Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort
IJWH. 2024-03-01; Volume 16: 451-462
DOI: 10.2147/IJWH.S448147
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Anwar I(1), Faye A(1), Pereira Gonçalves J(1), Briand Madrid L(1), Maradan G(2), Lalanne L(#)(3)(4), Jauffret-Roustide M(#)(5)(6)(7), Auriacombe M(#)(8)(9)(10),
Roux P(1).
Author information:
(1)Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de
la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France.
(2)ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille, France.
(3)INSERM 1114, Department of Psychiatry and Addictology, University Hospital of
Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS),
Strasbourg, 67000, France.
(4)Department of Psychiatry and Addictology, University Hospital of Strasbourg,
Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000,
France.
(5)CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris,
France.
(6)British Columbia Center on Substance Use, Vancouver, Canada.
(7)Baldy Center on Law and Social Policy, Buffalo University, New York, NY, USA.
(8)Univ. Bordeaux, Bordeaux, France.
(9)Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux,
France.
(10)Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France.
(#)Contributed equally
PURPOSE: Injection drug use is strongly associated with stigmatization by loved
ones, healthcare providers, and society in general. This stigmatization can have
negative consequences on the health of people who inject drugs (PWID) and limit
their access to care. Women who inject drugs face greater stigma than men
because of gendered social norms and the intersectional effect between gender
and drug use identities. For this analysis, we aimed to study discrimination –
which is closely linked to stigmatization – experienced by PWID, considering the
intersectionality between drug use discrimination and gender discrimination in
the French context.
METHODS: We used data from the COSINUS cohort study, conducted between June 2016
and May 2019 in four French cities. We selected 427 of the 665 PWID who
regularly injected drugs enrolled in COSINUS, at three months of follow-up, and
performed multivariable logistic regression to identify factors associated with
self-reported drug use discrimination.
RESULTS: Women comprised 20.6% of the study sample. Sixty-nine percent of the
participants declared drug use discrimination and 15% gender discrimination. In
the multivariable regression analysis, PWID who had hurried injection out of
fear of being seen were almost twice as likely to have experienced drug use
discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women
experiencing gender discrimination were almost three times as likely to have
experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037).
CONCLUSION: Women who inject drugs experienced gender and drug use
intersectional discrimination. This could be a reason for the low attendance
rates of women in healthcare settings. In addition, discrimination negatively
impacted injection drug use practices (eg, hurried injection), particularly for
people with unstable housing who injected in public spaces. We recommend
introducing adapted services in healthcare facilities for women who inject
drugs, and creating a favorable social and physical environment for all PWID in
order to improve their health and access to care.
© 2024 Anwar et al.
DOI: 10.2147/IJWH.S448147
PMCID: PMC10944247
PMID: 38495429
Conflict of interest statement: The authors report no conflicts of interest in
this work.