The idea that long-acting injectables to treat HIV are useful for marginalized populations isn’t new. Because of the stigma they face, drug users and sex workers in particular would derive great benefit from long-acting injectables, according to Cole Zaccaro, manager of harm reduction services at the Prevention Resource Network in Asbury Park, New Jersey. Zaccaro considers long-acting injectables a harm-reducing imperative.

“I’m talking about people who are in chaotic use or practicing sex work who are also unhoused or unstably housed,” Zaccaro says. “In some cases, they don’t have a safe, reliable place to store their medication. With these medications, an interruption can compromise their effectiveness. So a definite benefit of the injectables, especially for folks without a safe place to store their medication, is that their medication is with them at all times. They’re literally carrying it inside of them.”

Injectables also prevent disruptions to health care. And each doctor visit for those shots is an opportunity for drug users to get blood work or a flu shot or to get tested for sexually transmitted infections.

Each visit even provides a chance for them to discuss rehab options with a clinician. “I think giving people as many opportunities to engage as is convenient for them is only a good thing,” Zaccaro adds. “We here at Prevention Resource Network, we try our best to be a one-stop shop and resource for folks. We have a syringe access program that provides sterile works [equipment] for both injection drug use and for safer smoking as well as test strips for common adulterants.”

What about patients with no health coverage? Eric Wuethrich, MPH, is the manager of LGBTQ services at the Visiting Nurse Association Health Group in Asbury Park, New Jersey. He works closely with Zaccaro to help uninsured clients access high-quality health care. 

“If someone qualifies for Medicaid, they’re able to get registered for Medicaid and get care at the time of their first appointment,” he explains.


That’s helpful for Wuethrich’s patients in New Jersey, a state that quickly expanded Medicaid access after the Affordable Care Act (Obamacare) passed into law in 2010.

What about sex workers and drug users in Texas, Florida, Georgia, Wisconsin, Tennessee, Kansas, Alabama, Mississippi and Wyoming, where strict Medicaid rules remain in place due to culture war politics?

“There’s at least an avenue if they do not qualify for Medicaid,” Wuethrich explained. “Drug manufacturers have payment assistance programs.”

Wuethrich’s advice for anyone without health insurance: Find your closest federally qualified health center. Search online. There are options, even in states where the politicization of marginalized populations often leads to poor health care outcomes.

“Community health centers, as federally qualified health centers, have partnerships with Medicaid that they’re able to do presumptive eligibility,” Wuethrich explained. “They’re able to fill up the whole application. A new patient is covered for that appointment, and then until the state has a chance to review it and award them their full Medicaid ID or deny them, then all medical care, until that denial is provided, is covered through Medicaid. The community health centers are set up to be able to deliver care and insurance whenever possible.” And that might be the best option for drug users, especially those engaging in sex work to pay for their drugs.

“Harm reduction was started by people who use substances,” Zaccaro said. “And by sex workers for themselves, to take care of their own communities at a time that not only was no one else interested in supporting them, but at times, it was even illegal to do some of the work that they were doing. And they were doing it anyway because it was what their community needed to stay safe and stay alive. Letting folks with lived experience continue to lead the way is critical.”