communities. Needle and syringe exchange could then be added in the experimental communities.

A multi-national, multi-sector steering committee could help ensure the highest levels of scientific rigor and ethical protection for the trial. Full scientific vetting of protocol(s), informed consent provisions, data quality assurances, periodic review of progress, and transparency of results are requisite for such research integrity. An essential feature of the proposed trial is community involvement in its design and implementation, as well as the development of a community partnership to address concerns prior to and throughout the trial. Plans for sustainability and dissemination of effective interventions are also critical.

Policymakers presented with the suggestion for further research confront an inherent tension. On the one hand, there is evidence that multi-component programs are effective in reducing drug-related risk behavior. As noted in Chapter 3, lack of complete or definitive evidence should not impede implementation of programs vital for protecting public health. On the other hand, this report presents a compelling argument for collecting more evidence, derived from high-risk countries themselves. The policymaking process must be understood as providing ever-greater clarification. A randomized community trial would assure policymakers who are initiating or extending HIV prevention programs that they will learn important lessons, and that they can apply those lessons in a timely and effective way to minimize expenditures and maximize the benefits in their countries.

Gambia Hepatitis Study Group. 1987. The Gambia Hepatitis Intervention Study. Cancer Research. 47:5782–5787.

Research Triangle Institute (RTI) International. 2005. NIMH Collaborative HIV/STD Prevention Trial Project Overview. [Online]. Available: http://www.rti.org/u10/overview.cfm [accessed August 22, 2006].