THE GENDER SEGREGATION OF PRECARIOUS WORK CONTEXTS AMONG PEOPLE WHO USE DRUGS

Employment is a social determinant of health, yet people who use drugs (PWUD) often face barriers to employment. To meet their financial needs, some engage in alternate income-generating activities (e.g., sex work, recycling, drug selling) that expose them to social and health-related harm. Drawing from two cohorts of community-recruited PWUD in Vancouver, Canada (n=2366, 2006-2023), we used generalized estimating equations to characterize gendered patterns of income generation among men (n=1501, 63.4%) and women (n=865, 36.6%). Employment and income assistance were similarly patterned across genders and associated with fewer structural harms (e.g., criminalization), while drug selling and illegal activities were associated with elevated risks of harms, including incarceration and violence. Gendered differences emerged in street-based and sex work-activities often segregated by gender-revealing distinct social and structural exposures. These findings emphasize the need for income generation supports that address the specific needs and social locations of PWUD.