By J. Andrew Alexander, PhD Candidate, Strynadka Lab, CBR

This article’s title sounds elementary but despite decades of research, there are still many questions surrounding HIV/AIDS treatment and prevention that lack their more satisfying partners: the answers. If we are to discover solutions to public health crises, we need to start with a solid foundation of evidence-based scientific research.

Here at UBC’s Centre for Blood Research and the School of Population and Public Health, the BC Centre for Excellence in HIV/AIDS, and Simon Fraser University, researchers have collaborated to study the spread of HIV in their recent publication in Lancet HIV, titled “Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996-2013: a modelling study”. It is efforts such as these which will stand us in good stead when writing public policy and effecting positive change.

Using data collected from HIV positive patients in British Columbia between 1996 and 2013, these researchers examined the efficacy of two different strategies for preventing HIV transmission via contaminated needles. They were interested in comparing two harm reduction strategies (opioid replacement therapy and needle dispensing programmes), to the advantages gained by antiretroviral therapy (ART), which helps control the HIV infection in patients.

Though studies have shown that ART prevents HIV transmission between sexual partners, there is a dearth of evidence pertaining to the effect of ART on HIV transmission via needles. These authors worked to understand the effectiveness of the mentioned harm reduction strategies, which work to reduce the number of shared needles, and ART in isolation. They accomplished this by modelling hypothetical situations where either ART had no efficacy, or harm reduction strategies were not increased over 1996 levels.

While there are myriad factors potentially contributing to harm reduction, the authors chose needle sharing and opioid replacement therapy as two harm reduction strategies for which there were good data. Using computer models to examine the effects of ART and the two harm reduction initiatives in isolation, these researchers were able to provide guidance on the most salient methods of preventing HIV transmission via contaminated needles.

The study estimates approximately 3,200 HIV infections were avoided in BC from 1996 to 2013 due to the collaborative effects of ART and harm reduction strategies in the province. Nevertheless, the impact of this study was limited by the lack of data surrounding the effect of ART on HIV transmission via needles. As the HIV transmission rate via needles is not known for people taking ART, the authors based their predictions on the estimated influence of ART.

The authors note that even if ART is very effective at preventing needle based HIV transmission, harm reduction strategies can still play an important role and encourage governments around the world to use both ART and harm reduction strategies in combination. Dare we imagine the benefit to countless persons if evidence-based policy were more widely implemented throughout the world.

Sound research has always been imperative to writing good public health policies, and from this one study, we can see the benefits of implementing change through increased scientific knowledge. When HIV/AIDS made their mainstream debut in the 1980’s, we again relied on sound research to overcome the fear, prejudice, and ignorance surrounding this public health crisis. Let’s make sure we continue to support and take heed of further evidence-based research!