title: Socioeconomic marginalisation in the structural production of vulnerability to violence among people who use illicit drugs.
abstract: 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 physical or sexual violence using bivariate and multivariate generalised estimating equations, 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 sociodemographic characteristics, mental health status, and drug use patterns, violence was independently and positively associated with participation in street-based income generation activities (ie, recycling, squeegeeing and panhandling; adjusted OR (AOR)=1.39, 95% CI 1.23 to 1.57), sex work (AOR=1.23, 95% CI 1.00 to 1.50), drug dealing (AOR=1.63, 95% CI 1.44 to 1.84), and theft and other acquisitive criminal activity (AOR=1.51, 95% CI 1.27 to 1.80). Engagement in regular, self-employment 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 which can minimise vulnerability to violence among PWUD is therefore urgently required.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Richardson
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Long
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Public Policy, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Medicine (Division of AIDS), University of British Columbia, British Columbia, Canada.
authors.forename: M-J S
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Medicine (Division of AIDS), University of British Columbia, British Columbia, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Medicine (Division of AIDS), University of British Columbia, British Columbia, Canada.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001955:British Columbia / Q000453:epidemiology; D015897:Comorbidity; D019548:Crime Victims / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D013287:Illicit Drugs / Q000191:economics; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012309:Risk-Taking; D060386:Sex Workers; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D014754:Violence / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D013287:Illicit Drugs
keywords: EMPLOYMENT; SOCIAL EPIDEMIOLOGY; SUBSTANCE ABUSE; VIOLENCE