FRAD0103 | INVISIBLE AT THE INTERSECTIONS: JUSTICE-INVOLVED WOMEN WHO USE DRUGS AND THE FAILURE OF INTEGRATED PUBLIC HEALTH RESPONSES

Joanne Wanjiru, Melba Katindi, Wangari Kimemia | Next Generation Lawyers - Kenya, Nairobi, Kenya

Women who use drugs (WWUD) in Kenya face compounded marginalization due to criminalization, gender-based violence, and limited access to healthcare. The criminal justice system particularly excludes those involved from accessing harm reduction and HIV services. African countries' pursuit of health system integration leaves this population unseen. This abstract presents findings from an exploratory study highlighting how justice-involved WWUD are left behind by both legal and healthcare systems, challenging the promise of integrated HIV responses. A rapid assessment was conducted in 2023 across five urban counties (Nairobi, Mombasa, Kisumu, Nakuru, and Eldoret). Ten focus group discussions were conducted with women who use drugs (WWUD), in addition to twelve key informant interviews with harm reduction and legal aid providers. Data collection focused on service gaps at the intersections of incarceration, harm reduction, and reintegration. WWUD frequently reported harassment, arbitrary arrests, and incarceration without access to HIV prevention or harm reduction services. No opioid substitution therapy (OST), sterile injecting equipment, or condoms were available in detention facilities. Post-release, women lacked structured pathways to reintegrate into healthcare, housing, or harm reduction services. Over 80% reported experiencing gender-based violence, often linked to interactions with law enforcement. Public health facilities were often stigmatizing and failed to address trauma or mental health needs. Justice-involved WWUD are systematically excluded from both criminal justice reform and integrated health services. Without specific attention to their needs, integration may further entrench structural violence and exclusion.
Recommendations: 1. Decriminalize drug use and survival behaviors (e.g., sex work).
2. Provide harm reduction, HIV, and SRH services in detention settings.
3. Establish gender-sensitive reintegration and referral pathways post-incarceration.
4. Train justice and health personnel in trauma-informed, non-discriminatory care.
5. Include justice-involved WWUD as a priority group in national HIV strategies. The specific consideration of harm reduction policy for justice-involved women who use drugs is not optional—it is essential for ending AIDS and protecting rights in Africa’s criminalized environments.