Never flown one yet, hopefully one day I can experience this torturous approach. I may end up eating my own words after hearing some of your comments about it.
Anyways, I'm a air traffic controller at Pax River, MD. We have HI-TACANs here but they hardly ever get used. Pax is a very busy airfield, both local use as well as outside users. The HI approaches start at an altitude above our airspace. We ask the pilots if they can start their approach at 7K (the ceiling of our airspace) instead of 15K to avoid having to coordinate a pointout with Washington Center. I don't have the charts with me but I believe as long as you are above a certain altitude over a certain fix it is considered a HI whatever approach. It seems like more of the outside users, primarily AF F-16, request these approaches than the Navy.