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AIDS and Behavior

, Volume 23, Issue 12, pp 3267–3276 | Cite as

Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting

  • Lindsey RichardsonEmail author
  • Mitchell Mammel
  • M-J Milloy
  • Kanna Hayashi
Original Paper

Abstract

The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.

Keywords

Injection drug use Employment transitions HIV infection Socioeconomic marginalization 

Notes

Acknowledgements

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. The study was supported by the US National Institutes of Health (U01DA038886). Lindsey Richardson, Kanna Hayashi, and M-J Milloy are supported by New Investigator Awards from the Canadian Institutes of Health Research (CIHR; MSH 217672, MSH 141971, MSH 360816) and Scholar Awards from the Michael Smith Foundation for Health Research. Lindsey Richardson’s research is additionally supported by a CIHR Foundation Grant (FDN-154320). M-J Milloy is also supported by the US National Institutes of Health (U01-DA0251525). His institution has received an unstructured gift to support him from NG Biomed, Ltd., a private firm applying for a government license to produce cannabis. He holds the Canopy Growth professorship in cannabis science which was established through unstructured gifts to the University of British Columbia from Canopy Growth, a licensed producer of cannabis, and the Ministry of Mental Health and Addictions of the Government of British Columbia. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports Dr. Evan Wood, Director of the BC Centre on Substance Use.

