Over the past three decades, the field of evidence-based medicine has emerged as an approach to assess the effectiveness of clinical interventions that can inform socio-medical practice, including HIV prevention.  However, disagreement remains within the HIV prevention science community about the applicability of this paradigm, particularly because of the narrow way by which evidence has become defined as a product, chiefly, of randomized controlled trials (RCTs).  Social and policy interventions challenge the notion that RCTs should be the primary modality by which HIV prevention-oriented community-based organizations (CBOs) and AIDS service organizations (ASOs) conduct business.

These challenges exist concurrently with increasing pressure from governmental and non-governmental funding sources to adopt RCT-based prevention interventions.  For example, the U.S. Centers for Disease Control and Prevention (CDC), the primary funding agent of HIV prevention programs in the country, promotes a “tiers of evidence” paradigm that places RCTs at the highest, most fundable level. CDC encourages, if not requires, eligible CBOs and ASOs to adopt prevention models from a list of RCT-derived behavioral interventions that CDC deems efficacious. Additionally, other funding sources are requiring more rigorous evaluation of data than in the past to demonstrate the efficacy of the grassroots programs established by CBOs and ASOs.  However, most staffs of these organizations do not have the requisite scientific training to determine what constitutes appropriate evidence of program effectiveness, and most of them lack the financial resources to hire professional researchers.

The San Francisco AIDS Foundation believes that public health research, practice, and policy intersect best where diverse methodologies and outcome data are utilized to establish efficacy.  Over the next year, the Foundation, in partnership with the Caucus for Evidenced-Based Prevention¹, is spearheading a series of focused discussions with all stakeholders.  Goals of these discussions include defining and advancing a more productive way forward for evidence-based HIV prevention; reaching a consensus on an inclusive yet still rigorous notion of evidence, encompassing biological, behavioral, and social sciences; and including the lived experiences of individuals and communities affected by HIV/AIDS.  We initiated these discussions with special panel sessions held during the United States Conference on AIDS in November 2007 and the National HIV Prevention Conference in December 2007.  Other sessions are planned, including a global discussion at the upcoming International AIDS Conference in Mexico City in August 2008.  Please stay tuned to our Web site to keep informed of these activities and the overall initiative. For video and audio of past sessions, please the the Session Archive on the left sidebar of this page.