Association Between Access to Harm Reduction Services and Socioeconomic Improvement Among People Who Use Drugs in Nigeria

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This study examined the association between access to harm reduction services and improvements in substance use and socioeconomic outcomes among PWUD in three Nigerian states. Methods A cross-sectional analysis was conducted using data from 210 PWUD enrolled in harm reduction programmes across Abia, Gombe, and the Federal Capital Territory. Outcomes included self-reported improvements in substance use, housing, employment, relationships with family and friends, crime reduction, and community participation. Access to harm reduction services was dichotomised into high versus low/no access. Descriptive statistics, chi-square tests, and multivariable logistic regression models were used to assess associations, adjusting for age, sex, education, employment status, state, and stigma. Results High access to harm reduction services was significantly associated with reductions in substance use (aOR = 3.77, 95% CI: 1.61–8.84) and improvements in housing (aOR = 3.04, 95% CI: 1.49–6.22). Employment improvement was strongly associated with being employed (aOR = 4.85, 95% CI: 2.18–10.75). Improved relationships were more likely among older participants, females, those with secondary or higher education, while stigma significantly reduced the odds. Crime reduction and community participation also improved. Conclusion Harm reduction services in Nigeria appear to yield important benefits, particularly in reducing substance use and improving housing stability. Strengthening access, reducing stigma, and scaling evidence-based interventions may enhance the broader social reintegration of PWUD. Harm reduction People who use drugs (PWUD) Substance use reduction Socioeconomic outcomes Nigeria Figures Figure 1 Figure 2 Introduction People who use drugs (PWUD) face a wide range of interconnected social, economic, and health challenges that severely limit their well-being and life opportunities. Globally, an estimated 296 million people used drugs in 2021, with 39.5 million experiencing drug-related disorders requiring health and social support services (UNODC, 2023 ). Sub-Saharan Africa carries a growing share of this burden, marked by increasing prevalence of opioid and polydrug use, rising injection-related harms, and persistent barriers to evidence-based care (Olawole-Isaac et al., 2018 ; UNODC, 2023 ). In Nigeria, drug use has escalated significantly over the past decade. The National Drug Use Survey reported that 14.4% of the adult population, over 14 million people, used psychoactive substances in 2018, a rate nearly triple the global average (UNODC, 2018 ). PWUD in Nigeria often experience structural disadvantage, including unemployment, homelessness, stigma, police harassment, and limited access to healthcare (Dirisu et al., 2022 ; Idowu et al., 2023 ; Nelson, 2024 ). Harm reduction services, including needle–syringe programmes, opioid agonist therapy, naloxone distribution, psychosocial support, and legal aid, are internationally recognised as cost-effective interventions for reducing drug-related morbidity, mortality, and social harms (Dadi et al., 2025 ; Harm Reduction International, 2024 ). Beyond health effects, there is growing evidence that access to harm reduction services may support broader socioeconomic improvements, such as stabilising housing, enhancing employability, reducing criminal justice involvement, and strengthening family and community integration (Khan et al., 2022 ; Marlatt & Witkiewitz, 2010 ; Tseole & Pillay, 2025 ). These socioeconomic outcomes are important markers of recovery, resilience, and reintegration, yet they remain under-examined in sub-Saharan Africa, particularly in Nigeria. Nigeria has made incremental progress in expanding harm reduction activities through civil-society organisations and donor-supported programmes, despite ongoing political and legal barriers (Nelson, 2024 ; UNODC, 2024 ). However, empirical research examining the impact of harm reduction services on socioeconomic outcomes among Nigerian PWUD is limited. Existing studies focus primarily on health outcomes such as HIV, hepatitis, overdose, and mental health, with little attention to whether harm reduction participation improves daily functioning, social relationships, safety, or economic stability (Dadi et al., 2025 ; Dirisu et al., 2022 ). Understanding these relationships is crucial for informing national drug policy reforms, expanding community-based services, and strengthening social protection interventions for one of the country’s most marginalised populations. To address this gap, the present study examines the association between access to harm reduction services and a set of self-reported improvement outcomes among PWUD in three Nigerian states. These outcomes include reduced substance use, as well as several socioeconomic improvements such as improved housing, enhanced employment opportunities, strengthened family and social relationships, reduced involvement in crime, and increased participation in community activities. By analysing data from a multi-state harm reduction programme evaluation, this study offers novel evidence on the broader health, social, and economic benefits of harm reduction in the Nigerian context. The findings have important implications for national strategies aimed at reducing drug-related harm, promoting social reintegration, and strengthening evidence-based policy development. Materials and methods Study Design and Setting This study employed a cross-sectional analytical design using data from a harm reduction programme evaluation implemented across three Nigerian states: Abia, Gombe, and the Federal Capital Territory (FCT). The dataset includes detailed information on participants’ sociodemographic characteristics, access to harm reduction services, substance use practices, health complications, and socioeconomic conditions. Data were collected using interviewer-administered electronic questionnaires deployed through the Open Data Kit (ODK) platform. Data collection was conducted by trained enumerators with prior experience in community-based health and behavioural research Study Population and Sampling The study population consisted of adults aged 18 years and older who self-identified as people who use drugs (PWUD) and who had been exposed to at least one harm reduction service in their locality. Participants were recruited through harm reduction service centres, drop-in facilities, and community outreach activities. A multi-stage sampling strategy was used. First, the three study states were purposively selected based on the presence of active harm reduction programmes. Within each state, harm reduction service delivery sites were randomly selected. All eligible and consenting clients presenting at the selected sites were invited to participate in the study. Data Source and Variables Data were extracted from the “Harm Reduction Program Monitoring Dataset,” which includes multiple modules on demographics, substance use, health outcomes, economic conditions, stigma, and psychosocial support. Outcome Variables (socioeconomic and behavioural improvement indicators) Six socioeconomic and behavioural improvement domains were analysed. Each outcome captured self-reported positive changes following exposure to harm reduction services. All outcomes were dichotomised (1 = improvement; 0 = no improvement). These outcomes include substance use, housing, employment, relationship with family and friends, crime reduction, and community participation. Substance use reduction : Participants were asked whether their substance use had changed since joining the harm reduction programme (responses included decreased, increased, or remained the same). Those reporting decreased use were coded as 1; all other responses were coded as 0. Housing improvement : Participants reported whether the harm reduction programme influenced their housing quality (responses included improved, impaired, or no change). “Improved” was coded as 1; others as 0. Employment improvement : Participants indicated whether their employment conditions improved due to harm reduction services (responses included improved, impaired, or no change). “Improved” was coded as 1; others as 0. Improved relationship with family and friends : Responses followed the same structure (improved, impaired, no change), with “improved” coded as 1. Crime reduction : Participants indicated whether their involvement in crime had changed following harm reduction exposure. “Improved” (i.e., reduction) was coded as 1; others as 0. Lastly, community participation : Participants reported whether the programme influenced their involvement in community activities and social integration. “Improved” responses were coded as 1. Independent Variable Access to Harm Reduction Program: Participants were asked on how often do they have access to the harm reduction services, including needle syringe program, medication-assisted therapy (MAT), access to naloxone, drug consumption rooms, condoms and lubricant distribution, PrEP, mental health and psychosocial support services, information on safer drug use, and legal/paralegal services, and the responses were regularly, occasionally, rarely and never. Those who responded to having regular access to at least one harm reduction service were coded as 1, and the rest were coded as 0. Covariates Potential confounders were identified based on theoretical relevance and data availability. These include: Age, sex, education level, employment status, state of PWID, and stigma/discrimination. Age referred to the age of the participants at the time of the study and was measured as a continuous variable. Sex referred to the gender of the participants and was measured as male or female. Education level referred to the highest educational qualification of the participants and was measured as no education or primary, secondary and higher education. Employment status was captured as unemployed, employed and student. PWID state , referred to the states of residence of PWID, and was captured as the FCT, Abia and Gombe States. Lastly, stigma referred to ever being discriminated against because they were drug users and was measured as yes or no. Analytical approach This study analysed data from 210 PWID aged 