“People are going to do drugs:” harm reduction as a strategy for survivors of sex trafficking who use substances

Survivors of sex trafficking often experience co-occurring substance use and face significant barriers to accessing care. Harm reduction offers a nonjudgmental, survivor-centered approach to mitigating health risks associated with substance use and commercial sex. However, limited research has explored how harm reduction is understood and implemented by service providers working with this population. This study aimed to examine service providers’ perspectives on the role, impact, and challenges of harm reduction in supporting survivors of sex trafficking who use substances. This qualitative study employed purposive and snowball sampling to recruit 21 service providers from human trafficking, domestic violence, and other agencies across the southwestern US who serve survivors of sex trafficking. Semi-structured interviews were conducted to explore participants’ experiences with harm reduction strategies, perceived barriers, and relational dynamics in service provision. Interviews were transcribed verbatim and analyzed using thematic analysis, following Braun and Clarke’s six-step process. A constant comparative method was used to refine codes and identify emergent themes. Five major themes were identified: (1) comprehensive harm reduction as a lifesaving strategy, (2) education and health literacy as critical intervention tools, (3) navigating barriers to harm reduction, (4) relational foundations of harm reduction, and (5) ambivalence toward harm reduction as a standalone strategy. Participants described harm reduction as essential to preventing overdose, reducing disease transmission, and fostering engagement through nonjudgmental care. They emphasized the importance of peer-led outreach, trauma-informed education, and holistic support that includes meeting basic needs. However, providers also reported legal and institutional constraints, funding challenges, and public misconceptions that hindered implementation. A minority of participants expressed ambivalence about harm reduction, reflecting ongoing tensions between abstinence-based and non-abstinence approaches. Harm reduction is viewed by providers as a vital, relational, and flexible approach to supporting survivors of sex trafficking who use substances. Findings highlight the need for policy reform, increased investment in peer-led and trauma-informed models, and broader cultural shifts to reduce stigma. Future research should include survivor perspectives and explore harm reduction strategies across diverse geographic and demographic contexts.