Structural Racism and Low Threshold Shelters: Experience of Racially and Ethnically Diverse Unsheltered Individuals with Substance Use Disorder in Boston.

The City of Boston established seven low- threshold shelters (LTS) between 2022- 2023 to address unsheltered homelessness, which disproportionately affects racially and ethnically marginalized groups. Guided by Housing First and harm reduction principles, these shelters provide immediate support for individuals experiencing homelessness and substance use disorder. Semi- structured qualitative interviews with 23 guests self- identified as belonging to racially and ethnically marginalized groups and focus groups with 35 LTS staff revealed barriers to housing stability rooted in structural racism, such as stigma, discrimination, and criminal- legal system involvement. Thematic framework analysis highlighted the critical role of LTS in fostering stability by addressing immediate needs. However, challenges in transitioning to permanent housing persisted, including difficulties obtaining identification and inadequate long- term support. Both guests and staff stressed the need for sustained financial, social, behavioral health, and medical support to ensure lasting stability. While LTS advanced short- term racial equity, overcoming systemic inequities requires additional efforts to sustain housing retention.