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AIDS denialism refers to the views of a loosely connected group of individuals and organizations who deny that the human immunodeficiency virus (HIV) is the cause of acquired immune deficiency syndrome (AIDS). Some denialist groups reject the existence of HIV, while others accept that HIV exists but argue that it is a harmless passenger virus and not the cause of AIDS.

The causative role of HIV in the development of AIDS has been established by multiple lines of evidence as a subject of scientific consensus. AIDS-denialist claims have been rejected by the scientific community as based on faulty reasoning, cherry-picking, and misrepresentation of predominantly outdated scientific data. with the potential to endanger public health by dissuading people from using proven treatments. With the rejection of these arguments by the scientific community, AIDS denialist material is currently spread largely through the Internet. Public health researchers in South Africa and at Harvard University have independently investigated the human cost of AIDS denialism. Their estimates attribute 330,000 to 340,000 AIDS deaths, 171,000 HIV infections and 35,000 infant HIV infections to the South African government's former embrace of AIDS denialism.

Timeline

• 1983: A group of scientists and doctors at the Pasteur Institute in France, led by Luc Montagnier, discovers a new virus in a patient with signs and symptoms that often precede AIDS. They name their discovery lymphadenopathy-associated virus, or LAV, and send samples to Robert Gallo's team in the United States.
• 1984: On April 23, at a Washington press conference held after the relevant scientific publications have been peer reviewed and slated for publication in Science, Margaret Heckler, Secretary of Health and Human Services, announces that Gallo and his co-workers have discovered a virus that is the "probable" cause of AIDS. This virus is initially named HTLV-III.
• 1984: Casper Schmidt responds to Gallo's papers by writing The Group-Fantasy Origins of AIDS, which is published by the Journal of Psychohistory. He posits that AIDS is an example of "epidemic hysteria" in which groups of people are subconsciously acting out social conflicts, and compares it to documented cases of epidemic hysteria in the past which were mistakenly thought to be infectious. Schmidt himself dies of AIDS in 1994.
• 1986: The viruses discovered by Montagnier and Gallo, having been found to be genetically indistinguishable, are renamed HIV.
• 1987: Peter Duesberg questions the HIV theory of AIDS in his paper Retroviruses as Carcinogens and Pathogens: Expectations and Reality, published in the journal Cancer Research. This publication coincides with the start of major public health campaigns and the promotion of Zidovudine (AZT) as a treatment.
• 1988: A panel of the Institute of Medicine of the United States National Academy of Sciences finds that "the evidence that HIV causes AIDS is scientifically conclusive."
• 1988 Science publishes, in the same issue, Blattner, Gallo, and Temin's HIV causes AIDS, and Peter Duesberg's HIV is not the cause of AIDS.
• 1988: A group of denialists based in Perth, Australia ("Perth Group"), led by Eleni Papadopulos-Eleopulos, publishes in the non-peer-reviewed journal Medical Hypotheses their first article questioning aspects of HIV/AIDS research. They conclude that there is "no compelling reason for preferring the viral hypothesis of AIDS to one based on the activity of oxidising agents."
• 1989. Duesberg exercises his right, as a member of the National Academy of Sciences, to publish his arguments in Proceedings of the National Academy of Sciences (PNAS) without peer review. The editor of PNAS initially resists, but ultimately allows Duesberg to publish, saying: "If you wish to make these unsupported, vague, and prejudicial statements in print, so be it. But I cannot see how this would be convincing to any scientifically trained reader."
• 1990: Robert Root-Bernstein publishes his first peer-reviewed article detailing his objections to the mainstream view of AIDS and HIV, entitled Do we know the cause(s) of AIDS? In it, he questions both the mainstream view and the dissident view as potentially inaccurate.
• 1991: The Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis, comprised of twelve scientists, doctors, and activists, submits a short letter to various journals; the letter is rejected. Another similar letter is published 4 years later in the journal Science.
• 1993: Nature publishes an editorial by John Maddox titled Has Duesberg a right of reply? answering the titular question with "no." According to Duesberg, the full-page editorial is prompted by Duesberg's request for additional data about the article Does drug use cause AIDS?, which claims that the Duesberg hypothesis is wrong. Maddox accuses Duesberg of asking "unanswerable rhetorical questions"
• 1993: A trio of AIDS denialists allege in the journal Nature Biotechnology (then edited by fellow denialist Harvey Bialy) that the Western blot test for HIV is not standardized, non-reproducible, and of unknown specificity due to a claimed lack of a "gold standard".
• 1994, 28 October: Robert Willner, a physician whose medical license was revoked for, among other things, treating an AIDS patient with ozone therapy, publicly jabs his finger with blood he says is from an HIV-infected patient. Willner dies the following year of a heart attack.
• 1995: Continuum, a denialist group, places an advertisement in the British gay and lesbian magazine The Pink Paper offering a £1,000 reward to "the first person finding one scientific paper establishing actual isolation of HIV", according to a set of seven steps they claimed to have been drawn up by the Pasteur Institute in 1973.
• 1996: Various scientists, including Duesberg, dismiss the Continuum challenge, asserting that HIV doubtlessly exists.
• 1996:The British Medical Journal publishes Response: arguments contradict the "foreign protein-zidovudine" hypothesis as a response to a petition by Peter Duesberg: "In 1991 Duesberg challenged researchers…We and Darby et al. have provided that evidence". The paper argues that Duesberg was wrong regarding the cause of AIDS in haemophiliacs.
• The Perth Group questions the existence of HIV and speculates that the production of antibodies recognizing HIV proteins can be caused by allogenic stimuli and autoimmune disorders. They continue to repeat this speculation through at least 2006.
• 1998: Valerie Emerson prevails in court in Maine for her right to refuse to give AZT to her 4-year-old son Nikolas Emerson, after she witnessed the death of her daughter Tia, who died at the age of 3 in 1996. Nikolas Emerson died eight years later; the family refused to say if the death was AIDS related.
• 2000: South Africa's President Thabo Mbeki invites several HIV/AIDS denialists to join his Presidential AIDS Advisory Panel. The scientific community responds with the Durban declaration, a document affirming that HIV causes AIDS, signed by over 5,000 scientists and physicians.
• 2006: Celia Farber, a journalist and prominent AIDS denialist, publishes an essay in the March issue of Harper's Magazine entitled Out of Control: AIDS and the Corruption of Medical Science, in which she summarizes a number of arguments for AIDS denialism and alleges incompetence, conspiracy, and fraud on the part of the medical community. Leading scientists and AIDS activists extensively criticize the article as inaccurate, misleading, and poorly fact-checked.
• 2007: Members of the "Perth Group" testify at an appeals hearing for Andre Chad Parenzee, stating that HIV cannot be transmitted by heterosexual sex. The judge concludes: "I reject the evidence of Ms Papadopulos-Eleopulos and Dr Turner. I conclude…that they are not qualified to give expert opinions"
• 2008: A South African researcher and a group of Harvard scientists independently estimate that Thabo Mbeki's denialist policies led to the early deaths of more than 330,000 South Africans. Barbara Hogan, the health minister appointed by Mbeki's successor, voices shame over the studies' findings and states: "The era of denialism is over completely in South Africa."

The AIDS denialist community

Several scientists have been associated with AIDS denialism, although they have not themselves studied AIDS or HIV. One of the most famous and influential AIDS denialist scientists is Peter Duesberg, professor of molecular and cell biology at the University of California, Berkeley, who since 1987 has disputed that the scientific evidence shows that HIV causes AIDS. Other scientists associated with AIDS denialism include biochemists David Rasnick and Harvey Bialy. Kary Mullis, who was awarded a Nobel Prize for his role in the development of PCR, has expressed sympathy for denialist theories.

Additional notable AIDS denialists include Australian academic ethicist Hiram Caton, the late mathematician Serge Lang, former college administrator Henry Bauer, journalist Celia Farber and the late activist Christine Maggiore, whose 3-year-old daughter died of complications of AIDS. Nate Mendel, bassist with the rock band Foo Fighters, expressed support for AIDS denialist ideas and organized a benefit concert in January 2000 for Maggiore's organization Alive & Well AIDS Alternatives.

Organizations of AIDS denialists include the "Perth Group", composed of two Australian hospital workers.

AIDS denialism has received some support from political conservatives in the United States. Duesberg's work has been published by the conservative Heritage Foundation and Regnery Press, as has Tom Bethell's book The Politically Incorrect Guide to Science, which endorses AIDS denialism. Phillip E. Johnson has accused the Centers for Disease Control of "fraud" in relation to HIV/AIDS. Describing the political aspects of the AIDS denialism movement, Steven Epstein wrote in Impure Science that "... the appeal of Duesberg's views to conservatives—certainly including those with little sympathy for the gay movement—cannot be denied." The paleolibertarian blog LewRockwell.com has also published articles supportive of AIDS denialism.

Former dissidents

Several of the few prominent scientists who once voiced doubts about HIV/AIDS have since changed their views and accepted the idea that HIV plays a role in causing AIDS, in response to an accumulation of newer studies and data. Robert Root-Bernstein, author of Rethinking AIDS: The Tragic Cost of Premature Consensus and formerly a critic of the causative role of HIV in AIDS, has since distanced himself from the AIDS denialist movement, saying, "Both the camp that says HIV is a pussycat and the people who claim AIDS is all HIV are wrong… The denialists make claims that are clearly inconsistent with existing studies."

Joseph Sonnabend, who until the late 1990s regarded the issue of AIDS causation as unresolved, has reconsidered in light of the success of newer antiretroviral drugs, stating, "The evidence now strongly supports a role for HIV… Drugs that can save your life can also under different circumstances kill you. This is a distinction that denialists do not seem to understand." Sonnabend has also criticized AIDS denialists for falsely implying that he supports their position, saying:

Some individuals who believe that HIV plays no role at all in AIDS have implied that I support their misguided views on AIDS causation by including inappropriate references to me in their literature and on their web sites. Before HIV was discovered and its association with AIDS established, I held the entirely appropriate view that the cause of AIDS was then unknown. I have successfully treated hundreds of AIDS patients with antiretroviral medications, and have no doubt that HIV plays a necessary role in this disease.

Both Sonnabend and Root-Bernstein now favor a less controversial hypothesis, suggesting that while HIV is necessary for AIDS, cofactors may also contribute.

Walter Gilbert, winner of the 1980 Nobel Prize in Chemistry, once expressed skepticism about the role of HIV in AIDS. Like Sonnabend, he has since changed his mind in response to the effectiveness of antiretroviral treatment.

As of June 2008, denialist websites continue to claim that Root-Bernstein, Sonnabend and Gilbert doubt the role of HIV in AIDS. A former denialist wrote in the Journal of Medical Ethics in 2004:

The group regularly points to a substantial number of scientists supportive of its agenda to re-evaluate the HIV/AIDS hypothesis. Some of those members still listed are people who have been dead for a number of years. While it is correct that these people supported the objective of a scientific re-evaluation of the HIV/AIDS link when they were alive, it is clearly difficult to ascertain what these people would have made of the scientific developments and the accumulation of evidence for HIV as the crucial causative agent in AIDS, which has occurred in the years after their deaths.

Death of HIV-positive denialists

In 2007, aidstruth.org, a website run by HIV researchers to counter denialist claims, published a partial list of AIDS denialists who had died of AIDS-related causes. For example, the magazine Continuum, which consistently denied the existence of HIV/AIDS, shut down when its editors all died of AIDS-related causes. In every case, the AIDS denialist community attributed the deaths to unknown causes, secret drug use, or stress rather than HIV/AIDS. Similarly, several HIV-positive former dissidents have reported being ostracized by the AIDS-denialist community after they developed AIDS and decided to pursue effective antiretroviral treatment.

In 2008, activist Christine Maggiore died at the age of 52 while under a doctor's care for pneumonia. Maggiore, mother of two children, had founded an organisation to help other HIV-positive mothers avoid taking antiretroviral drugs that reduce the risk of HIV transmission from mother to child. After her three-year-old daughter died of AIDS-related pneumonia in 2005, Maggiore continued to believe that HIV is not the cause of AIDS, and she and her husband Robin Scovil sued Los Angeles County and others on behalf of their daughter's estate, for allegedly violating Eliza Scovill's civil rights by releasing an autopsy report that listed her cause of death as AIDS-related pneumonia. The litigants settled out of court, with the county paying Scovill $15,000 in March of 2009, with no admission of wrong-doing. The L.A. coroner's ruling that Eliza Jane Scovill died of AIDS remains standing as the official verdict.

AIDS denialists' claims

Although members of the AIDS denialist community are united by their disagreement with the concept that HIV is the cause of AIDS, the specific positions taken by various groups differ.

Denialist arguments have centered around claims that HIV does not exist or has not been adequately isolated, that the virus does not fulfill Koch's postulates, that HIV testing is inaccurate, or that antibodies to HIV neutralize the virus and render it harmless. Suggested alternative causes of AIDS include recreational drugs, malnutrition, and the very antiretroviral drugs used to treat the syndrome.

Such claims have been examined extensively in the peer-reviewed medical and scientific literature; a scientific consensus has arisen that denialist claims have been convincingly disproved, and that HIV does indeed cause AIDS. In the cases cited by Duesberg where HIV "cannot be isolated", PCR or other techniques demonstrate the presence of the virus, and denialist claims of HIV test inaccuracy result from an incorrect or outdated understanding of how HIV antibody testing is performed and interpreted.

Early denialist arguments held that the HIV/AIDS paradigm was flawed because it had not led to effective treatments. However, the introduction of highly active antiretroviral therapy in the mid-1990s and dramatic improvements in survival of HIV/AIDS patients reversed this argument, as these treatments were based directly on the HIV/AIDS paradigm. The development of effective anti-HIV therapy has been a major factor in convincing some denialist scientists to accept the causative role of HIV in AIDS.

Impact beyond the scientific community

AIDS-denialist claims have failed to attract support in the scientific community, where the evidence for the causative role of HIV in AIDS is considered conclusive. However, the movement has had a significant impact in the political sphere, culminating with former South African President Thabo Mbeki's embrace of AIDS-denialist claims. The resulting governmental refusal to provide effective anti-HIV treatment in South Africa has been blamed for hundreds of thousands of premature AIDS-related deaths in South Africa.

Impact in North America and Europe

Skepticism about HIV as the cause of AIDS began almost immediately after the discovery of HIV was announced. One of the earliest prominent skeptics was the journalist John Lauritsen, who argued in his writings for the New York Native that AIDS was in fact caused by amyl nitrite poppers, and that the government had conspired to hide the truth.

In the scientific literature

The publication of Peter Duesberg's first AIDS paper in 1987 provided visibility for denialist claims. Shortly afterwards, the journal Science reported that Duesberg's remarks had won him "a large amount of media attention, particularly in the gay press where he is something of a hero." However, Duesberg's support in the gay community dried up as he made a series of statements perceived as homophobic; in an interview with the Village Voice in 1988, Duesberg stated his belief that the AIDS epidemic was "caused by a lifestyle that was criminal twenty years ago."

In the following few years, others became skeptical of the HIV theory as researchers initially failed to produce an effective treatment or vaccine for AIDS. Journalists such as Neville Hodgkinson and Celia Farber regularly promoted denialist ideas in the American and British media; several television documentaries were also produced to increase awareness of the alternative viewpoint. In 1992–1993, The Sunday Times, where Hodgkinson served as scientific editor, ran a series of articles arguing that the AIDS epidemic in Africa was a myth. These articles stressed Duesberg's claims and argued that antiviral therapy was ineffective, HIV testing unreliable, and that AIDS was not a threat to heterosexuals. The Sunday Times coverage was heavily criticized as slanted, misleading, and potentially dangerous; the scientific journal Nature took the unusual step of printing a 1993 editorial calling the paper's coverage of HIV/AIDS "seriously mistaken, and probably disastrous."

Finding difficulty in publishing his arguments in the scientific literature, Duesberg exercised his right as a member of the National Academy of Sciences to publish in Proceedings of the National Academy of Sciences (PNAS) without going through the peer review process. However, Duesberg's paper raised a "red flag" at the journal and was submitted by the editor for non-binding review. All of the reviewers found major flaws in Duesberg's paper; the reviewer specifically chosen by Duesberg noted the presence of "misleading arguments", "nonlogical statements", "misrepresentations", and political overtones. Ultimately, the editor of PNAS acquiesced to publication, writing to Duesberg: "If you wish to make these unsupported, vague, and prejudicial statements in print, so be it. But I cannot see how this would be convincing to any scientifically trained reader."

In the lay press and via the Internet

With the introduction of highly active antiretroviral therapy (HAART) in 1996–1997, the survival and general health of people with HIV improved significantly. The positive response to treatment with anti-HIV medication cemented the scientific acceptance of the HIV/AIDS paradigm, and led several prominent AIDS denialists to accept the causative role of HIV. Finding their arguments increasingly discredited by the scientific community, denialists took their message to the popular press. A former denialist wrote:

Scientists among the HIV dissidents used their academic credentials and academic affiliations to generate interest, sympathy, and allegiances in lay audiences. They were not professionally troubled about recruiting lay people—who were clearly unable to evaluate the scientific validity or otherwise of their views—to their cause.

In addition to elements of the popular and alternative press, AIDS denialist ideas are propagated largely via the Internet. A 2007 article in PLoS Medicine noted:

Because these denialist assertions are made in books and on the Internet rather than in the scientific literature, many scientists are either unaware of the existence of organized denial groups, or believe they can safely ignore them as the discredited fringe. And indeed, most of the HIV deniers' arguments were answered long ago by scientists. However, many members of the general public do not have the scientific background to critique the assertions put forth by these groups, and not only accept them but continue to propagate them.

AIDS activists have expressed concern that denialist arguments about HIV's harmlessness may be responsible for an upsurge in HIV infections. Denialist claims continue to exert a significant influence in some communities; a survey conducted at minority gay pride events in four American cities in 2005 found that 33% of attendees doubted that HIV caused AIDS. According to Stephen Thomas, director of the University of Pittsburgh Center for Minority Health, "people are focusing on the wrong thing. They’re focusing on conspiracies rather than protecting themselves, rather than getting tested and seeking out appropriate care and treatment."

Impact in South Africa

AIDS denialist claims have had a major political, social, and public health impact in South Africa. The government of then President Thabo Mbeki was sympathetic to the views of AIDS denialists, with critics charging that denialist influence was responsible for the slow and ineffective governmental response to the country's massive AIDS epidemic.

Independent studies have arrived at almost identical estimates of the human costs of AIDS denialism in South Africa. According to a paper written by researchers from the Harvard School of Public Health, between 2000 and 2005, more than 330,000 deaths and an estimated 35,000 infant HIV infections occurred "because of a failure to accept the use of available to prevent and treat HIV/AIDS in a timely manner." Nicoli Nattrass of the University of Cape Town estimates that 343,000 excess AIDS deaths and 171,000 infections resulted from the Mbeki administration's policies, an outcome she refers to in the words of Peter Mandelson as "genocide by sloth".

Durban Declaration

In 2000, when the International AIDS Conference was held in Durban, Mbeki convened a Presidential Advisory Panel containing a number of AIDS denialists, including Peter Duesberg and David Rasnick. The Advisory Panel meetings were closed to the general press; an invited reporter from the Village Voice wrote that Rasnick advocated that HIV testing be legally banned and denied that he had seen "any evidence" of an AIDS catastrophe in South Africa, while Duesberg "gave a presentation so removed from African medical reality that it left several local doctors shaking their heads."

In his address to the International AIDS Conference, Mbeki reiterated his view that HIV was not wholly responsible for AIDS, leading hundreds of delegates to walk out on his speech. Mbeki also sent a letter to a number of world leaders likening the mainstream AIDS research community to supporters of the apartheid regime. The tone and content of Mbeki's letter led diplomats in the U.S. to initially question whether it was a hoax.

AIDS scientists and activists were dismayed at the president's behavior and responded with the Durban declaration, a document affirming that HIV causes AIDS, signed by over 5,000 scientists and physicians.

Criticism of governmental response

The former South African health minister Manto Tshabalala-Msimang also attracted heavy criticism, as she often promoted nutritional remedies such as garlic, lemons, beetroot and olive oil, to people suffering from AIDS, while emphasizing possible toxicities of antiretroviral drugs, which she has referred to as "poison". The South African Medical Association has accused Tshabalala-Msimang of "confusing a vulnerable public". In September 2006, a group of over 80 scientists and academics called for "the immediate removal of Dr. Tshabalala-Msimang as minister of health and for an end to the disastrous, pseudoscientific policies that have characterized the South African government's response to HIV/AIDS." In December 2006, deputy health minister Nozizwe Madlala-Routledge described "denial at the very highest levels" over AIDS. She was subsequently fired by Mbeki.

Former South African president, Thabo Mbeki's government was widely criticized for delaying the rollout of programs to provide antiretroviral drugs to people with advanced HIV disease and to HIV-positive pregnant women. The national treatment program began only after the Treatment Action Campaign (TAC) brought a legal case against Government ministers, claiming they were responsible for the deaths of 600 HIV-positive people a day who could not access medication. South Africa was one of the last countries in the region to begin such a treatment program, and roll-out has been much slower than planned.

At the XVI International AIDS Conference, Stephen Lewis, U.N. special envoy for AIDS in Africa, attacked Mbeki's government for its slow response to the AIDS epidemic and reliance on denialist claims:

It is the only country in Africa … whose government is still obtuse, dilatory and negligent about rolling out treatment… It is the only country in Africa whose government continues to promote theories more worthy of a lunatic fringe than of a concerned and compassionate state.

In 2002, Mbeki requested that AIDS denialists no longer use his name in denialist literature, and requested that denialists stop signing documents with "Member of President Mbeki's AIDS Advisory Panel". This coincided with the South African government's statement accompanying its 2002 AIDS campaign, that "...in conducting this campaign, government’s starting point is based on the premise that HIV causes AIDS". Nonetheless, Mbeki himself continued to promote and defend AIDS-denialist claims. His loyalists attacked former President Nelson Mandela in 2002 when Mandela questioned the government's AIDS policy, and Mbeki attacked Malegapuru Makgoba, one of South Africa's leading scientists, as a racist defender of "Western science" for opposing AIDS denialism.

In early 2005, former South African president Nelson Mandela announced that his son had died of complications of AIDS. Mandela's public announcement was seen as both an effort to combat the stigma associated with AIDS, and as a "political statement designed to… force the President out of his denial."

"The era of denialism is over"

In 2008, Mbeki was ousted from power and replaced as President of South Africa by Kgalema Motlanthe. On Motlanthe's first day in office, he removed Manto Tshabalala-Msimang, the controversial health minister who had promoted AIDS-denialist claims and recommended garlic, beetroot, and lemon juice as treatments for AIDS. Barbara Hogan, newly appointed as health minister, voiced shame at the Mbeki government's embrace of AIDS denialism and vowed a new course, stating: "The era of denialism is over completely in South Africa."

See also

• Actup SF
• HIV and AIDS misconceptions

Further reading

• The Political Management of HIV and AIDS in South Africa: One burden too many? by Pieter Fourie, Palgrave Macmillan, 2006, ISBN 0230006671

References

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External links

• National Institute of Allergy and Infectious Diseases (NIAID) Focus on the HIV-AIDS Connection: Resources and Links
• Series of articles in Science magazine examining denialist claims
• HIV Denial in the Internet Era, from PLoS Medicine, August 2007
• Avert.org: Evidence that HIV causes AIDS
• AEGIS: News and Views on AIDS Causality
• AidsTruth.org

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