Structural vulnerability and HIV risk among women who inject drugs in Nyanza, Kenya
Globally, women who inject drugs are disproportionately vulnerable to HIV and other health harms. In Kenya, HIV prevalence among injectors is 18% overall, but reaches 44% among women who inject. As Kenya introduces national harm reduction programs, gender sensitive services will be essential to curb the HIV epidemic. This study uses a structural vulnerability approach to examine HIV risk among women who inject drugs in Nyanza with the goal of informing HIV interventions. We draw on qualitative interviews conducted as part of a larger mixed methods study of injection drug use in Nyanza. In-depth interviews with women (n=13) employed a life history approach to explore early experiences, intimate partnerships and sexual risk, and progression of alcohol and drug use. Our inductive analysis used a structural vulnerability framework to identify themes linked to HIV risk. Case studies illustrate salient findings. Women described growing up in circumstances of hardship. Themes of exclusion (e.g., from education, family inheritance) and death of loved ones from HIV formed early paths of poverty that often initiated women into sex work and substance use. Drawing on the experiences of “Lacy” and “Rose,” we highlight how structural factors create the emotional antecedents to injection drug use, thereby exacerbating sexual risk, violence, social marginalization, and potential for HIV infection. Our study highlights specific features of women’s structural vulnerability to HIV and other health harms in Kenya vis-a-vis their disadvantaged position in society. Harm reduction programs should develop holistic approaches that address the intersecting social, economic, and health needs of women who inject drugs.
