Exploring housing instability through a gender lens among people who inject drugs in Montreal, Canada

Housing instability contributes to harm among people who inject drugs (PWID). We examined determinants of varying levels of housing instability and explored gender differences in housing instability and associated determinants among PWID.

We used baseline data from HEPCO, a community-based cohort of PWID in Montreal, Canada (2011-2022). Housing (past 3 months) was categorised as stable, precarious (i.e., temporary accommodation) or unsheltered. Multinomial logistic regression was used to assess relationships between sociodemographic factors, recent drug use, and housing instability. A multivariable model was constructed using the full sample. Gender differences were explored via stratified and unadjusted analyses given the relatively small number of women.

A total of 911 PWID (748 men and 163 women) were included. In the multivariable model, not living in a marriage-like relationship, recent incarceration, and not reporting recent heroin use were associated with both precarious housing and being unsheltered, relative to stable housing. Employment, consumption of cocaine, amphetamines, and other opioids were only associated with being unsheltered. In stratified analyses, precarious and unsheltered housing was reported by 14.1% and 23.3% of women and 20.9% and 30.9% of men. Sociodemographic factors and drug use patterns also differed by gender. Although most associations with housing instability were in similar directions for men and women, several estimates differed in magnitude, denoting some signals of gender differences.

Almost half the sample was unsheltered or precariously housed. Studies with larger samples of women should formally examine the relevance of developing gender-specific responses to housing instability.