<p>Harm reduction (HR) services are developing in Africa. In Senegal, the overall HR service coverage ratio is one WUD for every 10 men. By analysing gender-specific initiatives developed by HR stakeholders and evaluating their limitations, we explored HR in Senegal through a gender lens to better understand how to meet the specific needs of WWUD. The data for this study were collected through interviews, observations, and the researchers’ direct presence in drug use settings, as part of a social anthropology research project on the trajectories of WWUD in Senegal. The study reveals that in Senegal, two approaches (broadly integrating HR) are employed to address the specific health and psychosocial needs of WWUD: care exclusively dedicated to WWUD (e.g., gynaecological consultations, women-only days, HIV testing, discussion groups) and support focused on capacity building (e.g., community empowerment, training peer workers). However, this dual approach has limitations. It primarily targets WWUD who inject drugs such as cocaine and heroin, neglecting the needs of those using non-injectable substances (e.g., tramadol, alcohol, cannabis). Additionally, it does not account for the diverse social profiles of WWUD and their varying needs. Despite HR actors’ best efforts to provide tailored services, they face funding challenges. Moreover, the stigma surrounding drug use hinders WWUD’s participation in proposed activities. To address the limitations and challenges of the current HR offer, WWUD employ adaptive and resilience strategies through community empowerment initiatives. Addressing these gaps requires the development of HR services tailored to the specific needs of non-injecting WWUD, conducting in-depth research to better adapt interventions for this target population, and mobilising funding to implement innovative and effective approaches to improve their access to care.</p>