The debate over maternal-fetal HIV transmission prevention trials in Africa, Asia, and the Caribbean: racist exploitation or exploitation of racism?
Bayer, R.
American Journal of Public Health 88(4): 567-570
1998
ISSN/ISBN: 0090-0036 PMID: 9550995 DOI: 10.2105/ajph.88.4.567Document Number: 274466
Rather than a clash over first principles, this is a dispute over the application of agreed-upon principles in radically different social conditions. The controversy is also striking because persons with well-known commitments to the protection of the rights of research subjects find themselves confronting each other across a bitter divide. In the trials under attack, however, women have given their informed consent, however problematic, and the studies have been examined by local review committees and an ethics committee of UNAIDS. Perhaps most important, everyone acknowledges that the ACTG 076 regimen is not socially affordable in most nations, given the price of zidovudine and the infrastructure requirements for its administration. The tragedy of the recent trials is that they bear a profound moral taint, not of a malevolent research design but, rather, of a world economic order that makes effective prophylaxis for the interruption of maternal-fetal HIV transmission available but unaffordable for many-this is also true for a host of treatments for AIDS and other diseases. In a just world, this would not be the case and the very research under attack would be unnecessary. It is the social context of maldistribution of wealth and resources that both mandates these studies and, at the same time, renders them so troubling.