HIV infection among people who inject drugs (PWID) in Kenya is at 18%, and has been attributed to risky injecting practices. The risk environment enabling these practices has not been explored. This paper reports findings from Access to Care, a qualitative study in Kenya. Using in-depth interviews with PWID, we explore how the introduction of needle and syringe programmes (NSP) has impacted on needle and syringe sharing. PWID report significant reductions in sharing injecting equipment following NSP, although sharing continues, linked to challenges in supply and amongst PWID living with HIV, linked to hopelessness for the future. We conclude that NSP should expand across Kenya, linked to efforts to overcome delivery challenges and efforts to support people living with HIV.
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