Research, Therapy, and Bioethical Hegemony: The Controversy over Perinatal AZT Trials in Africa

Research on zidovudine (AZT) for pregnant women in Africa sparked worldwide debate in the late 1990s. The debate ultimately led to the rewriting of international ethics guidelines, in at least one case specifically to prohibit use of a placebo group (the most controversial aspect of the research) when known effective treatment is available. I draw upon clinical experience in Malawi and theoretical perspectives from anthropology to reframe the controversy. The dominant bioethical position constructed research and therapy as ethically distinct. This distinction ensured that inequalities of power and resources were perpetuated, not remedied, by the AZT debates.