18–52 in the States in Nigeria, including the FCT. Exploratory data checks were conducted to assess data completeness and consistency. A three-stage analytical approach was used to examine the association between access to harm reduction services and socioeconomic outcomes (Substance use, housing, employment, relationship with family and friends, crime reduction, and community participation). First, we computed descriptive analysis, using weighted frequencies for outcome variables, main predictor, and covariates. In addition, computed the descriptive estimates of all the harm reduction services available to the PWID in the study. Second, conducted a chi-Square bivariate relationship between access to harm reduction and all outcomes. Third, we conducted multivariable logistic regression models fitted separately for each outcome of this study. Results from the final model were reported as adjusted odds ratios (AORs) with 95% confidence intervals and a p-value set at <0.005 to provide interpretable estimates of the relationship between the predictor and the likelihood of experiencing socioeconomic improvement when being exposed to the harm reduction program. Ethical Considerations The study was conducted under ethical approval obtained from the National Health Research Ethics Committee of Nigeria (NHREC). Written informed consent was obtained from all participants before data collection. Data were anonymised, and participation was voluntary, with the right to withdraw at any time. Results Study characteristics We analysed data from 210 people who use drugs (PWUD) enrolled across three Nigerian states (Table 1). Overall, 74.76% of participants reported a reduction in substance use following engagement with harm reduction services. Improvements were also noted across several socioeconomic domains: 39.05% reported improved housing conditions, 30.0% experienced better employment prospects, and 64.76% reported strengthened relationships with family and friends. Additionally, 30.0% indicated reduced involvement in crime, while 70.48% reported increased participation in community activities. Access to harm reduction services was almost evenly distributed in the sample, with 49.05% reporting high access and 50.95% reporting low or no access. The participants’ sociodemographic characteristics revealed that the mean age of the study population is 28.87, while 60% were male and 40% were female. More than half (56.67%) had completed secondary education, while 25.71% attained higher education, and 17.62% had no or only primary education. Employment levels varied: 50.95% were employed, 39.52% were unemployed, and 9.52% were students. The sample was almost evenly distributed across the three study locations, with 33.81% residing in the FCT, 32.86% in Abia, and 33.33% in Gombe. Experiences of stigma were common, with 68.10% reporting discrimination due to drug use. Table 1: Characteristics of the study population n=210 Percentage Outcome Substance use reduction No Yes 53 157 25.24 74.76 Housing improvement No Yes 128 82 60.95 39.05 Employment improvement No Yes 147 63 70.0 30.0 Improved relationship with family and friends No Yes 74 136 35.24 64.76 Crime reduction No Yes 147 63 70.0 30.0 Improvement in community participation No Yes 62 148 29.52 70.48 Exposure Access to harm reduction services Low or no access High access 107 103 50.95 49.05 Sociodemographic Age Mean= 28.87; SD= 6.66 Gender Female Male 84 126 40.00 60.00 Education No education or primary Secondary Higher 37 119 54 17.62 56.67 25.71 Employment status Unemployed Employed Student 83 107 20 39.52 50.95 9.52 PWID state FCT Abia Gombe 71 69 70 33.81 32.86 33.33 Stigma No Yes 67 143 31.90 68.10 Access to Harm reduction services for PWUD Figure 1 illustrates the distribution of harm reduction services available to people who use drugs in the study setting. Access to prevention-focused interventions was high: 99% of participants reported access to condoms and lubricants, 82% had access to PrEP, and 77% accessed needle and syringe programmes. In addition, 74% received information on safer drug use, reflecting strong availability of educational and risk-reduction components. Supportive services were less consistently available. 50% of participants reported access to mental health support, while only 15% had access to legal or paralegal services. Critical overdose-prevention interventions, including access to naloxone, were available to a small proportion of participants. MAT had the lowest reported availability at just 2%, highlighting substantial gaps in evidence-based treatment options for opioid dependence. Prevalence and Bivariate Relationships Between Access to Harm Reduction, Substance Use Reduction and Socioeconomic Improvement Outcomes The bivariate analysis revealed notable differences in substance use reduction and selected socioeconomic improvement outcomes by level of access to harm reduction services (Table 2). Reductions in substance use and improvements in housing conditions were the only outcomes significantly associated with HR access. Substance use reduction was reported by 59.24% of participants with high HR access compared to 40.76% of those with low or no access (χ² = 25.84; p < 0.001). Similarly, housing improvement was more prevalent among participants with high access (58.54%) than among those with limited access (41.46%), a difference that was statistically significant (χ² = 4.85; p = 0.028). Other socioeconomic indicators, including employment improvement, improved relationships with family and friends, crime reduction, and enhanced community participation, did not show statistically significant variation by HR access level. For example, employment improvement was reported by 53.97% of participants with high access and 46.03% of those with limited access (p = 0.350), while improved family and friends relationships were reported by 45.59% and 54.41%, respectively (p = 0.174). Similarly, crime reduction (p = 0.217) and community participation (p = 0.630) did not differ significantly between access groups. Table 2: Bivariate Chi-Square Analysis and Prevalence of Substance Use Reduction and Socioeconomic Improvements Variables No or Low Access High Access χ 2 (P-value) Number (Percentage) Percentage (95%CI) Substance use reduction No Yes 43 (81.13) 64 (40.76) 10 (18.87) 93 (59.24) 25.8370 (<0.001) Housing improvement No Yes 73 (57.03) 34 (41.46) 55 (42.97) 48 (58.54) 4.8471 (0.028) Employment improvement No Yes 78 (53.06) 29 (46.03) 69 (46.84) 34 (53.97) 0.8720 (0.350) Improved relationship with family and friends No Yes 33 (44.59) 74 (54.41) 41 (51.41) 62 (45.59) 1.8482 (0.174) Crime reduction No Yes 79 (53.74) 28 (44.44) 68 (46.26) 35 (55.56) 1.5253 (0.217) Improvement in community participation No Yes 30 (48.39) 77 (52.03) 32 (51.61) 71 (47.97) 0.2317 (0.630) Multivariable findings Factors associated with substance use reduction In the multivariable analysis (Figure 2A), three factors showed statistically significant associations with reductions in substance use among PWUD. Participants with high access to harm reduction services had higher odds of reporting reduced substance use compared to those with low or no access (aOR = 3.77, 95% CI: 1.61–8.84). Being a student was also strongly associated with substance use reduction, with students showing substantially higher odds of substance use reduction compared to unemployed individuals (aOR = 5.54, 95% CI: 1.35–22.68). Participants residing in Abia State had significantly lower odds of substance use reduction compared with those in the FCT (aOR = 0.10, 95% CI: 0.03–0.33). Factors associated with housing improvement In the multivariable analysis (Figure 2B), several factors were significantly associated with improvements in housing conditions among PWUD. Participants with high access to harm reduction services had a higher odds of reporting improved housing compared with those with low or no access (aOR = 3.04, 95% CI: 1.49–6.22). Female participants were more likely to report improved housing compared to male participants (aOR = 3.04, 95% CI: 1.49–6.22). Employed participants showed higher odds of improved housing compared to unemployed individuals (aOR = 2.63, 95% CI: 1.28–5.42). Participants residing in Abia State (aOR = 6.66, 95% CI: 2.52–17.62) and Gombe State (aOR = 8.69, 95% CI: 3.45–21.90) had significantly higher odds of housing improvement compared with those in the Federal Capital Territory. Participants who experienced stigma related to drug use had a borderline lower odds of housing improvement (aOR ≈ 0.51, 95% CI: 0.25–1.02), suggesting that discrimination may undermine the broader benefits of harm reduction engagement. Factors associated with employment improvement The multivariable analysis in Figure 2C revealed that high access to harm reduction services is not significantly associated with improved employment. However, participants who were currently employed had substantially higher odds of reporting employment improvement compared with those who were unemployed (aOR = 4.85, 95% CI: 2.18–10.75). PWUD residing in Abia State had significantly greater odds of improvement in employment outcomes compared with those in the Federal Capital Territory (aOR = 5.81, 95% CI: 2.06–16.44). Those in Gombe State also exhibited higher odds (aOR = 9.53, 95% CI: 3.51–25.86; p < 0.001), suggesting stronger employment-related benefits in states where harm reduction service ecosystems may be more supportive. Although stigma approached significance, individuals who reported experiencing stigma had lower odds of employment improvement (aOR = 0.49, 95% CI: 0.23–1.02), indicating a potential negative influence that warrants further investigation. Factors associated with improved relationships with family and friends Access to Harm reduction services was not significantly associated with improvements in relationships with family and friends among PWUD in Figure 2D. Age was a significant predictor: each additional year of age was associated with higher odds of reporting improved relationships (aOR = 1.08, 95% CI: 1.01–1.16). Female participants had a higher odds of relationship improvement compared with males (aOR = 2.74, 95% CI: 1.17–6.42; p = 0.020). PWUD with secondary education (aOR = 7.60, 95% CI: 2.54–22.79; p < 0.001) and higher education (aOR = 7.16, 95% CI: 2.06–24.88; p = 0.002) had higher odds of improved family and friends relationships