Abstract
In 1994, American and French AIDS research showed that the drug AZT reduced the risk of HIV transmission from a pregnant HIV-positive woman to her fetus (perinatal transmission). Hailed as a breakthrough, the AIDS Clinical Trial Group protocol 076 (ACTG 076) soon became the standard of care in the US But ACTG 076 was too expensive for low-income countries where perinatal transmission rates were high; to find a more affordable prevention, the US principally funded studies in several low-income countries. Controversy over whether the short course of AZT studies was ethical, given their different standards of care and use of a placebo, erupted in 1997. These studies remain well known within the global health biomedical literature as illustrating differences between sending and receiving countries. But while rarely invoked within this literature, these two sets of studies have similarities that challenge this hierarchal division: both involved pregnant women as objects of clinical research instead of subjects of clinical care, reflective of the all-too-common focus in global health on disease containment rather than on health care, and both illustrate the ways the focus within global health has been on a solitary biomedical intervention rather than on discrimination, inequality, and poverty within and among countries.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 878-894 |
| Number of pages | 17 |
| Journal | Journal of Contemporary History |
| Volume | 57 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2022 |
Funding
I am thankful for an Undergraduate Research Assistant Program grant I received from Northwestern University in 2016–17 which enabled me to hire Azalea Lopez and Annie Oler, two amazing young women who were undergraduate students at that time. Lopez and Oler conducted some preliminary research for me on this topic, and though this paper ended up taking a different direction from where it was when they helped me years ago, their assistance grounded me in the topic, and I thank both of them. In addition, I want to thank the many undergraduates who have taken the Global Health Studies course, Global Bioethics, with me over the years and who have listened to my lecture on this subject, as teaching about the short course of AZT studies is what inspired me to consider writing about it. Finally, I want to thank the German Historical Institute in Washington, DC for accepting my proposal to be part of their ‘Global Knowledge, Global Legitimacy? Transatlantic Biomedicine since 1970’ conference in September 2019, and I especially want to thank the co-conveners, Axel Jansen and Claudia Roesch, for their work both on the symposium and for their providing strong editorial support (and encouragement) for this article.
Keywords
- HIV
- clinical research ethics
- global health
- medicine
- pregnancy
- women
ASJC Scopus subject areas
- Cultural Studies
- History
- Sociology and Political Science
