Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort

Figures & data

Table 1 Descriptive Analyses of Study Sample (n=427)

Drug Use Discrimination
	No	Yes	Total	p
	n=132 (30.9%)	n=295 (69.1%)	n=427 (100.0%)
Sociodemographic and socioeconomic characteristics
Age (years)
Median (IQR)	41 (33–47)	38 (31–46)	39 (32–46)	0.085
City of interview				0.744
Bordeaux	25 (18.9)	60 (20.3)	85 (19.9)
Marseille	40 (30.3)	80 (27.1)	120 (28.1)
Paris	53 (40.2)	114 (38.6)	167 (39.1)
Strasbourg	14 (10.6)	41 (13.9)	55 (12.9)
Gender				0.178
Man	110 (83.3)	229 (77.6)	339 (79.4)
Woman	22 (16.7)	66 (22.4)	88 (20.6)
Education level				0.787
<Upper secondary school certificate	93 (70.5)	204 (69.2)	297 (69.6)
≥Upper secondary school certificate	39 (29.5)	91 (30.8)	130 (30.4)
Born outside France				0.876
No	107 (81.1)	241 (81.7)	348 (81.5)
Yes	25 (18.9)	54 (18.3)	79 (18.5)
Living with a partner				0.442
No	104 (78.8)	221 (75.2)	325 (76.3)
Yes, but not a PWUD	7 (5.3)	26 (8.8)	33 (7.7)
Yes, a PWUD	21 (15.9)	47 (16.0)	68 (16.0)
Had a family member who used drugs				0.516
No	54 (40.9)	109 (37.6)	163 (38.6)
Yes	78 (59.1)	181 (62.4)	259 (61.4)
Housing type				0.255
Very stable	56 (42.4)	107 (36.3)	163 (38.2)
Precarious or unstable	32 (24.2)	65 (22.0)	97 (22.7)
Very precarious	44 (33.3)	123 (41.7)	167 (39.1)
Employment				0.779
No	111 (84.1)	244 (83.0)	355 (83.3)
Yes	21 (15.9)	50 (17.0)	71 (16.7)
Receiving social welfare allowance				0.217
No	48 (36.4)	126 (42.7)	174 (40.7)
Yes	84 (63.6)	169 (57.3)	253 (59.3)
Food aid^a				0.187
No	107 (81.1)	222 (75.3)	329 (77.0)
Yes	25 (18.9)	73 (24.7)	98 (23.0)
Health insurance				0.501
No	33 (25.0)	83 (28.1)	116 (27.2)
Yes	99 (75.0)	212 (71.9)	311 (72.8)
Past and current drug use
Time since first injection (years)				0.926
< 10 years	42 (32.3)	96 (32.8)	138 (32.6)
≥ 10 years	88 (67.7)	197 (67.2)	285 (67.4)
Daily opioid use^a,b				0.916
No	86 (65.2)	190 (64.6)	276 (64.8)
Yes	46 (34.8)	104 (35.4)	150 (35.2)
Daily stimulant use^a,c				0.691
No	86 (65.2)	198 (67.1)	284 (66.5)
Yes	46 (34.8)	97 (32.9)	143 (33.5)
Daily injection^a				0.682
No	56 (42.4)	131 (44.6)	187 (43.9)
Yes	76 (57.6)	163 (55.4)	239 (56.1)
Injection-body site risk level				0.759
Low-risk	70 (53.0)	148 (50.3)	218 (51.2)
Medium risk	34 (25.8)	86 (29.3)	120 (28.2)
High risk	28 (21.2)	60 (20.4)	88 (20.7)
Harmful alcohol consumption^d				0.859
No	67 (50.8)	147 (49.8)	214 (50.1)
Yes	65 (49.2)	148 (50.2)	213 (49.9)
Health characteristics and treatment
Currently on OAT				0.240
No	53 (40.2)	101 (34.2)	154 (36.1)
Yes	79 (59.8)	194 (65.8)	273 (63.9)
HCV status				0.074
HCV negative/did not know	102 (77.3)	203 (68.8)	305 (71.4)
HCV positive	30 (22.7)	92 (31.2)	122 (28.6)
Hurried injection because of the fear of being seen				0.004
No	89 (67.4)	154 (52.4)	243 (57.0)
Yes	43 (32.6)	140 (47.6)	183 (43.0)
Place for injecting				0.531
Private space	73 (55.3)	152 (51.5)	225 (52.7)
DCR	27 (20.5)	52 (17.6)	79 (18.5)
Public or semi-public space	30 (22.7)	83 (28.1)	113 (26.5)
Do not know/ no answer	2 (1.5)	8 (2.7)	10 (2.3)
DCR frequency (> 25% of injections or at least once per week)				0.866
No	83 (62.9)	188 (63.7)	271 (63.5)
Yes	49 (37.1)	107 (36.3)	156 (36.5)
Experienced gender discrimination				0.014
No	120 (90.9)	240 (81.6)	360 (84.5)
Yes	12 (9.1)	54 (18.4)	66 (15.5)
Experienced gender discrimination according to gender				0.069
Non-discriminated man	103 (78.0)	208 (70.7)	311 (73.0)
Discriminated man	7 (5.3)	21 (7.1)	28 (6.6)
Non-discriminated woman	17 (12.9)	32 (10.9)	49 (11.5)
Discriminated woman	5 (3.8)	33 (11.2)	38 (8.9)

Notes: p-value: Chi-2 or Wilcoxon test. ^aDuring the previous month; ^bHeroin, buprenorphine, methadone, morphine, other; ^cCocaine, crack/free base, amphetamines, methylphenidate; ^dAUDIT C score ≥ 3 for women and ≥ 4 for men.

