Despite the political barriers surrounding the controversy, the decision to not provide clean needles made it seem as though researchers did not care about reducing the risk of contracting HIV in participants who were receiving the placebo. To add insult to injury, the stakeholders concerns were not even addressed during the dissemination of the trial results. This, in turn, led to stakeholders’ mistrust of the trial team and question the legitimacy of the results.

Although the results of the trial ended up being promising, it may have been better to delay starting the trial until a larger discussion about the concerns of drug user advocates and the importance of providing clean needles to injection drug users was had. Lead PIs and coordinators could have also mentioned that they took note of stakeholders’ concerns, why they were unable to make changes, and that they planned to address them in future studies.

Researchers can engage stakeholders better by not only listening to their concerns but also taking them into strong consideration and mapping out the different possible outcomes of including or not including a suggestion. When politics and laws are involved, it is best to begin engagement early, provide statistical data to relevant lawmakers/strategists, and how changing a policy or allowing an exception for a study will help both the study population and the community at large.