Probably the trial design and structure should be different since the beginning considering to involve community representative and other stakeholders from civil societies to bring the input about how was the HIV prevention standards in the country and how to face this situation regarding the trial goals.
If the country has such a restrictive HIV prevention options and they don’t accept even clean needle exchange it doesn’t have any sense to run the trial without an initial consultation to figure out if this trial is accurate for a country with those barriers. Maybe NGOs and civil society can work jumping over the law and helping on the HIV prevention methods delivery and bringing the clean needle but there is also a huge risk for the advocates and activist. For instance, we are not having access to PrEP in Spain, and we are using 2 different studies / trials to get an early access for some vulnerable people but also we are trying to manage the “wild PrEP” that many of them are already taking and many other wants. It’s ilegal to get PrEP but is the public administration is not taking care of a accurate and possible HIV prevention package as we need it in the country, we, as a community members and representative should advocate to get this option asap and also work on other alternatives to get the best package.