compared with those with no or primary education. Participants residing in Abia State (aOR = 16.99, 95% CI: 5.73–50.37; p < 0.001) and (aOR = 23.62, 95% CI: 7.88–70.78; p < 0.001) had significantly greater odds of reporting improved relationships compared with those in the FCT. Experiencing stigma was a strong negative predictor. Participants who reported stigma had substantially lower odds of improved relationships (aOR = 0.23, 95% CI: 0.10–0.55; p = 0.001), suggesting that discriminatory experiences may significantly undermine social reintegration efforts. Factors associated with crime reduction In the adjusted analysis (Figure 2E), only one variable, state of residence, was significantly associated with crime reduction among PWUD. Participants living in Gombe State had higher odds of reporting reduced involvement in crime compared with those in the FCT (aOR = 54.93, 95% CI: 15.44–195.34). Access to harm reduction services and all other covariates were statistically insignificant. Factors associated with community participation In the adjusted analysis in Figure 2F, access to harm reduction was not significantly associated with improved community participation. However, the state of residence emerged as a strong predictor of improved community participation among PWUD. Participants residing in Abia State had significantly higher odds of reporting improved participation in community activities compared to those in the FCT (aOR = 3.27, 95% CI: 1.38–7.74). This association was even stronger for participants in Gombe State, who had nearly fifteen times higher odds of improved community engagement (aOR = 14.97, 95% CI: 4.97–45.09). Discussion This study provides new evidence on the relationship between access to harm reduction services and both substance use reduction and socioeconomic improvement outcomes among PWUD in Nigeria. While harm reduction is increasingly recognised globally as a critical component of public health and social protection systems, empirical research from West Africa, particularly Nigeria, remains limited. The present study contributes to this growing evidence base by highlighting how access to harm reduction services relates not only to substance use reduction but also to broader indicators of socioeconomic improvements and reintegration. Substance use reduction High access to harm reduction services emerged as a strong predictor of reduced substance use. Participants with regular access were nearly four times more likely to report reductions in drug use compared to those with low or no access. This aligns with previous evidence demonstrating that ongoing engagement with harm reduction services, such as safer-use education, psychosocial support, and structured outreach, supports behavioural change even in the absence of MAT (Farhoudian et al., 2022 ; Marlatt & Witkiewitz, 2010 ; Tseole & Pillay, 2025 ). Although MAT availability was very low in this study (2%), the observed behavioural improvements suggest that low-threshold, non-clinical harm reduction interventions still offer meaningful support to PWUD in resource-constrained settings. Students also showed significantly higher odds of substance use reduction. Education systems may offer greater social structure and supportive networks, which have been associated with increased readiness for behavioural change (Dirisu et al., 2022 ). Conversely, PWUD in Abia State had substantially lower odds of reducing substance use compared with those in the FCT, possibly reflecting local differences in service availability, policing, or stigma. Socioeconomic improvement outcomes Across socioeconomic indicators, the strongest associations were observed for housing improvement, employment conditions, family and friend relationships, and community participation. High access to harm reduction was significantly associated with improved housing conditions. Consistent with existing literature, stabilising drug use and gaining trust in support programmes may facilitate improved daily functioning and the ability to maintain shelter (Ingram et al., 2025 ; Marlatt & Witkiewitz, 2010 ). Women were also more likely to report housing improvements, echoing findings from Nigeria and elsewhere, suggesting that women often experience more acute levels of vulnerability and therefore benefit more immediately from supportive interventions (Dadi et al., 2025 ). Employment improvement was most strongly predicted by current employment status, suggesting that harm reduction services may reinforce rather than initiate economic reintegration. This pattern aligns with prior research indicating that individuals with some economic stability show greater responsiveness to harm reduction interventions due to reduced structural vulnerability (Nelson, 2024 ). Improved relationships with family and friends were strongly associated with age, gender, education level, and state of residence. Consistent with previous studies, older PWUD and women were more likely to report improved relationships, which may reflect stronger social bonds or caregiving responsibilities (Kidorf et al., 2016 ; Rushton et al., 2025 ). Higher educational attainment also showed strong predictive value, consistent with broader evidence linking education to improved treatment engagement and resilience (Cadri et al., 2024 ). The positive associations observed in Abia and Gombe States may reflect variations in community acceptance or the organisational strengths of implementing partners. Crime reduction and community participation Crime reduction was significantly associated only with residence in Gombe State. Gombe may possess contextual factors, such as stronger community-based programming or differing patterns of policing, conducive to reduced criminal involvement. Similarly, community participation was significantly higher among PWUD in Abia and Gombe, pointing to possible differences in local stigma, community programme integration, or social cohesion. Evidence suggests that community-embedded harm reduction programmes foster greater social reintegration in settings where they are well-established (Khan et al., 2022 ). The role of stigma Stigma appeared consistently as a barrier across several outcomes, including housing improvement, employment improvement, and family relationship strengthening. Stigma has been widely documented as a major determinant of exclusion, service avoidance, and poor reintegration outcomes among PWUD (Dirisu et al., 2022 ). These findings underscore the urgent need for anti-stigma programming alongside service expansion. Strengths and Limitations This study has several important strengths. It is one of the few empirical analyses in Nigeria to examine socioeconomic outcomes associated with harm reduction programs, addressing a critical gap in national and regional evidence. By drawing on data from PWUD across three different states, the study incorporates geographic diversity that enhances the general relevance of the findings within the Nigerian context. The inclusion of multiple socioeconomic outcome domains provides a holistic understanding of how harm reduction participation may influence broader aspects of stability and well-being. Despite these strengths, several limitations must be acknowledged. The cross-sectional study design precludes causal inference, meaning that observed improvements cannot be directly attributed to harm reduction exposure. All outcomes were self-reported and may therefore be influenced by recall bias or social desirability bias commonly observed in studies involving stigmatised behaviours. The measure of exposure, self-reported frequency of access to harm reduction services, may not fully capture the quality, intensity, or duration of service engagement. Additionally, the study sample consisted only of individuals already connected to harm reduction programmes, limiting generalisability to PWUD who remain unreached or disengaged from services. Finally, the relatively small sample size may have reduced statistical power for some analyses, especially for outcomes with lower prevalence. Conclusion This study provides important new evidence on the broader benefits of harm reduction services for people who use drugs in Nigeria. High access to harm reduction services was significantly associated with reductions in substance use and improvements in housing stability, while structural and demographic factors played key roles in employment, family relationships, and community engagement. Although not all socioeconomic outcomes were directly influenced by harm reduction access, the findings suggest that harm reduction can serve as an essential entry point for behavioural change and social reintegration, particularly when embedded within supportive community environments. To maximise impact, Nigeria’s harm reduction landscape requires substantial expansion, including wider availability of MAT, overdose prevention tools, mental health support, and legal services, alongside targeted strategies to reduce stigma and strengthen socioeconomic opportunities. As drug use continues to rise, scaling up comprehensive harm reduction services remains critical for reducing harm, promoting dignity, and supporting reintegration among one of the country’s most marginalised populations. Declarations Ethics approval and consent to participate The study was conducted in accordance with the ethical principles of the Declaration of Helsinki for research involving human participants. Ethical approval was obtained from the National Health Research Ethics Committee of Nigeria (NHREC: NHREC/01/01/2007). Written informed consent was obtained from all participants prior to data collection. Data were anonymised, participation was voluntary, and participants had the right to withdraw at any time without consequence. Consent for publication: Not applicable Availability of data and materials: The data used in this study are available upon reasonable request from YouthRISE Nigeria via https://youthriseng.org/. Competing interests: The authors declare that they have no competing interests Funding: This work was supported in part by the funding from Elton John Foundation. However the funders had no role in the study design, data collection and analysis, preparation of the manuscript, and decision to publish the study. 