Gender Differences in Social Networks of Women and Men Who Inject Drugs in Kenya

Hannah Manley; Lindsey Riback; Mercy Nyakowa; Chenshu Zhang; Peter T Vickerman; Jack Stone; Josephine G Walker; Rose Wafula; Nazila Ganatra; Matthew  Akiyama

doi:10.1016/j.drugpo.2026.105173

Gender Differences in Social Networks of Women and Men Who Inject Drugs in Kenya

Hannah Manley, Lindsey Riback, Mercy Nyakowa, Chenshu Zhang, Peter T Vickerman, Jack Stone, Josephine G Walker, Rose Wafula, Nazila Ganatra, Matthew Akiyama^*

^*Corresponding author for this work

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Abstract

Background:

Women who inject drugs (WWID) face heightened HCV and HIV risk compared to men (MWID); yet underlying differences in social and injection networks are not well understood, particularly in resource-limited countries.

Methods:

We enrolled 3152 people who inject drugs (PWID) in Kenya using respondent driven sampling. Participants were tested for HIV, HCV, and HBV, and completed a survey with behavioral and network questions. An individual’s social network members (NMs) were defined as participants they had used any drugs with and knew by name. Bivariate analyses were conducted for associations between gender, network characteristics, and injection behaviors. Multivariate logistic regressions were conducted for both men and women to examine the associations between network characteristics and disease status.

Results:

About one-tenth of participants were women (9.7%, N= 306), 19.3% were HCV antibody-positive (N = 610), and 9.7% were HIV-positive (N = 306). Women were significantly more likely to be HCV antibody-positive (26.5% vs. 18.6%, p < 0.001) and HIV-positive (31.1% vs. 7.4%, p < 0.001) than men. Women were significantly more likely to have injected and had sex with people in their networks than men were (3.9% vs. 1.0%, p < 0.001). Knowledge (or lack thereof) of NM’s HIV and HCV status had significant associations with HIV and HCV positivity for both women and men.

Conclusion:

Women face differential HCV- and HIV-related risk in part based upon their relationships to and behaviors with their network members. Further research examining nuances of injection and sexual relationships among women and men who inject drugs is needed. Interventions accounting for gender-based risks should also be considered.

Original language	English
Article number	105173
Number of pages	7
Journal	International Journal of Drug Policy
Volume	149
Early online date	28 Jan 2026
DOIs	https://doi.org/10.1016/j.drugpo.2026.105173
Publication status	Published - 1 Mar 2026

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Publisher Copyright:
© 2026. Published by Elsevier B.V.

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@article{38f58fae21a84964b3b9e63ccf0ef71e,

title = "Gender Differences in Social Networks of Women and Men Who Inject Drugs in Kenya",

abstract = "Background:Women who inject drugs (WWID) face heightened HCV and HIV risk compared to men (MWID); yet underlying differences in social and injection networks are not well understood, particularly in resource-limited countries. Methods:We enrolled 3152 people who inject drugs (PWID) in Kenya using respondent driven sampling. Participants were tested for HIV, HCV, and HBV, and completed a survey with behavioral and network questions. An individual{\textquoteright}s social network members (NMs) were defined as participants they had used any drugs with and knew by name. Bivariate analyses were conducted for associations between gender, network characteristics, and injection behaviors. Multivariate logistic regressions were conducted for both men and women to examine the associations between network characteristics and disease status. Results:About one-tenth of participants were women (9.7\%, N= 306), 19.3\% were HCV antibody-positive (N = 610), and 9.7\% were HIV-positive (N = 306). Women were significantly more likely to be HCV antibody-positive (26.5\% vs. 18.6\%, p < 0.001) and HIV-positive (31.1\% vs. 7.4\%, p < 0.001) than men. Women were significantly more likely to have injected and had sex with people in their networks than men were (3.9\% vs. 1.0\%, p < 0.001). Knowledge (or lack thereof) of NM{\textquoteright}s HIV and HCV status had significant associations with HIV and HCV positivity for both women and men. Conclusion:Women face differential HCV- and HIV-related risk in part based upon their relationships to and behaviors with their network members. Further research examining nuances of injection and sexual relationships among women and men who inject drugs is needed. Interventions accounting for gender-based risks should also be considered.",

author = "Hannah Manley and Lindsey Riback and Mercy Nyakowa and Chenshu Zhang and Vickerman, \{Peter T\} and Jack Stone and Walker, \{Josephine G\} and Rose Wafula and Nazila Ganatra and Matthew Akiyama",

note = "Publisher Copyright: {\textcopyright} 2026. Published by Elsevier B.V.",

year = "2026",

month = mar,

day = "1",

doi = "10.1016/j.drugpo.2026.105173",

language = "English",

volume = "149",

journal = "International Journal of Drug Policy",

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TY - JOUR

T1 - Gender Differences in Social Networks of Women and Men Who Inject Drugs in Kenya

