Residential eviction and exposure to violence among people who inject drugs in Vancouver, Canada

Abstract

Background People who inject drugs (PWID) experience markedly elevated rates of physical and sexual violence, as well as housing instability. While previous studies have demonstrated an association between homelessness and increased exposure to violence among PWID, the relationship between residential eviction and violence is unknown. We therefore sought to examine the association between residential eviction and experiencing violence among PWID in Vancouver, Canada. Methods Data were derived from two open prospective cohort studies of PWID: the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS). We used generalized estimating equations (GEE) to estimate the relationship between residential eviction and experiencing violence among male and female PWID, respectively. Results Between June 2007 and May 2014, 1689 participants were eligible for the analysis, contributing a median of 5.5 years of follow-up. Of these, 567 (33.6%) were female. In total, 259 (45.7%) of females and 566 (50.4%) of males experienced at least one incident of violence over the study period. In multivariable GEE models, residential eviction was independently associated with greater odds of experiencing violence among both females (Adjusted Odds Ratio [AOR] = 2.09; 95% confidence interval [CI]: 1.39–3.13) and males (AOR = 1.95; 95% CI = 1.49–2.55), after adjustment for potential confounders. Conclusion Residential eviction was independently associated with an increased likelihood of experiencing violence among both male and female PWID. These findings point to the need for evidence-based social-structural interventions to mitigate housing instability and violence among PWID in this setting.

Systematic review of psychosocial factors associated with evictions

“…Desmond, An, Winkler, & Ferriss, (Desmond et al., ) also conducted a particularly notable study combining survey and court data for a sizable sample. Other studies reported on prospective cohorts but the temporal relation between variables could not be determined and analyses were based on associations using time‐varying variables (Kennedy et al., ; Zivanovic et al., ). Overall, review of all ten studies revealed the most salient factors related to risk of evictions could be grouped into four categories, by order of the strength of their association reported in the literature: financial hardship (60% of studies), sociodemographic and household characteristics (40% of studies); substance use (40% of studies); and other health problems such as physical and mental conditions (80% of studies).…”

“…mental and physical health problems) in terms of risk factors for eviction (Van Laere et al., ). Lastly, although violence is not a specific health problem, a Canadian study of people who used illicit drugs found that experiencing violence was independently associated with evictions among both females and males (Kennedy et al., ).…”

“…Desmond, An, Winkler, & Ferriss, 2013 also conducted a particularly notable study combining survey and court data for a sizable sample. Other studies reported on prospective cohorts but the temporal relation between variables could not be determined and analyses were based on associations using time-varying variables (Kennedy et al, 2017;Zivanovic et al, 2016).…”

“…Eight of 10 studies (80%) included in our review all indicated that physical and mental health problems were associated with evictions (Böheim & Taylor, 2000;Crane & Warnes, 2000;Kennedy et al, 2017;Montgomery et al, 2017;Phinney et al, 2007;Rodriguez, Panero, & Tannen, 2010;Van Laere et al, 2009a;Zivanovic et al, 2016). There have been several U.S.-based studies along with studies of eviction in other countries.…”

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

“…This framework hypothesizes that a set of intersecting environments—policy, economic, social, and geographic—constrains the range of choices available to individuals to avoid risky injection-related behaviors. The risk environment framework has been particularly useful for studies investigating the sociostructural antecedents of health and social harm experienced by PWID (Kennedy et al, 2017; Rhodes, 2002; Small, Rhodes, Wood, & Kerr, 2007), and is therefore well-suited to a consideration of the impact of migration on risks associated with drug injecting. Using this framework, we hypothesize that migration contributes to risk environments that may expand the risk for injection initiation among migrants and consequent risks for blood-borne disease transmission and the expansion of syndemics of injecting and blood-borne disease.…”