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Harm Reduction Journal 2022 19:1 , 19 (1), 35-. https://doi.org/10.1186/S12954-022-00622-8 Kidorf, M., Latkin, C., & Brooner, R. K. (2016). Presence of Drug-Free Family and Friends in the Personal Social Networks of People Receiving Treatment for Opioid Use Disorder. Journal of Substance Abuse Treatment , 70 , 87–92. https://doi.org/10.1016/J.JSAT.2016.08.013 Marlatt, G. A., & Witkiewitz, K. (2010). Update on harm-reduction policy and intervention research. Annual Review of Clinical Psychology , 6 (Volume 6, 2010), 591–606. https://doi.org/10.1146/ANNUREV.CLINPSY.121208.131438/CITE/REFWORKS Nelson, E.-U. (2024). Harm reduction programmes for people who inject drugs in Nigeria: Challenges in implementation and sustainability . Olawole-Isaac, A., Ogundipe, O., Amoo, E. O., & Adeloye, D. (2018). Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. South African Journal of Child Health , 12 (SPE), s79–s84. https://doi.org/10.7196/SAJCH.2018.V12I2.1524 Rushton, C. M., Beck, A. K., Kelly, P. J., Coleman, P., & Larance, B. (2025). Characteristics of family, friends, and significant others affected by another’s alcohol or other drug use in Australia and correlates of help-seeking. Drug and Alcohol Dependence , 112996. https://doi.org/10.1016/J.DRUGALCDEP.2025.112996 Tseole, N. P., & Pillay, J. D. (2025). Harm reduction in substance use: perspectives and experiences of community volunteers and student interns in Durban, South Africa. Harm Reduction Journal 2025 22:1 , 22 (1), 91-. https://doi.org/10.1186/S12954-025-01253-5 UNODC. (2018). DRUG USE IN NIGERIA Executive Summary . https://www.unodc.org/documents/data-and-analysis/statistics/Drugs/Drug_use_Survey_Nigeria_2019_executive-summary.pdf UNODC. (2023). World Drug Report 2023 . www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html UNODC. (2024). UNODC strategic vision for Nigeria 2024 . https://www.unodc.org/conig/uploads/documents/2024-05-13_UNODC_Strategic_Vision_for_Nigeria_2024-PRINT_VERSION.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 Apr, 2026 Reviews received at journal 05 Apr, 2026 Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 27 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 20 Mar, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers invited by journal 18 Mar, 2026 Editor invited by journal 20 Feb, 2026 Editor assigned by journal 18 Feb, 2026 Submission checks completed at journal 18 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8865927","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609469252,"identity":"4c3c30be-d0ea-444e-a5cb-1197c8a40ea6","order_by":0,"name":"Adeolu oluwole Adebiyi","email":"","orcid":"","institution":"Marilak Services Limited","correspondingAuthor":false,"prefix":"","firstName":"Adeolu","middleName":"oluwole","lastName":"Adebiyi","suffix":""},{"id":609469254,"identity":"8f7cae5c-9f07-464c-b00a-c95085b4e46e","order_by":1,"name":"Oluwafisayo Alao-Amiola","email":"","orcid":"","institution":"Youth Initiative for Drug Research Information Support and Education in Nigeria (YouthRISE Nigeria)","correspondingAuthor":false,"prefix":"","firstName":"Oluwafisayo","middleName":"","lastName":"Alao-Amiola","suffix":""},{"id":609469255,"identity":"099c563f-740d-42c7-99f3-cbffc89bab48","order_by":2,"name":"Henry Silas Okiwu","email":"","orcid":"","institution":"Youth Initiative for Drug Research Information Support and Education in Nigeria (YouthRISE Nigeria)","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"Silas","lastName":"Okiwu","suffix":""},{"id":609469257,"identity":"2ea2e579-1fc5-4d9b-9a4f-fbf75dffc3ec","order_by":3,"name":"Ololade Julius Baruwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACAygtw8DOwCDBUAFkMjM3EKWFh4EZpOUMSAsjKVoY20BsAlrM2c8+k+apseHhZ2Z+eOPjvNpo/naglh8V23BqsexJN5PmOZbGI9nMZmw5c9vx3BmHGRsYe87cxu2wA2ls0jlsh3kMDjOYSfNuO5bbANTCzNiGR8v5Z0At/0Ba2L9J/51zLHc+QS03gLbktoG08JhJMzbU5G4gpMVyxjNm6799IL/wFFv2HDuQuxGo5SA+v5jzpzHenPHNRo6fvX3jjR81dbnzzh8++OBHBW4t6OAwmDxAtHogqCNF8SgYBaNgFIwQAACt5lS7QHot1QAAAABJRU5ErkJggg==","orcid":"","institution":"University of Cape Town","correspondingAuthor":true,"prefix":"","firstName":"Ololade","middleName":"Julius","lastName":"Baruwa","suffix":""}],"badges":[],"createdAt":"2026-02-12 22:38:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8865927/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8865927/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105195896,"identity":"3b829e4d-ca7c-494b-aabb-557c0846c19a","added_by":"auto","created_at":"2026-03-23 10:17:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64834,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of access to harm reduction services available to PWUD\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8865927/v1/43a9313801bf2cd17037dd0d.png"},{"id":105195897,"identity":"391802c2-fcb2-448b-a6e1-647c1f74dc4b","added_by":"auto","created_at":"2026-03-23 10:17:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":230991,"visible":true,"origin":"","legend":"\u003cp\u003eAdjusted odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with substance use reduction and socioeconomic improvement outcomes among people who use drugs (PWUD): (A) reduced substance use, (B) housing improvement, (C) employment improvement, (D) improved relationships with family and friends, (E) crime reduction, and (F) community participation improvement.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8865927/v1/3d0ccbb6ec958153c2fd17a3.png"},{"id":105563766,"identity":"c6a37754-ea80-41e3-9c1b-a2f0aeea84eb","added_by":"auto","created_at":"2026-03-27 12:47:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1236054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8865927/v1/8571d56f-2735-4369-96f8-00c232841feb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Access to Harm Reduction Services and Socioeconomic Improvement Among People Who Use Drugs in Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeople who use drugs (PWUD) face a wide range of interconnected social, economic, and health challenges that severely limit their well-being and life opportunities. Globally, an estimated 296\u0026nbsp;million people used drugs in 2021, with 39.5\u0026nbsp;million experiencing drug-related disorders requiring health and social support services (UNODC, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Sub-Saharan Africa carries a growing share of this burden, marked by increasing prevalence of opioid and polydrug use, rising injection-related harms, and persistent barriers to evidence-based care (Olawole-Isaac et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; UNODC, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In Nigeria, drug use has escalated significantly over the past decade. The National Drug Use Survey reported that 14.4% of the adult population, over 14\u0026nbsp;million people, used psychoactive substances in 2018, a rate nearly triple the global average (UNODC, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). PWUD in Nigeria often experience structural disadvantage, including unemployment, homelessness, stigma, police harassment, and limited access to healthcare (Dirisu et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Idowu et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nelson, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHarm reduction services, including needle\u0026ndash;syringe programmes, opioid agonist therapy, naloxone distribution, psychosocial support, and legal aid, are internationally recognised as cost-effective interventions for reducing drug-related morbidity, mortality, and social harms (Dadi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Harm Reduction International, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Beyond health effects, there is growing evidence that access to harm reduction services may support broader socioeconomic improvements, such as stabilising housing, enhancing employability, reducing criminal justice involvement, and strengthening family and community integration (Khan et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Marlatt \u0026amp; Witkiewitz, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Tseole \u0026amp; Pillay, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These socioeconomic outcomes are important markers of recovery, resilience, and reintegration, yet they remain under-examined in sub-Saharan Africa, particularly in Nigeria.\u003c/p\u003e \u003cp\u003eNigeria has made incremental progress in expanding harm reduction activities through civil-society organisations and donor-supported programmes, despite ongoing political and legal barriers (Nelson, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; UNODC, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, empirical research examining the \u003cem\u003eimpact\u003c/em\u003e of harm reduction services on socioeconomic outcomes among Nigerian PWUD is limited. Existing studies focus primarily on health outcomes such as HIV, hepatitis, overdose, and mental health, with little attention to whether harm reduction participation improves daily functioning, social relationships, safety, or economic stability (Dadi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Dirisu et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Understanding these relationships is crucial for informing national drug policy reforms, expanding community-based services, and strengthening social protection interventions for one of the country\u0026rsquo;s most marginalised populations.\u003c/p\u003e \u003cp\u003eTo address this gap, the present study examines the association between access to harm reduction services and a set of self-reported improvement outcomes among PWUD in three Nigerian states. These outcomes include reduced substance use, as well as several socioeconomic improvements such as improved housing, enhanced employment opportunities, strengthened family and social relationships, reduced involvement in crime, and increased participation in community activities. By analysing data from a multi-state harm reduction programme evaluation, this study offers novel evidence on the broader health, social, and economic benefits of harm reduction in the Nigerian context. The findings have important implications for national strategies aimed at reducing drug-related harm, promoting social reintegration, and strengthening evidence-based policy development.