Pregnant Women, HIV, and Clinical Research to Prevent Perinatal Transmission in the 1990s

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.