Gender differences in the provision of injection initiation assistance: a comparison of three North American settings

• Published in: Harm reduction journal 2018-12, Vol.15 (1), p.59-5, Article 59
• Main Authors: Meyers, Stephanie A, Scheim, Ayden, Jain, Sonia, Sun, Xiaoying, Milloy, M J, DeBeck, Kora, Hayashi, Kanna, Garfein, Richard S, Werb, Dan
• Format: Article
• Language: English
• Subjects: Alcohol; Bloodborne diseases; Brief Report; British Columbia; California; Confidence intervals; Cross-Sectional Studies; Demographic aspects; Disease transmission; Distribution; Drug abusers; Drug use; Female; Females; Gender; Gender aspects; Gender differences; Harm reduction; Health aspects; Hepatitis; Humans; Independent variables; Injectable drugs; Injection; Injection initiation; Male; Mexico; Needle exchange programs; Needle-Exchange Programs - statistics & numerical data; People who inject drugs; Psychological aspects; Regression analysis; Regression models; Risk factors; San Diego; Sex differences; Sex differences (Biology); Sex Distribution; Statistical analysis; Substance Abuse, Intravenous - rehabilitation; Systematic review; Tijuana; Transgender persons; Vancouver; Womens health; Young adults
• ISSN: 1477-7517; 1477-7517
• DOI: 10.1186/s12954-018-0270-6

Individuals experience differential risks in their initiation into drug injecting based on their gender. Data suggest women are more likely to be injected after their initiator and to share injection equipment. Little is known, however, regarding how gender influences the risk that people who inject drugs (PWID) may assist others into injection initiation. We therefore sought to investigate the role of "initiator" gender in the provision of injection initiation assistance across multiple settings. We employed data from PReventing Injecting by Modifying Existing Responses (PRIMER), a multi-cohort study investigating factors influencing injection initiation assistance provision. Data were drawn from three cohort studies of PWID in San Diego, USA (STAHR II); Tijuana, Mexico (El Cuete IV); and Vancouver, Canada (VDUS). Site-specific logistic regression models were fit, with lifetime provision of injection initiation assistance as the outcome and gender as the independent variable. Overall, 3.2% (24/746) of the women and 4.6% (63/1367) of the men reported providing injection initiation assistance. In Tijuana, men were more than twice as likely to have provided injection initiation assistance after controlling for potential confounders (adjusted odds ratio = 2.17, 95% confidence interval: 1.22-3.84). Gender was not significantly associated with providing injection initiation assistance in other sites. We identified that being male in Tijuana, specifically, was associated with providing injection initiation assistance, which could inform targeted outreach aimed at reducing the influence of PWID populations on non-injectors in this site. This will likely require that existing interventions address gender- and site-specific factors for effectiveness.