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\n\u003cp\u003eThis study employed a cross-sectional analytical design using data from a harm reduction programme evaluation implemented across three Nigerian states: Abia, Gombe, and the Federal Capital Territory (FCT). The dataset includes detailed information on participants\u0026rsquo; sociodemographic characteristics, access to harm reduction services, substance use practices, health complications, and socioeconomic conditions. Data were collected using interviewer-administered electronic questionnaires deployed through the Open Data Kit (ODK) platform. Data collection was conducted by trained enumerators with prior experience in community-based health and behavioural research\u003c/p\u003e\n\u003cp\u003eStudy Population and Sampling\u003c/p\u003e\n\u003cp\u003eThe study population consisted of adults aged 18 years and older who self-identified as people who use drugs (PWUD) and who had been exposed to at least one harm reduction service in their locality. Participants were recruited through harm reduction service centres, drop-in facilities, and community outreach activities.\u003c/p\u003e\n\u003cp\u003eA multi-stage sampling strategy was used. First, the three study states were purposively selected based on the presence of active harm reduction programmes. Within each state, harm reduction service delivery sites were randomly selected. All eligible and consenting clients presenting at the selected sites were invited to participate in the study.\u003c/p\u003e\n\u003cp\u003eData Source and Variables\u003c/p\u003e\n\u003cp\u003eData were extracted from the \u0026ldquo;Harm Reduction Program Monitoring Dataset,\u0026rdquo; which includes multiple modules on demographics, substance use, health outcomes, economic conditions, stigma, and psychosocial support.\u003c/p\u003e\n\u003cp\u003eOutcome Variables (socioeconomic and behavioural improvement indicators)\u003c/p\u003e\n\u003cp\u003eSix socioeconomic and behavioural improvement domains were analysed. Each outcome captured self-reported positive changes following exposure to harm reduction services. All outcomes were dichotomised (1 = improvement; 0 = no improvement). These outcomes include substance use, housing, employment, relationship with family and friends, crime reduction, and community participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSubstance use reduction\u003c/em\u003e: Participants were asked whether their substance use had changed since joining the harm reduction programme (responses included decreased, increased, or remained the same). Those reporting decreased use were coded as 1; all other responses were coded as 0. \u003cem\u003eHousing improvement\u003c/em\u003e: Participants reported whether the harm reduction programme influenced their housing quality (responses included improved, impaired, or no change). \u0026ldquo;Improved\u0026rdquo; was coded as 1; others as 0. \u003cem\u003eEmployment improvement\u003c/em\u003e: Participants indicated whether their employment conditions improved due to harm reduction services (responses included improved, impaired, or no change). \u0026ldquo;Improved\u0026rdquo; was coded as 1; others as 0. \u003cem\u003eImproved relationship with family and friends\u003c/em\u003e: Responses followed the same structure (improved, impaired, no change), with \u0026ldquo;improved\u0026rdquo; coded as 1. \u003cem\u003eCrime reduction\u003c/em\u003e: Participants indicated whether their involvement in crime had changed following harm reduction exposure. \u0026ldquo;Improved\u0026rdquo; (i.e., reduction) was coded as 1; others as 0. Lastly, \u003cem\u003ecommunity participation\u003c/em\u003e: Participants reported whether the programme influenced their involvement in community activities and social integration. \u0026ldquo;Improved\u0026rdquo; responses were coded as 1.\u003c/p\u003e\n\u003cp\u003eIndependent Variable\u003c/p\u003e\n\u003cp\u003eAccess to Harm Reduction Program: Participants were asked on how often do they have access to the harm reduction services, including needle syringe program, medication-assisted therapy (MAT), access to naloxone, drug consumption rooms, condoms and lubricant distribution, PrEP, mental health and psychosocial support services, information on safer drug use, and legal/paralegal services, and the responses were regularly, occasionally, rarely and never. Those who responded to having regular access to at least one harm reduction service were coded as 1, and the rest were coded as 0.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCovariates\u003c/p\u003e\n\u003cp\u003ePotential confounders were identified based on theoretical relevance and data availability. These include: Age, sex, education level, employment status, state of PWID, and stigma/discrimination. \u003cem\u003eAge\u003c/em\u003e referred to the age of the participants at the time of the study and was measured as a continuous variable. \u003cem\u003eSex\u003c/em\u003e referred to the gender of the participants and was measured as male or female. \u003cem\u003eEducation level\u003c/em\u003e referred to the highest educational qualification of the participants and was measured as no education or primary, secondary and higher education. \u003cem\u003eEmployment status\u003c/em\u003e was captured as unemployed, employed and student. \u003cem\u003ePWID state\u003c/em\u003e, referred to the states of residence of \u0026nbsp;PWID, and was captured as the FCT, Abia and Gombe States. Lastly, \u003cem\u003estigma\u003c/em\u003e referred to ever being discriminated against because they were drug users and was measured as yes or no.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalytical approach\u003c/p\u003e\n\u003cp\u003eThis study analysed data from 210 PWID aged 18\u0026ndash;52 in the States in Nigeria, including the FCT. Exploratory data checks were conducted to assess data completeness and consistency. A three-stage analytical approach was used to examine the association between access to harm reduction services and socioeconomic outcomes (Substance use, housing, employment, relationship with family and friends, crime reduction, and community participation). First, we computed descriptive analysis, using weighted frequencies for outcome variables, main predictor, and covariates. In addition, computed the descriptive estimates of all the harm reduction services available to the PWID in the study. Second, conducted a chi-Square bivariate relationship between access to harm reduction and all outcomes. Third, we conducted multivariable logistic regression models fitted separately for each outcome of this study. Results from the final model were reported as adjusted odds ratios (AORs) with 95% confidence intervals and a p-value set at \u0026lt;0.005 to provide interpretable estimates of the relationship between the predictor and the likelihood of experiencing socioeconomic improvement when being exposed to the harm reduction program.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eThe study was conducted under ethical approval obtained from the National Health Research Ethics Committee of Nigeria (NHREC). Written informed consent was obtained from all participants before data collection. Data were anonymised, and participation was voluntary, with the right to withdraw at any time.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eStudy characteristics\u003c/p\u003e\n\u003cp\u003eWe analysed data from 210 people who use drugs (PWUD) enrolled across three Nigerian states (Table 1). Overall, 74.76% of participants reported a reduction in substance use following engagement with harm reduction services. Improvements were also noted across several socioeconomic domains: 39.05% reported improved housing conditions, 30.0% experienced better employment prospects, and 64.76% reported strengthened relationships with family and friends. Additionally, 30.0% indicated reduced involvement in crime, while 70.48% reported increased participation in community activities. Access to harm reduction services was almost evenly distributed in the sample, with 49.05% reporting high access and 50.95% reporting low or no access.\u003c/p\u003e\n\u003cp\u003eThe participants\u0026rsquo; sociodemographic characteristics revealed that the mean age of the study population is 28.87, while 60% were male and 40% were female. More than half (56.67%) had completed secondary education, while 25.71% attained higher education, and 17.62% had no or only primary education. Employment levels varied: 50.95% were employed, 39.52% were unemployed, and 9.52% were students. The sample was almost evenly distributed across the three study locations, with 33.81% residing in the FCT, 32.86% in Abia, and 33.33% in Gombe. Experiences of stigma were common, with 68.10% reporting discrimination due to drug use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=210\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstance use reduction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25.24\u003c/p\u003e\n \u003cp\u003e74.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousing improvement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.95\u003c/p\u003e\n \u003cp\u003e39.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment improvement\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImproved relationship with family and friends\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35.24\u003c/p\u003e\n \u003cp\u003e64.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrime reduction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImprovement in community participation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29.52\u003c/p\u003e\n \u003cp\u003e70.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to harm reduction services\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLow or no access\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh access\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.95\u003c/p\u003e\n \u003cp\u003e49.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eMean= 28.87; SD= 6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo education or primary\u003c/p\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigher\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.62\u003c/p\u003e\n \u003cp\u003e56.67\u003c/p\u003e\n \u003cp\u003e25.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39.52\u003c/p\u003e\n \u003cp\u003e50.95\u003c/p\u003e\n \u003cp\u003e9.