Through many years’ experience working in harm reduction programs the founders of Women Nest noted that due to the limited numbers of  girls and women who use drugs in the harm reduction programs little attention was given to their unique needs.

They experienced low access to harm reduction interventions, stigma/discrimination from health care workers and violence from intimate partners, police and the community. Experience with the criminal justice system meant that many women who use drugs were arrested spending days in police cells and later jails. With no harm reduction services in prison women experienced untold suffering. Upon release from jail many of the women died because of drug overdose due to using heroin after prolonged durations of non-use. Besides, the women were not accepted by the community or their families due to the stigma associated with drug use and being incarcerated.

Further many of the women lost custody of their children while in jail, many of the children also dropping out school and joining criminal gangs in the streets.The Medically Assisted Therapy (MAT) program in Kenya started in late 2014 and brought a lot of hope to women who use heroin. However with time MAT became a big challenge to them. First the women who had been inducted to MAT reduced drug use and moved out of the drug injecting sites. However they did not have any economic empowerment opportunities so they were idle and reverted back to drug use and risky sexual behavior. Secondly since many of the women lived far away from the MAT clinics they lacked money to pay for transport cost and this affected treatment adherence. The burden of taking care of young children also affected the women because they could not always carry the children to the MAT clinics. This resulted to the women dropping out of the MAT intervention and back to the drug injecting sites.

Many of these women especially those on HIV treatment died from opportunistic infections due to non-adherence to HIV treatment. This scenario shows that in low and middle income countries like Kenya MAT intervention may not be effective without considering economic empowerment opportunities. The founders of women Nest also noted that there was limited data on women who use drugs. The harm reduction programs in Kenya do not have a research arm. The national surveys that have been conducted lacked data on women who use drugs and only included data on women who used heroin yet girls and women in Kenya use other licit and illicit drugs  as single drugs or combination of several  drugs  with very serious health consequences. 

Since treatment for drug addiction in Kenya is very expensive, most women in low income urban settings cannot afford it and experience severe harms from drug use and high mortalities.Doctoral research by one of the founders of Women Nest (Catherine Mwangi)(https://theconversation.com/women-using-heroin-in-kenya-why…; https://www.longdom.org/…/assessment-of-retrospective-and-c…income-urban-settings-in-kenya.pdf) showed that majortiy of  women who inject drugs were initiated into drug use by older intimate sexual partners during the adolescence phase of life after dropping out of school due to poverty. These initimate sexual relationships were short lived and the girls moved into other relationships with older male partners. Further these short lived relationships introduced different licit and illicit drugs to the girls. In about 12 years after initial onset of drug use at adolescence these girls were already using heroin in early adulthood. Prevention and mitigation of early substance use among adolescent girls is key in stopping progression to use of narcotic drugs like heroin in early adulthood.

Harm reduction is life saving when the girls and women are already using heroin and other opioids through injection or non-injection mode of use. Women Nest uses these  public health based approaches to address drug use among girls and women in Kenya