Partially treated: AIDS, inequality and ethics: The controversy over the short course AZT trials

Brooke Cunningham, University of Pennsylvania

Abstract

In 1994, the results of the AIDS Clinical Trial Group (ACTG) 076 study demonstrated that a long course of AZT prevented mother to child transmission of HIV. Concerned that the ACTG 076 regimen could not be implemented in resource poor settings, researchers subsequently began clinical trials of short course AZT in Uganda, South Africa, Tanzania, Cote d'Ivoire, Burkina Faso, and Thailand. These trials were criticized as unethical because researchers did not provide all of the participants AZT; some women were randomized to placebos. This study seeks to account for the emergence, legitimation, and resolution of these trials as a social problem. It traces the historical roots and evolution of the debate, including the experiences and interpretive frameworks of participants. My data includes semi-structured interviews with researchers, bioethicists, government officials, and key opinion leaders and a qualitative content analysis of the medical literature and public press. The study finds that (1) researchers were aware of the surveillance of biomedical institutions by activist groups and anticipated that placebo controls could become a social problem; (2) the cultural authority of the New England Journal of Medicine and the cultural memory of past exploitation were important factors in the emergence and legitimation of the trials as a social problem; (3) participants in the debate challenged the moral authority of the West; and (4) descriptions of the women research participants shifted with antagonists' positions on the trials and often served to construct the African and Asian women as significantly different from Western women. Although the ethical questions these trials posed were difficult, and the reality that all women did not receive AZT disturbing, this study suggests that these facts alone do not account for the emergence of these trials as a public problem. In addition, this study identifies other factors, only been partially explored in previous analyses, that affect international research projects and problematize ethical deliberations.

Subject Area

Sociology|Public health

Recommended Citation

Cunningham, Brooke, "Partially treated: AIDS, inequality and ethics: The controversy over the short course AZT trials" (2006). Dissertations available from ProQuest. AAI3211052.
https://repository.upenn.edu/dissertations/AAI3211052

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