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePWID state\u003cbr\u003e\u003c/strong\u003eFCT\u003c/p\u003e\n \u003cp\u003eAbia\u003c/p\u003e\n \u003cp\u003eGombe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33.81\u003c/p\u003e\n \u003cp\u003e32.86\u003c/p\u003e\n \u003cp\u003e33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStigma\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31.90\u003c/p\u003e\n \u003cp\u003e68.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccess to Harm reduction services for PWUD\u003c/p\u003e\n\u003cp\u003eFigure 1 illustrates the distribution of harm reduction services available to people who use drugs in the study setting. Access to prevention-focused interventions was high: 99% of participants reported access to condoms and lubricants, 82% had access to PrEP, and 77% accessed needle and syringe programmes. In addition, 74% received information on safer drug use, reflecting strong availability of educational and risk-reduction components.\u003c/p\u003e\n\u003cp\u003eSupportive services were less consistently available. 50% of participants reported access to mental health support, while only 15% had access to legal or paralegal services. Critical overdose-prevention interventions, including access to naloxone, were available to a small proportion of participants. MAT had the lowest reported availability at just 2%, highlighting substantial gaps in evidence-based treatment options for opioid dependence.\u003c/p\u003e\n\u003cp\u003ePrevalence and Bivariate Relationships Between Access to Harm Reduction, Substance Use Reduction and Socioeconomic Improvement Outcomes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe bivariate analysis revealed notable differences in substance use reduction and selected socioeconomic improvement outcomes by level of access to harm reduction services (Table 2). Reductions in substance use and improvements in housing conditions were the only outcomes significantly associated with HR access. Substance use reduction was reported by 59.24% of participants with high HR access compared to 40.76% of those with low or no access (\u0026chi;\u0026sup2; = 25.84; p \u0026lt; 0.001). Similarly, housing improvement was more prevalent among participants with high access (58.54%) than among those with limited access (41.46%), a difference that was statistically significant (\u0026chi;\u0026sup2; = 4.85; p = 0.028).\u003c/p\u003e\n\u003cp\u003eOther socioeconomic indicators, including employment improvement, improved relationships with family and friends, crime reduction, and enhanced community participation, did not show statistically significant variation by HR access level. For example, employment improvement was reported by 53.97% of participants with high access and 46.03% of those with limited access (p = 0.350), while improved family and friends relationships were reported by 45.59% and 54.41%, respectively (p = 0.174). Similarly, crime reduction (p = 0.217) and community participation (p = 0.630) did not differ significantly between access groups. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Bivariate Chi-Square Analysis and Prevalence of Substance Use Reduction and Socioeconomic Improvements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo or Low Access \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh Access\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(P-value)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (Percentage)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePercentage (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstance use reduction\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43 (81.13)\u003c/p\u003e\n \u003cp\u003e64 (40.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (18.87)\u003c/p\u003e\n \u003cp\u003e93 (59.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e25.8370 (\u0026lt;0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousing improvement\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;73 (57.03)\u003c/p\u003e\n \u003cp\u003e34 (41.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55 (42.97)\u003c/p\u003e\n \u003cp\u003e48 (58.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.8471 (0.028)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment improvement\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78 (53.06)\u003c/p\u003e\n \u003cp\u003e29 (46.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69 (46.84)\u003c/p\u003e\n \u003cp\u003e34 (53.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.8720 (0.350)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImproved relationship with family and friends\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (44.59)\u003c/p\u003e\n \u003cp\u003e74 (54.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (51.41)\u003c/p\u003e\n \u003cp\u003e62 (45.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.8482 (0.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrime reduction\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e79 (53.74)\u003c/p\u003e\n \u003cp\u003e28 (44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (46.26)\u003c/p\u003e\n \u003cp\u003e35 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5253 (0.217)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImprovement in community participation\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (48.39)\u003c/p\u003e\n \u003cp\u003e77 (52.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (51.61)\u003c/p\u003e\n \u003cp\u003e71 (47.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2317 (0.630)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariable findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFactors associated with substance use reduction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the multivariable analysis (Figure 2A), three factors showed statistically significant associations with reductions in substance use among PWUD. Participants with high access to harm reduction services had higher odds of reporting reduced substance use compared to those with low or no access (aOR = 3.77, 95% CI: 1.61\u0026ndash;8.84). Being a student was also strongly associated with substance use reduction, with students showing substantially higher odds of substance use reduction compared to unemployed individuals (aOR = 5.54, 95% CI: 1.35\u0026ndash;22.68). Participants residing in Abia State had significantly lower odds of substance use reduction compared with those in the FCT (aOR = 0.10, 95% CI: 0.03\u0026ndash;0.33).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactors associated with housing improvement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the multivariable analysis (Figure 2B), several factors were significantly associated with improvements in housing conditions among PWUD. Participants with high access to harm reduction services had a higher odds of reporting improved housing compared with those with low or no access (aOR = 3.04, 95% CI: 1.49\u0026ndash;6.22). Female participants were more likely to report improved housing compared to male participants (aOR = 3.04, 95% CI: 1.49\u0026ndash;6.22). Employed participants showed higher odds of improved housing compared to unemployed individuals (aOR = 2.63, 95% CI: 1.28\u0026ndash;5.42). Participants residing in Abia State (aOR = 6.66, 95% CI: 2.52\u0026ndash;17.62) and Gombe State (aOR = 8.69, 95% CI: 3.45\u0026ndash;21.90) had significantly higher odds of housing improvement compared with those in the Federal Capital Territory. Participants who experienced stigma related to drug use had a borderline lower odds of housing improvement (aOR \u0026asymp; 0.51, 95% CI: 0.25\u0026ndash;1.02), suggesting that discrimination may undermine the broader benefits of harm reduction engagement.\u003c/p\u003e\n\u003cp\u003eFactors associated with employment improvement\u003c/p\u003e\n\u003cp\u003eThe multivariable analysis in Figure 2C revealed that high access to harm reduction services is not significantly associated with improved employment. However, participants who were currently employed had substantially higher odds of reporting employment improvement compared with those who were unemployed (aOR = 4.85, 95% CI: 2.18\u0026ndash;10.75). PWUD residing in Abia State had significantly greater odds of improvement in employment outcomes compared with those in the Federal Capital Territory (aOR = 5.81, 95% CI: 2.06\u0026ndash;16.44). Those in Gombe State also exhibited higher odds (aOR = 9.53, 95% CI: 3.51\u0026ndash;25.86; p \u0026lt; 0.001), suggesting stronger employment-related benefits in states where harm reduction service ecosystems may be more supportive. Although stigma approached significance, individuals who reported experiencing stigma had lower odds of employment improvement (aOR = 0.49, 95% CI: 0.23\u0026ndash;1.02), indicating a potential negative influence that warrants further investigation.\u003c/p\u003e\n\u003cp\u003eFactors associated with improved relationships with family and friends\u003c/p\u003e\n\u003cp\u003eAccess to Harm reduction services was not significantly associated with improvements in relationships with family and friends among PWUD in Figure 2D. Age was a significant predictor: each additional year of age was associated with higher odds of reporting improved relationships (aOR = 1.08, 95% CI: 1.01\u0026ndash;1.16). Female participants had a higher odds of relationship improvement compared with males (aOR = 2.74, 95% CI: 1.17\u0026ndash;6.42; p = 0.020).\u003c/p\u003e\n\u003cp\u003ePWUD with secondary education (aOR = 7.60, 95% CI: 2.54\u0026ndash;22.79; p \u0026lt; 0.001) and higher education (aOR = 7.16, 95% CI: 2.06\u0026ndash;24.88; p = 0.002) had higher odds of improved family and friends relationships compared with those with no or primary education. Participants residing in Abia State (aOR = 16.99, 95% CI: 5.73\u0026ndash;50.37; p \u0026lt; 0.001) and (aOR = 23.62, 95% CI: 7.88\u0026ndash;70.78; p \u0026lt; 0.001) had significantly greater odds of reporting improved relationships compared with those in the FCT. Experiencing stigma was a strong negative predictor. Participants who reported stigma had substantially lower odds of improved relationships (aOR = 0.23, 95% CI: 0.10\u0026ndash;0.55; p = 0.001), suggesting that discriminatory experiences may significantly undermine social reintegration efforts.