References

  1. 1.
    Bartley M, Ferrie J, Montgomery SM. Health and labour market disadvantage: unemployment, non-employment, and job insecurity. In: Wilkinson RG, Marmot M, editors. Social Determinants of Health, 2nd ed. Oxford: Oxford University Press; 2006.Google Scholar
  2. 2.
    Bambra C. Work, worklessness and the political economy of health inequalities. J Epidemiol Community Health. 2011;65:746–50.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    McLeod CB, Lavis JN, MacNab YC, Hertzman C. Unemployment and mortality: a comparative study of Germany and the United States. Am J Public Health. 2012;102:1542–50.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Lundberg O, Dahl E, Fritzell J, Palme J, Sjöberg O. Social protection, income and health inequalities: final report from task group on GDP, Taxes, Income and Welfare. Review of Social Determinants and the Health Divide in the WHO European Region. 2016.Google Scholar
  5. 5.
    Raphael S, Winter-Ebmer R. Identifying the effect of unemployment on crime. J Law Econ. 2001;44:259–83.CrossRefGoogle Scholar
  6. 6.
    Jaffe K, Dong H, Godefroy A, et al. Informal recycling, income generation and risk: health and social harms among people who use drugs. Int J Drug Policy. 2018;60:40–6.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Richardson LA, Long C, DeBeck K, et al. Socioeconomic marginalisation in the structural production of vulnerability to violence among people who use illicit drugs. J Epidemiol Community Health. 2015;69:686–92.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Ti L, Richardson L, DeBeck K, et al. The impact of engagement in street-based income generation activities on stimulant drug use cessation among people who inject drugs. Drug Alcohol Depend. 2014;141:58–64.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Richardson LA, Kerr TH, Dobrer S, et al. Socioeconomic marginalization and plasma HIV-1 RNA nondetectability among individuals who use illicit drugs in a Canadian setting. AIDS. 2015;29(18):2487–95.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Jahoda M. Employment and unemployment: a social-psychological analysis. Cambridge: CUP Archive; 1982.Google Scholar
  11. 11.
    Creed PA, Macintyre SR. The relative effects of deprivation of the latent and manifest benefits of employment on the well-being of unemployed people. J Occup Health Psychol. 2001;6(4):324–31.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Paul KI, Moser K. Unemployment impairs mental health: meta-analyses. J Vocat Behav. 2009;74:264–82.CrossRefGoogle Scholar
  13. 13.
    Mandal B, Ayyagari P, Gallo WT. Job loss and depression: the role of subjective expectations. Soc Sci Med. 2011;72(4):576–83.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Kinicki AJ, Prussia GE, McKee-Ryan FM. A panel study of coping with involuntary job loss. Acad Manag J. 2000;43:90–100.Google Scholar
  15. 15.
    Gallo WT, Bradley EH, Siegel M, Kasl SV. Health effects of involuntary job loss among older workers: findings from the health and retirement survey. J Gerontol B Psychol Sci Soc Sci. 2000;55(3):S131–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health impacts of the great recession: a critical review. Curr Epidemiol Rep. 2016;3(1):81–91.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Browning M, Heinesen E. Effect of job loss due to plant closure on mortality and hospitalization. J Health Econ. 2012;31(4):599–616.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Selenko E, Batinic B, Paul K. Does latent deprivation lead to psychological distress? Investigating Jahoda’s model in a four-wave study. J Occup Organ Psychol. 2011;84:723–40.CrossRefGoogle Scholar
  19. 19.
    World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations—2016 Update. 2016.Google Scholar
  20. 20.
    Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Jolley E, Rhodes T, Platt L, et al. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy. BMJ Open. 2012;2:e001465.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Small W, Maher L, Lawlor J, Wood E, Shannon K, Kerr T. Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: social organization and systemic violence. Int J Drug Policy. 2013;24(5):479–87.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Henkel D. Unemployment and substance use: a review of the literature (1990–2010). Curr Drug Abuse Rev. 2011;4(1):4–27.PubMedCrossRefGoogle Scholar
  24. 24.
    Richardson L, Wood E, Montaner J, Kerr T. Addiction treatment-related employment barriers: the impact of methadone maintenance. J Subst Abuse Treat. 2012;43(3):276–84.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Bray JW, Zarkin GA, Dennis ML, French MT. Symptoms of dependence, multiple substance use, and labor market outcomes. Am J Drug Alcohol Abuse. 2000;26:77–95.PubMedCrossRefGoogle Scholar
  26. 26.
    French MT, Roebuck MC, Alexandre PK. Illicit drug use, employment, and labor force participation. South Econ J. 2001;68:349–68.CrossRefGoogle Scholar
  27. 27.
    Richardson LA, Milloy MJ, Kerr TH, Parashar S, Montaner JS, Wood E. Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care. J Epidemiol Community Health. 2014;68:93–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Lundgren LM, Schilling RF, Ferguson F, Davis K, Amodeo M. Examining drug treatment program entry of injection drug users: human capital and institutional disaffiliation. Eval Program Plann. 2003;26(2):123–32.PubMedCrossRefGoogle Scholar
  29. 29.
    March JC, Oviedo-Joekes E, Romero M. Drugs and social exclusion in ten European cities. Eur Addict Res. 2006;12(1):33–41.PubMedCrossRefGoogle Scholar
  30. 30.
    McDonough P, Amick BC III. The social context of health selection: a longitudinal study of health and employment. Soc Sci Med. 2001;53(1):135–45.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Burton-Jeangros C, Cullati S, Sacker A, Blane D. A life course perspective on health trajectories and transitions. Berlin: Springer; 2015.CrossRefGoogle Scholar
  32. 32.
