[Unsafe practices fostering cutaneous abscesses in people who inject substances : Results from the ANRS-OUTSIDER study]. / Des pratiques à risque favorisant la survenue d'abcès cutanés chez les personnes qui injectent des substances : résultats de l'étude ANRS-OUTSIDER.

INTRODUCTION: Cutaneous abscesses are a common complication of intravenous substance use. Although these skin and soft tissue infections represent one of the main causes of emergency room visits and hospitalizations in people who inject drugs (PWID), data on their prevalence and causes are scarce. The present study was part of the larger ANRS-OUTSIDER project and aimed to study the factors associated with skin abscesses in PWID, focusing in particular on the different stages of injection. METHOD: Analyses were based on data of the 164 persons who regularly injected psychoactive substances participating in the French ANRS-OUTSIDER project. A face-to-face questionnaire collected data on sociodemographics, substance use, injection practices, and experience of skin abscesses in the previous six months. Factors associated with skin abscesses were studied using a logistic regression model. RESULTS: Of the 140 participants for whom abscess data were recorded at inclusion, 35% reported having a skin abscess in the previous six months. Factors associated with skin abscesses were: benefiting from universal health coverage (PUMA/CMU/AME) (Odd ratio (OR) = 0.28, confidence interval (CI) à 95%=0.08-0.99), finding the vein to inject by touch (OR=3.44, 95% CI=1.41-8.43) and licking the needle before injection (OR=5.16, 95% CI=1.10-24.30). CONCLUSION: Our results highlight that skin abscesses were very frequent among the complications observed in our sample of French PWID, and that certain injection practices fostered their occurrence. These data will provide stakeholders with useful information to improve prevention and harm reduction messages for PWID.

Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort.

Purpose: Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. Methods: We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Results: Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Conclusion: Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.