\u003c/p\u003e\n\u003cp\u003eFactors associated with crime reduction\u003c/p\u003e\n\u003cp\u003eIn the adjusted analysis (Figure 2E), only one variable, state of residence, was significantly associated with crime reduction among PWUD. Participants living in Gombe State had higher odds of reporting reduced involvement in crime compared with those in the FCT (aOR = 54.93, 95% CI: 15.44\u0026ndash;195.34). Access to harm reduction services and all other covariates were statistically insignificant.\u003c/p\u003e\n\u003cp\u003eFactors associated with community participation\u003c/p\u003e\n\u003cp\u003eIn the adjusted analysis in Figure 2F, access to harm reduction was not significantly associated with improved community participation. However, the state of residence emerged as a strong predictor of improved community participation among PWUD. Participants residing in Abia State had significantly higher odds of reporting improved participation in community activities compared to those in the FCT (aOR = 3.27, 95% CI: 1.38\u0026ndash;7.74). This association was even stronger for participants in Gombe State, who had nearly fifteen times higher odds of improved community engagement (aOR = 14.97, 95% CI: 4.97\u0026ndash;45.09).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides new evidence on the relationship between access to harm reduction services and both substance use reduction and socioeconomic improvement outcomes among PWUD in Nigeria. While harm reduction is increasingly recognised globally as a critical component of public health and social protection systems, empirical research from West Africa, particularly Nigeria, remains limited. The present study contributes to this growing evidence base by highlighting how access to harm reduction services relates not only to substance use reduction but also to broader indicators of socioeconomic improvements and reintegration.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSubstance use reduction\u003c/h2\u003e \u003cp\u003eHigh access to harm reduction services emerged as a strong predictor of reduced substance use. Participants with regular access were nearly four times more likely to report reductions in drug use compared to those with low or no access. This aligns with previous evidence demonstrating that ongoing engagement with harm reduction services, such as safer-use education, psychosocial support, and structured outreach, supports behavioural change even in the absence of MAT (Farhoudian et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Marlatt \u0026amp; Witkiewitz, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Tseole \u0026amp; Pillay, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Although MAT availability was very low in this study (2%), the observed behavioural improvements suggest that low-threshold, non-clinical harm reduction interventions still offer meaningful support to PWUD in resource-constrained settings.\u003c/p\u003e \u003cp\u003eStudents also showed significantly higher odds of substance use reduction. Education systems may offer greater social structure and supportive networks, which have been associated with increased readiness for behavioural change (Dirisu et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Conversely, PWUD in Abia State had substantially lower odds of reducing substance use compared with those in the FCT, possibly reflecting local differences in service availability, policing, or stigma.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eSocioeconomic improvement outcomes\u003c/h2\u003e \u003cp\u003eAcross socioeconomic indicators, the strongest associations were observed for housing improvement, employment conditions, family and friend relationships, and community participation. High access to harm reduction was significantly associated with improved housing conditions. Consistent with existing literature, stabilising drug use and gaining trust in support programmes may facilitate improved daily functioning and the ability to maintain shelter (Ingram et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Marlatt \u0026amp; Witkiewitz, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Women were also more likely to report housing improvements, echoing findings from Nigeria and elsewhere, suggesting that women often experience more acute levels of vulnerability and therefore benefit more immediately from supportive interventions (Dadi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmployment improvement was most strongly predicted by current employment status, suggesting that harm reduction services may reinforce rather than initiate economic reintegration. This pattern aligns with prior research indicating that individuals with some economic stability show greater responsiveness to harm reduction interventions due to reduced structural vulnerability (Nelson, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproved relationships with family and friends were strongly associated with age, gender, education level, and state of residence. Consistent with previous studies, older PWUD and women were more likely to report improved relationships, which may reflect stronger social bonds or caregiving responsibilities (Kidorf et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Rushton et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Higher educational attainment also showed strong predictive value, consistent with broader evidence linking education to improved treatment engagement and resilience (Cadri et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The positive associations observed in Abia and Gombe States may reflect variations in community acceptance or the organisational strengths of implementing partners.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eCrime reduction and community participation\u003c/h2\u003e \u003cp\u003eCrime reduction was significantly associated only with residence in Gombe State. Gombe may possess contextual factors, such as stronger community-based programming or differing patterns of policing, conducive to reduced criminal involvement. Similarly, community participation was significantly higher among PWUD in Abia and Gombe, pointing to possible differences in local stigma, community programme integration, or social cohesion. Evidence suggests that community-embedded harm reduction programmes foster greater social reintegration in settings where they are well-established (Khan et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eThe role of stigma\u003c/h2\u003e \u003cp\u003eStigma appeared consistently as a barrier across several outcomes, including housing improvement, employment improvement, and family relationship strengthening. Stigma has been widely documented as a major determinant of exclusion, service avoidance, and poor reintegration outcomes among PWUD (Dirisu et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These findings underscore the urgent need for anti-stigma programming alongside service expansion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several important strengths. It is one of the few empirical analyses in Nigeria to examine socioeconomic outcomes associated with harm reduction programs, addressing a critical gap in national and regional evidence. By drawing on data from PWUD across three different states, the study incorporates geographic diversity that enhances the general relevance of the findings within the Nigerian context. The inclusion of multiple socioeconomic outcome domains provides a holistic understanding of how harm reduction participation may influence broader aspects of stability and well-being.\u003c/p\u003e \u003cp\u003eDespite these strengths, several limitations must be acknowledged. The cross-sectional study design precludes causal inference, meaning that observed improvements cannot be directly attributed to harm reduction exposure. All outcomes were self-reported and may therefore be influenced by recall bias or social desirability bias commonly observed in studies involving stigmatised behaviours. The measure of exposure, self-reported frequency of access to harm reduction services, may not fully capture the quality, intensity, or duration of service engagement. Additionally, the study sample consisted only of individuals already connected to harm reduction programmes, limiting generalisability to PWUD who remain unreached or disengaged from services. Finally, the relatively small sample size may have reduced statistical power for some analyses, especially for outcomes with lower prevalence.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides important new evidence on the broader benefits of harm reduction services for people who use drugs in Nigeria. High access to harm reduction services was significantly associated with reductions in substance use and improvements in housing stability, while structural and demographic factors played key roles in employment, family relationships, and community engagement. Although not all socioeconomic outcomes were directly influenced by harm reduction access, the findings suggest that harm reduction can serve as an essential entry point for behavioural change and social reintegration, particularly when embedded within supportive community environments.