Here’s the part that should reframe how this gap gets talked about. When Hepatitis C treatment is delivered through models actually built for people who inject drugs — rather than a standard clinic visit structure — the results are excellent. New York’s own innovative treatment models specifically designed for this population, several of which pair HCV treatment directly with medication for opioid use disorder, achieved a 95% confirmed cure rate among patients who completed treatment and returned for follow-up testing. The medicine isn’t the limiting factor. Program design is.

The same pattern holds for the infrastructure that prevents new infections in the first place. New York City’s own health department states directly that access to sterile syringes has helped reduce new HIV cases among injection drug users by 95% over the last 20 years, and syringe service programs are independently documented as effective against Hepatitis C transmission specifically. And yet, according to the National Institute on Drug Abuse’s own 2024 review, these programs remain enormously effective, but underused nationally relative to the population that could benefit from them.