Gender differences in the association between sex work and housing status among people who inject drugs in Montreal, Canada.

Author: Farzaneh Vakili, Stine Bordier Høj, Julie Bruneau, Sarah Larney

Theme: Epidemiology & Public Health Research Year: 2023

Housing is an important social determinant of health for people who inject drugs (PWID), but gender differences in housing instability and gender-specific relationships with other risk exposures remain understudied. Additionally, few studies employ granular measures that account for varying degrees of housing instability, potentially masking important insights. We examined gender differences in housing instability and associated factors, with a focus on sex work experience.

We analyzed baseline questionnaire data from the Hepatitis C cohort of PWID in Montreal, Canada (2011-2022). Participants were at least 18 years old and had injected drugs during the past six months. Housing status (past three months) was categorized as stable, precariously housed, or unsheltered based on The Canadian Definition of Homelessness. Sex work experience was defined as any prior engagement in sex work. We stratified the sample by gender and used multinominal logistic regression to assess relationships between sex work and housing status, adjusting for sociodemographic factors, recent sexual behavior, and recent drug consumption.

909 PWID (748 men, 163 women) were included. Women were more likely to report sex work experience (59.7%) than men (20.4%), and more likely to be stably housed (62.3% vs. 48.3%). Precarious housing was reported by 14.2% of women and 20.9% of men, while 23.5% of women and 30.8% of men were unsheltered. Among women, sex work experience was associated with precarious housing status (aOR=4.57, 95%CI:1.21-17.16) but not with being unsheltered (aOR=1.18, 95%CI:0.44-3.10). Among men, sex work was not associated with either precarious housing (aOR=0.96, 95%CI:0.59-1.56) or being unsheltered (aOR=0.87, 95%CI:0.56-1.35).

Our study highlighted gender differences in housing status and associated factors that may contribute to health risks while unstably housed. Links between sex work and housing instability among women who inject should be further explored to pave the way for tailored responses and gender-sensitive harm-reduction strategies.

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