Catherine Mwangi, harm reduction advocate with more than 10 years working in harm reduction programs in Kenya. Together with women who use drugs they founded Women Nest in Nairobi Informal settlements. She is also a researcher with special interest in Women and substance use, holds a PhD in public health.

Background: Sex workers who use drugs experience increased health and social vulnerabilities in Kenya. Service delivery disparities and access challenges exist, but current national level programmes do not fully accommodate intersectional community needs. The Empowering the Voiceless study explored harm reduction service barriers, challenges and opportunities for sex workers who use drugs from different backgrounds in Kenya.
Methods: Using an exploratory research design and community-based participatory research (CBPR) approach building from an iteration in Indonesia, this study involved peer capacitation using unique training methodologies in recruiting 57 sex workers who use drugs across four sites in Nairobi, May-June 2022.
Results: Knowledge of harm reduction services was low; 36.8%- 63.2% had never accessed these services, as perceived to be exclusive for people who inject drugs and not sex workers. Transgender sex workers who use drugs reported higher frequency of needles/syringes sharing including while administering HRT, yet access to NSP was lacking, with providers not aware of/nor accommodate this. Respondents identified benefits of using drugs but at the same time reported heightened risk of situational violence. Analysis indicated 100% of respondents engaged in poly drug use and 66.6% also drank alcohol. Respondents who consumed alcohol while using heroin did so without understanding attendant overdose risk. Overdose incidence was high (63.2%).
Conclusion: There is an overwhelming paucity of mainstreamed, cross-sectoral, horizontally linked services that respond to the changing services needs of sex workers who use drugs, suggesting the need for an integrated/inclusive service delivery model that disrupts current siloed key population services in Kenya. There is a need for further CBPR mixed methods studies to quantify the risks resulting from intersecting practices and respond to emerging needs among key populations and to further capacitate community in research that resonates with community needs.