Abbreviations: DCR, drug consumption rooms; HCV, hepatitis C virus; IQR, interquartile range; OAT, opioid agonist therapy; PWUD, people who use drugs.

Table 2 Univariable and Multivariable Logistic Regression Analyses (n=427)

	Univariable Analyses		Multivariable Analyses
	OR [CI95%]	p	aOR [CI95%]	p
Sociodemographic and socioeconomic characteristics
Age (years)	0.98 [0.96, 1.00]	0.048
City of interview
Bordeaux	1.20 [0.66, 2.19]	0.552
Marseille	Ref
Paris	1.08 [0.65, 1.77]	0.776
Strasbourg	1.46 [0.72, 3.00]	0.296
Gender
Man	Ref
Woman	1.44 [0.85, 2.46]	0.179
Education level
<Upper secondary school certificate	Ref
≥Upper secondary school certificate	1.06 [0.68, 1.67]	0.787
Born outside France
No	Ref
Yes	0.96 [0.57, 1.62]	0.876
Living with a partner
No	Ref
Yes, but not a PWUD	1.75 [0.73, 4.16]	0.207
Yes, with a PWUD	1.05 [0.60, 1.85]	0.857
Had a family member who used drugs
No	Ref
Yes	1.15 [0.75, 1.75]	0.516
Housing type
Very stable	Ref
Precarious or unstable	1.06 [0.62, 1.81]	0.822
Very precarious	1.46 [0.91, 2.35]	0.114
Employment
No	Ref
Yes	1.08 [0.62, 1.89]	0.779
Receiving social welfare allowance
No	Ref
Yes	0.77 [0.50, 1.17]	0.218
Food aid^a
No	Ref
Yes	1.41 [0.85, 2.34]	0.189
Health insurance
No	Ref
Yes	0.85 [0.53, 1.36]	0.501
Past and current drug use
Time since first injection (years)
<10 years	Ref
≥10 years	0.98 [0.63, 1.52]	0.926
Daily opioid use^a,b
No	Ref
Yes	1.02 [0.67, 1.57]	0.916
Daily stimulant use^a,c
No	Ref
Yes	0.92 [0.59, 1.41]	0.691
Daily injection^a
No	Ref
Yes	0.92 [0.61, 1.39]	0.682
Injection-body site risk level
Low-risk	Ref
Medium risk	1.2 [0.73, 1.95]	0.472
High risk	1.01 [0.60, 1.72]	0.960
Harmful alcoholconsumption^d
No	Ref
Yes	1.04 [0.69, 1.56]	0.859
Health characteristics and treatment
Currently on OAT
No	Ref
Yes	1.29 [0.84, 1.97]	0.240
HCV status
HCV negative/did not know	Ref
HCV positive	1.56 [0.96, 2.53]	0.075
Hurried injection because of the fear of being seen
No	Ref		Ref
Yes	1.88 [1.22, 2.89]	0.004	1.77 [1.15, 2.74]	0.010
Place for injecting
Private space / Not concerned	Ref
DCR	0.92 [0.54, 1.59]	0.778
Public or semi-public space	1.33 [0.80, 2.20]	0.267
Don’t know/ no answer	1.92 [0.40, 9.27]	0.416
DCR use (>25% of injections or at least once per week)
No	Ref
Yes	0.96 [0.63, 1.48]	0.866
Gender discrimination
No	Ref
Yes	2.25 [1.16, 4.37]	0.016
Gender discrimination according to gender
Non-discriminated man	Ref		Ref
Discriminated man	1.49 [0.61, 3.61]	0.382	1.51 [0.62, 3.70]	0.364
Non-discriminated woman	0.93 [0.49, 1.76]	0.828	0.93 [0.49, 1.77]	0.836
Discriminated woman	3.27 [1.24, 8.62]	0.017	2.84 [1.07, 7.56]	0.037

Notes: ^aDuring the previous month; ^bHeroin, buprenorphine, methadone, morphine, other; ^cCocaine, crack/free base, amphetamines, methylphenidate; ^dAUDIT C score ≥ 3 for women and ≥ 4 for men.

Abbreviations: DCR, drug consumption rooms; HCV, hepatitis C virus; OAT, opioid agonist therapy; PWUD, people who use drugs; Ref, reference.