Socio-economic marginalization in the structural production of vulnerability to violence among people who use illicit drugs

Objective: Many people who use illicit drugs (PWUD) face challenges to their financial stability. Resulting activities that PWUD undertake to generate income may increase their vulnerability to violence. We therefore examined the relationship between income generation and exposure to violence across a wide range of income generating activities among HIV-positive and HIV-negative PWUD living in Vancouver, Canada. Methods: Data were derived from cohorts of HIV-seropositive and HIV-seronegative PWUD (n=1876) between December 2005 and November 2012. We estimated the relationship between different types of income generation and suffering any kind of violence using bivariate and multivariate generalized estimating equations (GEE), as well as the characteristics of violent interactions. Results: Exposure to violence was reported among 977 (52%) study participants over the study period. In multivariate models controlling for socio-demographic characteristics, mental health status, and drug use patterns, violence was independently and positively associated with participation in street-based income generation activities (i.e., recycling, squeegeeing, and panhandling; adjusted odds ratio [AOR]=1.39, 95% confidence interval [CI]=1.23-1.57), sex work (AOR=1.23, 95%CI=1.00-1.50), drug dealing (AOR=1.63, 95%CI=1.44-1.84), and theft and other acquisitive criminal activity (AOR=1.51, 95%CI=1.27-1.80). Engagement in regular, self or temporary employment was not associated with being exposed to violence. Strangers were the most common perpetrators of violence (46.7%) and beatings the most common type of exposure (70.8%). Conclusions: These results suggest that economic activities expose individuals to contexts associated with social and structural vulnerability to violence. The creation of safe economic opportunities that minimize vulnerability to violence among PWUD is therefore urgently required.Arts, Faculty ofMedicine, Faculty ofOther UBCNon UBCMedicine, Department ofSociology, Department ofReviewedFacult