Anthropology Assessment: Exploring drug and substance use in relation to sexual and reproductive health access for adolescents and young people

I will be living in th present moment!

Executive summary
Cross-Cutting Findings
By Claude Nyatsine

Across the diverse adolescent and young people groups interviewed, several common trends emerged related to substance use and associated sexual and reproductive health behaviours:

1. Drivers of drug and substance use 
Peer influence and social networks: Exposure to drug use behaviours by peers and admiration towards those who take drugs perceived as if they are cooler were identified as significant risk factors for substance use among young people in Mbare and Epworth.
Family dynamics: Family conflicts and exposure to drug use within the family were observed as risk factors at family level.
Economic stress: Unemployment and financial instability were prevalent among youth, contributing to substance use as a coping mechanism.
Emotional disturbance was one of the key push factors across all groups interviewed as a result of life hardships, relations with families or between a boyfriend and girlfriend etc.

2. Risky sexual behaviours
Multiple sexual partners and transactional behaviours Substance use among adolescents and young people is strongly correlated with increased sexual risktaking, including having multiple sexual partners and engaging in transactional sex. This trend was observed across all study groups but was particularly acute among young females, street-connected youth, and those using high-dependence substances like crystal meth.

i) Transactional sex driven by addiction and poverty 
For many adolescent girls and young females who are addicted to drugs or substances but lack the financial means to sustain their use, transactional sex becomes a coping and survival mechanism. Participants reported instances where young females exchanged sex for drugs or money to purchase substances, often with older men or drug suppliers. This form of sexual exploitation is not always perceived as ‘sex work’ by the girls themselves, but rather a necessary trade-off to meet an immediate need, access to a high or relief from withdrawal. The power imbalance in such exchanges often leaves young women unable to negotiate condom use, further increasing their vulnerability to HIV, STIs, and unintended pregnancies.

ii) Drug-induced/substances changes in libido and behaviour 
Certain substances, like alcohol or crystal meth, were reported to have a marked effect on sexual behaviour and libido. Several participants and community observers noted that crystal meth use heightened sexual desire, sometimes leading users to engage in frequent, impulsive, or unsafe sexual encounters. This increased libido, combined with impaired judgment and social inhibition, amplifies the risk of having multiple sexual partners during or shortly after drug use episodes. For female users particularly, this often resulted in loss of sexual boundaries, leaving them exposed to high-risk sexual environments, including unprotected sex with strangers or in group settings. These patterns reflect a dangerous intersection between addiction, economic desperation, and gendered power dynamics, all of which significantly elevate the SRH risks for adolescent girls and young females who use drugs.

Inconsistent or no use of preventive measures against STIs, HIV and pregnancies
One of the most consistent sexual health risks identified across all groups was the inconsistent or complete lack of use of preventive measures such as condoms, contraceptives, or PrEP. Despite varying levels of awareness about the risks of STIs, HIV and unintended pregnancies, actual preventive behaviours were weakly practiced or neglected altogether.

i) Substance use and impaired decision-making: Many adolescents and young people engaged in sexual activity while under the influence of drugs or alcohol, which impaired their judgment and significantly reduced the likelihood of using condoms or other protective methods. Intoxication was
sometimes cited as a reason for ‘forgetting’ to use protection or not caring about the consequences in the moment.

ii) Low negotiation power, especially among girls: Girls, especially those engaged in transactional sex or dependent on male drug suppliers, reported having limited ability to insist on condom use. In some cases, condoms were intentionally avoided by clients or partners, who offered extra payment for unprotected sex or falsely claimed to be ‘clean’.

iii) Misinformation and fear around contraceptives: Among school-going adolescents and those with limited education, there were widespread myths and misconceptions about contraception, such as the belief that contraceptives cause infertility or cancer. Some youth feared being judged or stigmatized if seen acquiring condoms or family planning methods from health facilities, which further discouraged proactive prevention.

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Conclusion of Results Section
The findings demonstrate that drug and substance use among adolescents and young people in Mbare and Epworth is deeply interconnected with a range of risky sexual behaviours, socio-economic hardships, and service accessibility barriers. Each group faces unique vulnerabilities, which require
differentiated approaches in MSF's adolescent SRH programming. This also highlights the key causes and effects of drug and substance use among AYP and offers valuable insights into how to address these critical pain points.