/territories) to enhance the depth and scope of the project, provided all are free from conflict of interest (i.e., are not named in another application).
Eligible Expenses:
All expenses are deemed eligible apart from paying compensation of the award recipient, overhead / indirect costs or any retroactive expenses.
Application Procedure:
Applications for this fund are only accepted through the ResearchNB application portal and are evaluated against the evaluation criteria for this fund.
Prior to peer review, the Department of Health will conduct an initial eligibility screening. Applications that are deemed out of scope at this stage may be declined and will not proceed with the peer review process.
Award Duration and Reporting:
Recipients will be asked to meet virtually with the Department for a kick-off meeting, regular check-in meeting during the project and for a close-out meeting.
Project is expected to be completed within 12 months of receiving the Notice of Decision letter. A final report shall be submitted through the portal 90 days from the end of the project. These reports are to be completed via the application portal.
Fund Manager: Vy Cung (vy@researchnb.ca)
Application Form:
Evaluation Criteria: