UCSF

ABSTRACT

Resistant to Treatment:

AIDS, Science, and Power at the Dawn of Uganda's 'Treatment Era'

Johanna Tayloe Crane

Drug resistance, which occurs when HIV mutates to render AIDS medications (antiretrovirals) ineffective, has been a highly politicized topic within international health. Fears of "antiretroviral anarchy" leading to widespread drug resistance have been cited as a reason to exercise caution in extending access to HIV medication in poor countries, particularly those in sub-Saharan Africa. Nonetheless, the exact definition, causes and consequences of drug resistance remain topics of uncertainty and debate within HIV science. This is especially true in relation to drug resistance in Africa, where studies of drug resistance are just beginning as HIV drugs become more widely available. Using ethnographic research conducted among North American and Ugandan HIV researchers, my dissertation asks the questions: What do we know about drug resistance in Africa, and--more importantly--how do we know it? This multi-sited project combines approaches from science and technology studies and critical medical anthropology to interrogate the political economy of transnational scientific research.

Resistant to Treatment examines the nexus of professional, economic, and ethical relations that is emerging between North American and Ugandan AIDS researchers in the context of multilateral efforts to provide widespread access to HIV drugs in sub-Saharan African countries. The immanent availability of these drugs has created research opportunities that are powerful both politically and professionally, and has resulted in an influx of research funding to Uganda via American researchers seeking to collaborate with Ugandan physicians. I describe how these partnerships are fueled by humanitarian and professional ambitions on both sides, and how researchers must negotiate these sometimes competing goals in the context of a donor/recipient relationship in which collaboration includes (but is not limited to) a strategic exchange of American research funding for access to Ugandan patients. I argue that commensurability becomes a key issue in these collaborations, as the profound incommensurability of the Ugandan and American HIV epidemics must be at least partially reconciled in order to render U.S. scientific and ethical protocols operable in Uganda. In addition, I explore how Ugandan AIDS experts negotiate their position as enablers of and participants in these emerging research opportunities.