AIDS denialism

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). HIV/AIDS denialists prefer the terms "rethinker" or "dissident". 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 the subject of scientific consensus. Denialist arguments are considered to be the result of cherry-picking and misrepresentation of predominantly outdated scientific data, with the potential to endanger public health by dissuading people from using proven treatments.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 have raised alarm at the human cost of AIDS denialism; independent 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 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 died 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 for the first time 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 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 would be published 4 years later in the journal Science.
 * 1993: Nature publishes an editorial by John Maddox titled Has Duesberg a right of reply?. 1993. Maddox answers the titular question with a "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: The Perth group publishes at Biotechnology the article Is a positive western blot proof of HIV infection?. The Group asked for a reappraisal of the Western Blot test used to detect the HIV. They allege that the test is not standardized, non-reproducible, and of unknown specifity, due to an alleged lack of use of a gold standard in the development of the test.
 * 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: The denialist group Continuum places an advertisement in The Pink Paper offering a £1,000 reward to "the first person finding one scientific paper establishing actual isolation of HIV" (according to their specific set of rules).
 * 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 argued that Duesberg was wrong regarding the cause of AIDS in haemophiliacs.
 * In 1997 the Perth Group publishes HIV antibodies: further questions and a plea for clarification. 1997, followed in 1998 by HIV antibody tests and viral load — more unanswered questions and a further plea for clarification. The group hypothesized that the production of antibodies recognizing HIV proteins can be caused by allogenic stimuli and autoimmune disorders, questioning the existence of HIV based upon this speculation. They repeated this argument in a 2006 article No proof HIV antibodies are caused by a retroviral infection.
 * 1998: Valerie Emerson, of Bangor, Maine, 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.
 * 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 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 criticized the article as inaccurate, misleading, and poorly fact-checked.
 * 2007: Eleni Papadopulos-Eleopulos and Valendar Francis Turner testify at an appeals hearing for Andre Chad Parenzee, stating that HIV cannot be transmitted by heterosexual sex. The judge concluded: "I reject the evidence of Ms Papadopulos-Eleopulos and Dr Turner. I conclude…that they are not qualified to give expert opinions"
 * 2008: Researchers estimate that Thabo Mbeki's denialist policies led to the deaths of more than 330,000 South Africans, reproducing the results of a South African researcher. Barbara Hogan, the health minister appointed by Mbeki's successor, voices shame over the study's findings and states: "The era of denialism is over completely in South Africa."

The AIDS denialist community
People critical of the scientific consensus on AIDS include HIV-positive persons, government employees, scientists, doctors, and activists in several countries. 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 has been contesting the mainstream view of AIDS causation since 1987. 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 dissident theories.

Other notable AIDS denialists include Australian academic ethicist Hiram Caton, the late mathematician Serge Lang, chemist Henry Bauer, journalist Celia Farber and late activist Christine Maggiore.

Organizations of AIDS denialists include the Perth Group, based in Perth, Western Australia), and the Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis.

AIDS denialism has received some support from some 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&mdash;certainly including those with little sympathy for the gay movement&mdash;cannot be denied." p. 158 The paleolibertarian blog LewRockwell.com has also published articles supportive of AIDS denialism.

Former dissidents
Several 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:

Both Sonnabend and Root-Bernstein now favor a less controversial hypothesis, suggesting that cofactors in addition to HIV are necessary to cause AIDS.

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:

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 maintain that HIV does not cause AIDS.

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.Major studies confirming the benefits and effectiveness of modern anti-HIV therapy include, but are not limited to: 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.
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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 South African President Thabo Mbeki's embrace of AIDS-denialist claims. The resulting governmental refusal 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." , p. 118

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:

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:

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:

Impact in South Africa
AIDS denialist claims have had a major political, social, and public health impact in South Africa. The government of former 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 [antiretroviral drugs] 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:

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". Nonetheless, Mbeki 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 [Mbeki] 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 HIV. 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."

Other reading
See also Pieter Fourie, "The Political Management of HIV and AIDS in South Africa: One burden too many?" Palgrave Macmillan, 2006, ISBN 0230006671

Scientific consensus

 * 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

Denialist

 * Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis
 * Peter Duesberg website
 * The Perth Group