Understanding the role of street medicine in harm reduction: a case study of Street Medicine St. Louis
An article in Harm Reduction Journal, published October 6, 2025.
Authors: Ari Gzesh, Jeremiah S. Truel, Danielle R. Adams, Luke Zabotka, Sara Malone, Nathanial S. Nolan
This study explores how Street Medicine St. Louis builds trust with homeless individuals to effectively provide medical care and harm reduction services. It shows how relational approaches can improve health interventions in vulnerable populations. Some key takeaways:
Social Determinants of Health: Homelessness is deeply connected to factors like poverty, racism, and lack of healthcare access, which can worsen physical and mental health issues. These factors also affect HIV risk and care accessibility.
Street Medicine and Harm Reduction: The street medicine movement aims to reduce harm by providing medical care directly to unsheltered homeless individuals in settings that minimize barriers.
Trust Development: This study emphasizes the importance of building trust for effective care. Trust is formed through consistent outreach, respectful interactions, and non-judgmental care. These factors help homeless individuals feel safe and willing to engage with services.
Increased Utilization of Services: When trust is established, individuals are more likely to use harm reduction resources, such as Fentanyl test strips (which help prevent HIV transmission among people who use injectable drugs), and Naloxone to reverse opioid overdoses.
Education and Harm Reduction Practices: Trust not only makes individuals more receptive to harm reduction resources but also more open to education about safer practices. This increased willingness to learn and apply harm reduction techniques can further reduce HIV risk.
Nathanial Nolan, MD, corresponding author of the research paper and instructor at WashU, explained the key takeaway points: “This study supports the idea that marginalized communities require trauma informed care that is rooted in relationship building and self-efficacy. Mutual aid is a key way in which these communities care for themselves and efforts to support for these communities have to be centered around efforts to uplift them. Harm reduction is in part a social justice and equity movement that provides communities the tools with which to care for themselves. This is directly applicable to those living with HIV who are often from multiple marginalized communities.”