GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN RECENT INCARCERATION AND HOUSING STATUS AMONG PEOPLE WHO INJECT DRUGS

Background

Housing instability and incarceration are highly prevalent, and both contribute to overdoses and blood-borne viral transmission among people who inject drugs (PWID). How these adverse social determinants are related and vary by gender in this population remains 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 its association with recent incarceration.

Methods:

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. Incarceration was defined as having been incarcerated in the past three months; those reporting having spent most of their time in prison were excluded. We stratified the sample by gender and used multinominal logistic regression to assess relationships between incarceration and housing status, adjusting for age and income.  

Results:

876 PWID (718 men, 158 women) were included. Men were more likely to report recent incarceration (11.7%) than women (6.3%) and less likely to be stably housed (53.1% vs. 63.9%). Precarious housing was reported by 12.7% of women and 17.4% of men, while 23.4% of women and 29.5% of men were unsheltered. Among women and relative to being stably housed, there was evidence of an association between recent incarceration and being unsheltered (aOR=6.42, 95%CI:1.5-27.4). However, there was no evidence of an association between recent incarceration and being precariously housed (aOR=1.80, 95%CI:0.1-18.6). Among men, there was evidence of an association between recent incarceration and either precarious housing (aOR=2.21, 95%CI:1.1-4.1) or being unsheltered (aOR=2.92, 95%CI:1.7-4.9). 

Conclusion:

Our exploratory findings showed that the recent history of incarceration is associated with being precariously housed among men and being unsheltered among men and women which highlights the heightened vulnerability to drug-related harms among both genders. These findings suggest the importance of pre-release planning for PWID detainees in an attempt to design homelessness prevention measures.