“Meet Them Where They're at:” Service Provider Perspectives on Harm Reduction for Survivors of Sex Trafficking Who Use Substances

Background and Purpose: Survivors of sex trafficking experience profound and sustained trauma resulting in high rates of substance use disorder (SUD), anxiety, depression, and post-traumatic stress disorder (PTSD). Access to comprehensive aftercare is critical to promoting long-term healing and well-being; however, research is needed on effective models and best practices for sustained support for this population. Harm reduction offers a nonjudgmental, survivor-centered approach that seeks to reduce health risks associated with substance use and commercial sex while prioritizing autonomy and safety. Little research has explored how harm reduction is understood and implemented by service providers working with survivors of sex trafficking. Therefore, 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.

Methods: This qualitative study employed purposive and snowball sampling to recruit 21 service providers from human trafficking, domestic violence, and related service agencies who work with survivors of sex trafficking across the southwestern United States. In-depth, semi-structured interviews lasting approximately one hour were conducted to explore participants’ experiences with harm reduction strategies, perceived barriers to implementation, and relational dynamics in service provision. Interviews were audio-recorded, transcribed verbatim, and returned to participants for member checking. Participants received a $50 gift card upon completion. Data analysis followed a constant comparative approach, beginning after the first interview and continuing throughout data collection. Two members of the research team independently coded transcripts using Braun and Clarke’s six-stage thematic analysis process to develop and refine emergent themes.

Results: Five major themes were identified: (1) comprehensive harm reduction as a lifesaving strategy, (2) education and health literacy as critical interventions, (3) navigating structural and institutional barriers to harm reduction, (4) the relational foundations of harm reduction practice, and (5) ambivalence toward harm reduction as a standalone approach. Participants consistently described harm reduction as essential for preventing overdose, reducing disease transmission, and promoting sustained engagement through nonjudgmental, survivor-centered care. Providers highlighted the value of peer-led outreach, trauma-informed education, and holistic support, including addressing basic needs. At the same time, participants identified legal and institutional constraints, funding limitations, and public misconceptions as significant barriers to implementation. A subset of providers expressed ambivalence toward harm reduction, underscoring ongoing tensions between abstinence-based and non-abstinence frameworks in service delivery.

Conclusions and Implications: Service providers view harm reduction as an essential, relational, and adaptable framework for supporting survivors of sex trafficking who use substances. The findings underscore the need for policy reform, greater investment in peer-led and trauma-informed approaches, and broader cultural shifts to address stigma surrounding substance use and survivorship. Future research should meaningfully incorporate survivor perspectives and examine the application of harm reduction across diverse cultural, demographic, and geographic contexts. Ultimately, this research affirms that harm reduction is a vital approach that honors the lived realities of survivors and supports their right to access care on their own terms.