AU - Manley, Hannah

AU - Riback, Lindsey

AU - Nyakowa, Mercy

AU - Zhang, Chenshu

AU - Vickerman, Peter T

AU - Stone, Jack

AU - Walker, Josephine G

AU - Wafula, Rose

AU - Ganatra, Nazila

AU - Akiyama, Matthew

PY - 2026/3/1

Y1 - 2026/3/1

N2 - Background:Women who inject drugs (WWID) face heightened HCV and HIV risk compared to men (MWID); yet underlying differences in social and injection networks are not well understood, particularly in resource-limited countries. Methods:We enrolled 3152 people who inject drugs (PWID) in Kenya using respondent driven sampling. Participants were tested for HIV, HCV, and HBV, and completed a survey with behavioral and network questions. An individual’s social network members (NMs) were defined as participants they had used any drugs with and knew by name. Bivariate analyses were conducted for associations between gender, network characteristics, and injection behaviors. Multivariate logistic regressions were conducted for both men and women to examine the associations between network characteristics and disease status. Results:About one-tenth of participants were women (9.7%, N= 306), 19.3% were HCV antibody-positive (N = 610), and 9.7% were HIV-positive (N = 306). Women were significantly more likely to be HCV antibody-positive (26.5% vs. 18.6%, p < 0.001) and HIV-positive (31.1% vs. 7.4%, p < 0.001) than men. Women were significantly more likely to have injected and had sex with people in their networks than men were (3.9% vs. 1.0%, p < 0.001). Knowledge (or lack thereof) of NM’s HIV and HCV status had significant associations with HIV and HCV positivity for both women and men. Conclusion:Women face differential HCV- and HIV-related risk in part based upon their relationships to and behaviors with their network members. Further research examining nuances of injection and sexual relationships among women and men who inject drugs is needed. Interventions accounting for gender-based risks should also be considered.

AB - Background:Women who inject drugs (WWID) face heightened HCV and HIV risk compared to men (MWID); yet underlying differences in social and injection networks are not well understood, particularly in resource-limited countries. Methods:We enrolled 3152 people who inject drugs (PWID) in Kenya using respondent driven sampling. Participants were tested for HIV, HCV, and HBV, and completed a survey with behavioral and network questions. An individual’s social network members (NMs) were defined as participants they had used any drugs with and knew by name. Bivariate analyses were conducted for associations between gender, network characteristics, and injection behaviors. Multivariate logistic regressions were conducted for both men and women to examine the associations between network characteristics and disease status. Results:About one-tenth of participants were women (9.7%, N= 306), 19.3% were HCV antibody-positive (N = 610), and 9.7% were HIV-positive (N = 306). Women were significantly more likely to be HCV antibody-positive (26.5% vs. 18.6%, p < 0.001) and HIV-positive (31.1% vs. 7.4%, p < 0.001) than men. Women were significantly more likely to have injected and had sex with people in their networks than men were (3.9% vs. 1.0%, p < 0.001). Knowledge (or lack thereof) of NM’s HIV and HCV status had significant associations with HIV and HCV positivity for both women and men. Conclusion:Women face differential HCV- and HIV-related risk in part based upon their relationships to and behaviors with their network members. Further research examining nuances of injection and sexual relationships among women and men who inject drugs is needed. Interventions accounting for gender-based risks should also be considered.

U2 - 10.1016/j.drugpo.2026.105173

DO - 10.1016/j.drugpo.2026.105173

M3 - Article (Academic Journal)

C2 - 41610680

SN - 0955-3959

VL - 149

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 105173

ER -

Gender Differences in Social Networks of Women and Men Who Inject Drugs in Kenya

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