BMC Researcher Collaborates With People Who Use Drugs to Boost HIV Prevention Access

People who use drugs continue to face significant barriers to HIV prevention, even as highly effective medications are available to prevent infection. There have been several outbreaks of HIV in the greater Boston area in people who use drugs since 2016, and the CDC’s 2024 National HIV Behavioral Surveillance found that only 2% of HIV-negative people who inject drugs reported using pre-exposure prophylaxis, or PrEP. 

The gap is also evident among people involved in the criminal legal system. Research suggests that people involved in the justice system who use drugs can face multiple risk factors for HIV while also underestimating their risk and having limited access to PrEP.  

For Alysse Wurcel, MD, a general internal medicine physician and researcher at Boston Medical Center (BMC) who also works at one Suffolk County jail, these differences are closely connected to inherent biases and assumptions that shape medical care. Dr. Wurcel’s research focuses on challenging those assumptions and expanding access to HIV prevention for people who use drugs, including exploring how long-acting injectable PrEP can be incorporated into care. Through a new project spanning three states, Dr. Wurcel and her colleagues are collaborating with people who have lived experience to improve access to PrEP. 

HealthCity: What does your infectious disease on HIV prevention research hope to accomplish? 

Alysse Wurcel, MD: At its core, I want to expand access to HIV prevention medications. When the first medications to prevent HIV came out, they were really targeted toward men who have sex with men. We now have a tremendous amount of real-world data showing how to expand HIV prevention related to sexual transmission. A lot of our approaches to prescribing PrEP to people who use drugs have been extrapolated from studies in other populations, but we need evidence specific to people who use drugs to develop approaches that work for them. 

I’m particularly interested in long-acting injectable PrEP, which can provide protection without requiring someone to remember to take a pill every day. There are formulations that can be given every two months or six months, which could be transformative for people who have difficulty taking medications regularly. 

But having an effective medication available doesn’t mean people will automatically receive it. I also work as a jail doctor, and I’ve seen how complicated conversations around PrEP can become. Sometimes suggesting medication to prevent HIV is interpreted as us saying, “We don’t believe you when you say you’re going to stop using drugs.” But that’s not what we’re saying. We’re trying to give people another way to protect themselves. 

There’s also a clinical reason to think carefully about how we prescribe PrEP. If someone takes it inconsistently, there is a risk of developing HIV that is resistant to the medication. We need to design approaches that fit people’s lives rather than simply telling people what they should do. 

One way we’re addressing the provider side of that challenge is through academic detailing. In our study, pharmacists will work directly with clinicians in targeted, one-on-one conversations to understand what they know about PrEP, what concerns or misconceptions they may have, and what barriers are preventing them from prescribing it to people who use drugs. The goal isn’t simply to give clinicians more information; it’s to identify the specific barriers to prescribing and help move practice forward. 

I see that as an important place where research and advocacy meet. We can have the best medication in the world, but if clinicians aren’t comfortable prescribing it or patients can’t realistically use it, we’re not going to achieve the impact we’re hoping for. The solution starts with listening to the people who experience these systems and designing care around what they need. 

HC: What inspired you to pursue a career in infectious disease research? 

AW: My dad worked in finance at Yale, and when I was 16, I became a volunteer there. I remember bringing books to patients’ rooms, including one where a patient was experiencing a mental crisis. I wasn’t allowed to go into that room, but I remember thinking that this person might have needed company more than anyone. That experience stayed with me. I became interested in caring for people whose lives and health were shaped by circumstances I didn’t yet understand. 

Ultimately, I want to show that long-acting HIV prevention can be delivered to people who use drugs, that it works, and that it’s worth investing in. If we have the best medications available, people shouldn’t have to overcome unnecessary barriers to get them.

dr. alysse wurcel, infectious disease physician, boston medical center

That interest continued to grow in college, when I worked with Dr. Vivek Murthy who had started an HIV organization in India. I was inspired to do my honors thesis on motherhood, HIV, and cultural factors surrounding HIV prevention and diagnosis. After college, I cared for people who were incarcerated and saw differences in how people with conditions like hepatitis C were treated depending on where they received care. I began to understand how substance use, incarceration, stigma, and access to medical care intersect. Over time, those experiences made me interested not just in infectious diseases, but in the systems surrounding care — who gets treatment, who doesn’t, and why. 

That perspective deepened when my daughter was diagnosed with Type 1 diabetes at age 5. She’s 12 now, and experiencing chronic disease as a parent changed how I think about research and clinical care. There’s a difference between developing a treatment that works in a clinical trial and developing a solution someone can realistically incorporate into their life. It made me realize that solutions have to be practical, patient-facing, and designed around people’s lives. 

That’s something I carry into my research today. The science matters, but if solutions don’t work for people’s lives, we won’t achieve the impact we’re hoping for. 

HC: What are the broader impacts of your infectious disease research on patients and families? 

AW: People may come into the hospital because of a different infectious disease concern, or something related to substance use. That encounter creates an opportunity to offer HIV prevention to someone who may not otherwise have access to it. But simply offering a medication doesn’t mean we’ve created a solution that works for that person. 

That’s where human-centered design comes in. On a different project, I work with colleagues at Duke University, University of Miami and University of Pittsburgh using human-centered design to develop interventions supporting people who use drugs. I am taking lessons learned from that project to work with a community advisory board that includes people with lived experience to understand what makes HIV prevention accessible, practical, and realistic in people’s lives. 

Ultimately, I want to show that long-acting HIV prevention can be delivered to people who use drugs, that it works, and that it’s worth investing in. If we have the best medications available, people shouldn’t have to overcome unnecessary barriers to get them.

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This interview has been edited and condensed for clarity and length.