    Hyde M, Jones IR. The long shadow of work—does time since labour market exit affect the association between socioeconomic position and health in a post-working population. J Epidemiol Communtity Health. 2007;61:533–9.CrossRefGoogle Scholar
  33. 33.
    Richardson L, Wood E, Kerr T. The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs. Soc Sci Med. 2013;76:126–33.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Richardson L, Small W, Kerr T. Pathways linking drug use and labour market trajectories: the role of catastrophic events. Sociol Health Illn. 2016;38:137–52.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11(8):F59–65.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Lima VD, St-Jean M, Rozada I, et al. Progress towards the United Nations 90–90-90 and 95–95-95 targets: the experience in British Columbia, Canada. J Int AIDS Soc. 2017;20(3):e25011.PubMedCentralCrossRefGoogle Scholar
  37. 37.
    Olding M, Enns B, Panagiotoglou D, et al. A historical review of HIV prevention and care initiatives in British Columbia, Canada: 1996-2015. J Int AIDS Soc. 2017;20(1):21941.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Government of Canada. EI Regular Benefits—Overview. 2018. Available from: https://www.canada.ca/en/services/benefits/ei/ei-regular-benefit.html.
  39. 39.
    Government of British Columbia. Income Assistance. 2018. Available from: https://www2.gov.bc.ca/gov/content/family-social-supports/income-assistance/payment-dates.
  40. 40.
    Tweddle A, Aldridge H. Welfare in Canada, 2017. 2018. Available from: https://maytree.com/wp-content/uploads/Welfare_in_Canada_2017.pdf.
  41. 41.
    Wood E, Tyndall MW, Spittal PM, et al. Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help. CMAJ. 2001;165(4):405–10.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Liu S, Blomley N. Making news and making space: framing Vancouver’s Downtown Eastside. Can Geogr. 2013;57:119–32.CrossRefGoogle Scholar
  43. 43.
    Ahamad K, Hayashi K, Nguyen P, et al. Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study. Lancet HIV. 2015;2(10):e445–50.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Corneil TA, Kuyper LM, Shoveller J, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006;12(1):79–85.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    DeBeck K, Kerr T, Li K, et al. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ. 2009;181(9):585–9.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Kerr T, Small W, Buchner C, et al. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Am J Public Health. 2010;100(8):1449–53.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Kerr T, Shannon K, Ti L, et al. Sex work and HIV incidence among people who inject drugs. AIDS (London, England). 2016;30(4):627–34.PubMedCentralCrossRefGoogle Scholar
  48. 48.
    Maas B, Fairbairn N, Kerr T, Li K, Montaner JSG, Wood E. Neighborhood and HIV infection among IDU: place of residence independently predicts HIV infection among a cohort of injection drug users. Health Place. 2007;13(2):432–9.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Boyd J, Richardson L, Anderson S, Kerr T, Small W. McNeil R Transitions in income generation among marginalized people who use drugs: a qualitative study on recycling and vulnerability to violence. Int J Drug Policy. 2018;18:36–43.CrossRefGoogle Scholar
  50. 50.
    Miller CL, Kerr T, Frankish JC, et al. Binge drug use independently predicts HIV seroconversion among injection drug users: implications for public health strategies. Subst Use Misuse. 2006;41(2):199–210.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    O’Connell JM, Kerr T, Li K, et al. Requiring help injecting independently predicts incident HIV infection among injection drug users. JJ Acquir Immune Defic Syndr. 2005;40(1):83–8.CrossRefGoogle Scholar
  52. 52.
    Sorensen JL, Copeland AL. Drug abuse treatment as an HIV prevention strategy: a review. Drug Alcohol Depend. 2000;59(1):17–31.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Tyndall MW, Currie S, Spittal P, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17(6):887–93.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Hubbard AE, Ahern J, Fleischer NL, et al. To GEE or Not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21(4):467–74.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Kalleberg AL. Good jobs, bad jobs. New York: Russel Sage Foundation; 2011.Google Scholar
  56. 56.
    Conyers LM, Richardson LA, Datti PA, Koch LC, Misrok M. A critical review of health, social, and prevention outcomes associated with employment for people living with HIV. AIDS Educ Prev. 2017;29(5):475–90.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Schneider S. Violence, organized crime, and illicit drug markets: a Canadian case study. Sociologia. 2013;71:125–43.Google Scholar
  58. 58.
    Bungay VA. Health experiences of women who are street-involved and use crack cocaine: inequity, oppression, and relations of power in Vancouver’s Downtown Eastside [dissertation]. University of British Columbia; 2008.Google Scholar
  59. 59.
    Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev. 2010;29(3):293–300.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Braitstein P, Li K, Tyndall M, et al. Sexual violence among a cohort of injection drug users. Soc Sci Med. 2003;57(3):561–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Milloy M-J, Wood E, Milloy M-J, et al. Incarceration experiences in a cohort of active injection drug users. Drug Alcohol Rev. 2008;27:693–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Fischer B, Medved W, Kirst M, Rehm J. Illicit opiates and crime: results of an untreated user cohort study in Toronto. Can J Criminol. 2001;43:197.Google Scholar
  63. 63.
    Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.PubMedCrossRefGoogle Scholar
  64. 64.
    Spittal PM, Craib KJP, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166:894–9.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Evans L, Strathdee SA. A roof is not enough: unstable housing, vulnerability to HIV infection and the plight of the SRO. Int J Drug Policy. 2006;17:115–7.CrossRefGoogle Scholar
  66. 66.
