Carl Fredrik Sjöland is a PhD candidate in Global Health Epidemiology at Karolinska Institutet. His research focuses on infectious diseases and social and economic pressures in marginalized communities.

Background: Decades of armed conflict and a thriving drug trade, together with systematic human rights abuses and low health literacy, shape the lives of many women in remote areas of Myanmar. This study explores how services targeting women who engage in sex work and drug use can better meet their harm reduction and sexual health needs.

Methods: Data were collected in 2022-2024 through 15 in-depth interviews (IDIs) with harm reduction providers and key stakeholders, as well as 9 IDIs with female sex workers who use/inject drugs, and 5 women who use/inject drugs. Transcribed audio recordings were translated from Burmese into English and thematically analysed using the interview guide as coding framework.

Results: Women in these contexts express remarkable resilience in the face of limited autonomy. Engagement in sex work and drug use is often shaped by social and economic pressures, with associated stigma further reinforcing marginalization. Amphetamine inhalation or oral use is frequently introduced and maintained as a coping mechanism during sex work, while injectable opioids are used recreationally. Health care seeking is negatively impacted by stigma against sex work and female drug use, as well as time and transportation constraints. Clients expressed prioritizing avoiding pregnancy, whereas concerns relating to substance use and infectious disease risks were less pronounced. Views that sexual health services could require abstinence from drug use were also expressed.

Conclusions: The adoption of women-centric, integrated sexual health services by harm reduction providers, in combination with education on risks related to infectious diseases and substance use, may improve uptake of both sexual health and harm reduction services, leading to improved overall well-being.