\u003c/p\u003e \u003cp\u003eTo maximise impact, Nigeria\u0026rsquo;s harm reduction landscape requires substantial expansion, including wider availability of MAT, overdose prevention tools, mental health support, and legal services, alongside targeted strategies to reduce stigma and strengthen socioeconomic opportunities. As drug use continues to rise, scaling up comprehensive harm reduction services remains critical for reducing harm, promoting dignity, and supporting reintegration among one of the country\u0026rsquo;s most marginalised populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles of the\u0026nbsp;\u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e for research involving human participants. Ethical approval was obtained from the National Health Research Ethics Committee of Nigeria (NHREC: NHREC/01/01/2007). Written informed consent was obtained from all participants prior to data collection. Data were anonymised, participation was voluntary, and participants had the right to withdraw at any time without consequence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are available upon reasonable request from YouthRISE Nigeria via https://youthriseng.org/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported in part by the funding from Elton John Foundation. However the funders had no role in the study design, data collection and analysis, preparation of the manuscript, and decision to publish the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors, AA, OA, HO, and JS, contributed to the conceptualisation of the study, data analysis, drafting, and reviewing the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCadri, A., Beema, A. N., Schuster, T., Barnett, T., Asampong, E., \u0026amp; Adams, A. M. (2024). School-based interventions targeting substance use among young people in low-and-middle-income countries: A scoping review. \u003cem\u003eAddiction\u003c/em\u003e, \u003cem\u003e119\u003c/em\u003e(12), 2048\u0026ndash;2075. https://doi.org/10.1111/ADD.16623;PAGE:STRING:ARTICLE/CHAPTER\u003c/li\u003e\n \u003cli\u003eDadi, A. N., Arije, O. O., Eruchalu, K., Anyanti, J., Idogho, O., Okonkwo, Y., \u0026amp; Ikani, P. (2025). Package of interventions for harm reduction among women who inject drugs in Nigeria. \u003cem\u003eArchives of Public Health\u003c/em\u003e, \u003cem\u003e83\u003c/em\u003e(1), 276. https://doi.org/10.1186/S13690-025-01753-7\u003c/li\u003e\n \u003cli\u003eDirisu, O., Adediran, M., Omole, A., Akinola, A., Ebenso, B., Shoyemi, E., Eluwa, G., Tun, W., \u0026amp; Adebajo, S. (2022). The Syndemic of Substance Use, High-Risk Sexual Behavior, and Violence: A Qualitative Exploration of the Intersections and Implications for HIV/STI Prevention Among Key Populations in Lagos, Nigeria. \u003cem\u003eFrontiers in Tropical Diseases\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e, 822566. https://doi.org/10.3389/FITD.2022.822566/BIBTEX\u003c/li\u003e\n \u003cli\u003eFarhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., Mohammadi, M. R., \u0026amp; Malekinejad, M. (2022). Barriers and Facilitators to Substance Use Disorder Treatment: An Overview of Systematic Reviews. \u003cem\u003eSubstance Abuse: Research and Treatment\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e. https://doi.org/10.1177/11782218221118462;JOURNAL:JOURNAL:SATA;WEBSITE:WEBSITE:SAGE;WGROUP:STRING:PUBLICATION\u003c/li\u003e\n \u003cli\u003eHarm Reduction International. (2024). \u003cem\u003eMAKING THE INVESTMENT CASE ECONOMIC EVIDENCE FOR HARM REDUCTION (2024 UPDATE)\u003c/em\u003e. https://hri.global/wp-content/uploads/2020/04/advocacy-brief-Final-online.pdf\u003c/li\u003e\n \u003cli\u003eIdowu, A., Aremu, A. O., Akanbi, I. M., Eseigbe, G., Adewale, V., Awubite, L., Adebayo, O., Arisa, D., Adetona, B., Olaniyan, A., Olafisoye, E., Olorunshola, O., Eyitayo, J., Ogunlana, O., Aboloye, O., Mayor, A., \u0026amp; Olatunde, E. (2023). Prevalence, pattern and determinants of substance abuse among youths in a rural community of Osun State, Southwest Nigeria. \u003cem\u003eAfrican Health Sciences\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(4), 563. https://doi.org/10.4314/AHS.V23I4.59\u003c/li\u003e\n \u003cli\u003eIngram, C., Buggy, C., \u0026amp; Perrotta, C. (2025). Barriers and enablers of addiction recovery amongst people experiencing homelessness in Dublin, Ireland: A proposed conceptual framework adapted from the REC-CAP. \u003cem\u003eJournal of Substance Use and Addiction Treatment\u003c/em\u003e, \u003cem\u003e172\u003c/em\u003e, 209669. https://doi.org/10.1016/J.JOSAT.2025.209669\u003c/li\u003e\n \u003cli\u003eKhan, G. K., Harvey, L., Johnson, S., Long, P., Kimmel, S., Pierre, C., \u0026amp; Drainoni, M. L. (2022). Integration of a community-based harm reduction program into a safety net hospital: a qualitative study. \u003cem\u003eHarm Reduction Journal 2022 19:1\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 35-. https://doi.org/10.1186/S12954-022-00622-8\u003c/li\u003e\n \u003cli\u003eKidorf, M., Latkin, C., \u0026amp; Brooner, R. K. (2016). Presence of Drug-Free Family and Friends in the Personal Social Networks of People Receiving Treatment for Opioid Use Disorder. \u003cem\u003eJournal of Substance Abuse Treatment\u003c/em\u003e, \u003cem\u003e70\u003c/em\u003e, 87\u0026ndash;92. https://doi.org/10.1016/J.JSAT.2016.08.013\u003c/li\u003e\n \u003cli\u003eMarlatt, G. A., \u0026amp; Witkiewitz, K. (2010). Update on harm-reduction policy and intervention research. \u003cem\u003eAnnual Review of Clinical Psychology\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(Volume 6, 2010), 591\u0026ndash;606. https://doi.org/10.1146/ANNUREV.CLINPSY.121208.131438/CITE/REFWORKS\u003c/li\u003e\n \u003cli\u003eNelson, E.-U. (2024). \u003cem\u003eHarm reduction programmes for people who inject drugs in Nigeria: Challenges in implementation and sustainability\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eOlawole-Isaac, A., Ogundipe, O., Amoo, E. O., \u0026amp; Adeloye, D. (2018). Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. \u003cem\u003eSouth African Journal of Child Health\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(SPE), s79\u0026ndash;s84. https://doi.org/10.7196/SAJCH.2018.V12I2.1524\u003c/li\u003e\n \u003cli\u003eRushton, C. M., Beck, A. K., Kelly, P. J., Coleman, P., \u0026amp; Larance, B. (2025). Characteristics of family, friends, and significant others affected by another\u0026rsquo;s alcohol or other drug use in Australia and correlates of help-seeking. \u003cem\u003eDrug and Alcohol Dependence\u003c/em\u003e, 112996. https://doi.org/10.1016/J.DRUGALCDEP.2025.112996\u003c/li\u003e\n \u003cli\u003eTseole, N. P., \u0026amp; Pillay, J. D. (2025). Harm reduction in substance use: perspectives and experiences of community volunteers and student interns in Durban, South Africa. \u003cem\u003eHarm Reduction Journal 2025 22:1\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 91-. https://doi.org/10.1186/S12954-025-01253-5\u003c/li\u003e\n \u003cli\u003eUNODC. (2018). \u003cem\u003eDRUG USE IN NIGERIA Executive Summary\u003c/em\u003e. https://www.unodc.org/documents/data-and-analysis/statistics/Drugs/Drug_use_Survey_Nigeria_2019_executive-summary.pdf\u003c/li\u003e\n \u003cli\u003eUNODC. (2023). \u003cem\u003eWorld Drug Report 2023\u003c/em\u003e. www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html\u003c/li\u003e\n \u003cli\u003eUNODC. (2024). \u003cem\u003eUNODC strategic vision for Nigeria 2024\u003c/em\u003e. https://www.unodc.org/conig/uploads/documents/2024-05-13_UNODC_Strategic_Vision_for_Nigeria_2024-PRINT_VERSION.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Harm reduction, People who use drugs (PWUD), Substance use reduction, Socioeconomic outcomes, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8865927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8865927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePeople who use drugs (PWUD) in Nigeria face intersecting social, economic, and health challenges, yet evidence on the broader socioeconomic benefits of harm reduction remains limited. This study examined the association between access to harm reduction services and improvements in substance use and socioeconomic outcomes among PWUD in three Nigerian states.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional analysis was conducted using data from 210 PWUD enrolled in harm reduction programmes across Abia, Gombe, and the Federal Capital Territory. Outcomes included self-reported improvements in substance use, housing, employment, relationships with family and friends, crime reduction, and community participation. Access to harm reduction services was dichotomised into high versus low/no access. Descriptive statistics, chi-square tests, and multivariable logistic regression models were used to assess associations, adjusting for age, sex, education, employment status, state, and stigma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHigh access to harm reduction services was significantly associated with reductions in substance use (aOR\u0026thinsp;=\u0026thinsp;3.77, 95% CI: 1.61\u0026ndash;8.84) and improvements in housing (aOR\u0026thinsp;=\u0026thinsp;3.04, 95% CI: 1.49\u0026ndash;6.22). Employment improvement was strongly associated with being employed (aOR\u0026thinsp;=\u0026thinsp;4.85, 95% CI: 2.18\u0026ndash;10.75). Improved relationships were more likely among older participants, females, those with secondary or higher education, while stigma significantly reduced the odds. Crime reduction and community participation also improved.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHarm reduction services in Nigeria appear to yield important benefits, particularly in reducing substance use and improving housing stability. Strengthening access, reducing stigma, and scaling evidence-based interventions may enhance the broader social reintegration of PWUD.\u003c/p\u003e","manuscriptTitle":"Association Between Access to Harm Reduction Services and Socioeconomic Improvement Among People Who Use Drugs in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-23 10:17:35","doi":"10.21203/rs.3.rs-8865927/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-07T03:12:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T19:43:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T18:19:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310571919976718117111619110987228638906","date":"2026-03-27T14:14:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130117919940502960912469003052146439640","date":"2026-03-25T09:56:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281532531758247700207628606472711029245","date":"2026-03-20T12:26:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57520727767491195039926523867913133166","date":"2026-03-19T15:11:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T11:58:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T06:40:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-19T00:21:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T00:21:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-12T22:27:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ef6526b-cdf2-49b8-a402-261b29bbe740","owner":[],"postedDate":"March 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T10:17:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-23 10:17:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8865927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8865927","identity":"rs-8865927","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}