Understanding barriers to healthcare and harm reduction services among women who inject drugs in Nigeria: A qualitative assessment.

Women who inject drugs (WID) face barriers to healthcare, harm reduction, and social support, alongside stigma, violence, and legal risk. Evidence from Nigeria remains limited. This study explored how WID experience access to healthcare and harm reduction services and examined the social and structural conditions shaping that access. We used a phenomenological qualitative design in three Nigerian states: Abia, Gombe, and Oyo. Data were collected through 24 key informant interviews and six focus group discussions (FGDs) with WID (10 participants per group). Interview guides explored service availability, preferred access points, perceived quality of care, sexual and reproductive health needs, safety and violence, and barriers to service use. Data were audio-recorded, transcribed, de-identified, and analyzed thematically using ATLAS.ti 24. Four themes were identified: patterns of women's injecting drug use, access to healthcare and harm reduction services, experiences of gender-based violence, and social and structural barriers. Sterile needles and syringes, HIV and sexually transmitted infection (STI) testing, and some family planning services were reported to be more consistently available through one-stop shops and outreach services, while antenatal care and prevention of mother-to-child transmission (PMTCT) services were mainly accessed through formal health facilities and were less frequently used due to stigma and fear of disclosure. Access through informal drug-use locations ("bunks") and peer networks was frequently preferred due to convenience, anonymity, and reduced stigma. Improving access for WID requires integration of sexual and reproductive health services within harm reduction platforms, expansion of community-based and outreach delivery models, strengthening of trauma-informed care within health facilities, and establishment of safe and confidential referral systems that reduce exposure to stigma and law enforcement risk.