    Wright NM, Tompkins CN, Jones L. Exploring risk perception and behavior of homeless injecting drug users diagnosed with hepatitis C. Health Soc Care Community. 2005;13(1):75–83.PubMedCrossRefGoogle Scholar
  67. 67.
    Small W, Rhodes T, Wood E, Kerr T. Public injection settings in Vancouver: physical environment, social context and risk. Int J Drug Policy. 2007;18(1):27–36.PubMedCrossRefGoogle Scholar
  68. 68.
    Baldwin ML, Marcus SC, De Simone J. Job loss discrimination and former substance use disorders. Drug Alcohol Depend. 2010;110:1–7.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    DeBeck K, Shannon K, Wood E, Li K, Montaner J, Kerr T. Income generating activities of people who inject drugs. Drug Alcohol Depend. 2007;91(1):50–6.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Kandel DB, Yamaguchi K. Job mobility and drug use: an event history analysis. Am J Sociol. 1987;92:836–78.CrossRefGoogle Scholar
  71. 71.
    Hoffmann JP, Dufur M, Huang L. Drug use and job quits: a longitudinal analysis. J Drug Issues. 2007;37:569–96.CrossRefGoogle Scholar
  72. 72.
    Inciardi JA, Pottieger AE. Kids, crack, and crime. J Drug Issues. 1991;21:257–70.CrossRefGoogle Scholar
  73. 73.
    Ribeiro M, Dunn J, Sesso R, Lima MS, Laranjeira R. Crack cocaine: a five-year follow-up study of treated patients. Eur Addict Res. 2007;13(1):11–9.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Wood E, Tyndall MW, Spittal PM, et al. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS. 2002;16(6):941–3.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Pouget ER, Deren S, Fuller CM, et al. Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program. J Acquir Immune Defic Syndr. 2005;39(4):471–7.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Fairbairn N, Small W, Van Borek N, Wood E, Kerr T. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study. Harm Reduct J. 2010;7:20.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Lloyd-Smith E, Rachlis BS, Tobin D, et al. Assisted injection in outdoor venues: an observational study of risks and implications for service delivery and harm reduction programming. Harm Reduct J. 2010;7:6.PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Sherman SG, Latkin CA, Gielen AC. Social factors related to syringe sharing among injecting partners: a focus on gender. Subst Use Misuse. 2001;36(14):2113–36.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Lindsay MK, Peterson HB, Boring J, Gramling J, Willis S, Klein L. Crack cocaine: a risk factor for human immunodeficiency virus infection type 1 among inner-city parturients. Obstet Gynecol. 1992;80(6):981–4.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28(4):321–9.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2011;8:CD004145.Google Scholar
  82. 82.
    Nolan S, Hayashi K, Milloy M-J, et al. The impact of low-threshold methadone maintenance treatment on mortality in a Canadian setting. Drug Alcohol Depend. 2015;156:57–61.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Kerr T, Marsh D, Li K, Montaner J, Wood E. Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver. Drug Alcohol Depend. 2005;80:329–35.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009;20(3):193–201.PubMedCrossRefGoogle Scholar
  85. 85.
    Akers R. Social learning and social structure. Abingdon: Routledge; 2017.CrossRefGoogle Scholar
  86. 86.
    Debeck K, Wood E, Qi J, et al. Interest in low-threshold employment among people who inject illicit drugs: implications for street disorder. Int J Drug Policy. 2011;22:376–84.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Koo DJ, Chitwood DD, Sánchez J. Factors for employment: a case-control study of fully employed and unemployed heroin users. Subst Use Misuse. 2007;42:1035–54.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Richardson L, Sherman SG, Kerr T. Employment amongst people who use drugs: a new arena for research and intervention [editorial]. Int J Drug Policy. 2012;23(1):3.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Ferguson KM. Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths. Community Mental Health J. 2012;48:490–502.CrossRefGoogle Scholar
  90. 90.
    Clayton S, Barr B, Nylen L, et al. Effectiveness of return-to-work interventions for disabled people: a systematic review of government initiatives focused on changing the behaviour of employers. Eur J Public Health. 2011;22(3):434–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Lloyd C. The stigmatization of problem drug users: a narrative literature review. Drugs Educ Prev Policy. 2013;20:85–95.CrossRefGoogle Scholar
  92. 92.
    Sherman SG, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care. 2006;18:1–11.PubMedCrossRefGoogle Scholar
  93. 93.
    Bardwell G, Anderson S, Richardson L, et al. The perspectives of structurally vulnerable people who use drugs on volunteer stipends and work experiences provided through a drug user organization: opportunities and limitations. Int J Drug Policy. 2018;55:40–6.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Wong CJ, Silverman K. Establishing and maintaining job skills and professional behaviors in chronically unemployed drug abusers. Subst Use Misuse. 2007;42(7):1127–40.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Wood E, Schechter MT, Tyndall MW, Montaner… JSG. Antiretroviral medication use among injection drug users: two potential futures. AIDS. 2000.Google Scholar
  96. 96.
    Strathdee SA, Hallett TB, Bobrova N, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376:268–84.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Sigurdsson SO, DeFulio A, Long L, Silverman K. Propensity to work among chronically unemployed adult drug users. Subst Use Misuse. 2011;46:599–607.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

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Authors and Affiliations

  1. 1.British Columbia Centre On Substance UseVancouverCanada
  2. 2.Department of SociologyUniversity of British ColumbiaVancouverCanada
  3. 3.Division of AIDS, Department of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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