AIDS – as a disease – has an almost emotive side to it. Talk of it is altogether different from, say, Cancer. This is not to suggest that the urgency about AIDS (globally) is any less, but there are remnants of a by-gone era which rear their ugly (and discredited) head from time to time. The Catholic Church unfortunately, is one institution which has form in promoting that by-gone thinking; the attitude which tells us that “Aids is bad!…no doubt… but not as BAD as Condoms, heaven forbid”. But kicking The Holy See is good knockabout stuff – and I’m sure I’m bound to revisit our friends in the Vatican later – but this post is NOT going to be about that. Rather, it deals with the unscientific ideas about Aids and how a suspension of critical faculties in examining them, can lead to catastrophic consequences.
One of the bête noire(s) of this blog is outright Science Denialism. This is not a rejection of people fawning over scientists. Clearly they are fallible; prone to biases and errors as much as anyone (though science as an institution does have really good ways of accounting for those biases). Instead, it is about the people who show blatant disregard for carefully acquired peer-reiewed (i.e subject to the best scrutiny) evidence on matters of Science, Health and Medicine. This is exactly the kind of thing I talked about previously while looking at the Creationists and Anti-Vaccine Proponents. If you revisit those posts, you’ll find many similarities in the kind of tricks and fallacious arguments used by people to advance politically charged beliefs that are not supported by the facts. While there is a sliding scale of the impact of such corrosive ideas (I would argue that Vaccine conspiracy theories are potentially more dangerous than Creationism) few can match the sheer numbers-affected, the ferocity and the downright viciousness of Aids Denialism (or AIDS dissidents as they like to call themselves).
A Brief Overview of AIDs
Acquired immune deficiency syndrome (AIDS) was first reported by the US Center for Disease Control in July 1981. In lay terms it is a disease which compromises the immune system of the body which would otherwise mount a response to various viral and bacteria based threats to the system. This is a good accessible explanation of the Biological processes involved. Initially there was a lot of confusion as to what caused it. Then in 1983, a group of scientists under the supervision of Luc Montagnier, discovered a new retrovirus in a patient with signs and symptoms that often preceded AIDS. They named the retrovirus lymphadenopathy-associated virus, or LAV, and sent samples to Robert Gallo‘s team (which was another US-based group working on a retrovirus which they believed caused AIDS); findings were peer reviewed and were set for publication in the journal Science. Meanwhile in 1984, the US Department of Health and Human Services announced that the virus found by Gallo’s team was the likely cause for AIDS. After a few years of toil, (in 1986) it was discovered that the two retroviruses found by Gallo and Montagnier were genetically indistinguishable and were renamed human immunodeficiency virus HIV. This was the breakthrough discovery of the (virus) disease which in 2009, the UNAIDS estimated infected
33.4 million people worldwide (living), with 2.7 million new HIV infections per year and 2.0 million annual deaths due to AIDS (UNAIDS Report)
This makes it one of the biggest killers ever. It is difficult, even to comprehend the utter devastation brought about by this disease. Although treatments for HIV/AIDS can slow the course of the disease, there is no known cure or an ‘HIV vaccine’ of any kind as of yet. Anti-retroviral treatment reduces both the deaths and new infections from HIV/AIDS, but these drugs are expensive and the medications are not available in all countries – a fact which was to prove utterly devastating for the populations of Africa in particular. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the pandemic with health organizations promoting safe sex and needle exchange programes in attempts to slow the spread of the virus.
History of a Corrosive Counter-Claim
Perhaps the first recognizable murmurings of AIDs denialism came in 1984 when Casper Schmidt, a psychiatrist, published a paper in Journal of Psychoshistory entitled “The Group-Fantasy Origins of AIDS” which basically argued that AIDS was not a disease but rather an example of epidemic hysteria in which groups of people would subconsciously act out social conflicts rather than displaying symptoms any real disease. This was at a time when the Science did not have a handle on what caused AIDS, or in many ways what was AIDS. So these ideas were never too far from the surface. Schmidt, himself – in a twist of dark irony – would later die of AIDS in 1994. But the meme was planted, that ‘AIDs was something fake and cooked up’. And from that, came Peter Duesberg (an academic at UC Berkeley) – who would go on to become possibly the most prominent AIDS-denialist out there – when he first questioned the link between the link between HIV and AIDS in his paper Retroviruses as Carcinogens and Pathogens: Expectations and Reality, in the journal Cancer Research. In itself, questioning Scientific orthodoxy is no bad thing. In fact that is how Science is meant to progress, ruling out other factors that may challenge the consensus view (which was steadily emerging in favour of HIV causing AIDS).
But insisting on the same things when you’r arguments have been addressed is another matter altogether. Duesberg’s work got quite a lot traction among many, early on – enough even, to get him published in a Journal alongside some of the mainstream stuff. As time went by though, the evidence (for HIV causing AIDS) hardened and in 1988, a a panel of the Institute of Medicine of the US National Academy of Sciences found that “the evidence that HIV causes AIDS is scientifically conclusive. But as we find with most conspiracy theories,a hardening of evidence is never enough to stop these ideas in their tracks. And so it proved to be the case as Duesberg embarked upon a campaign of quackery and conspiracy theory which saw him steadily gain influence among some of the most powerful people in the world (particular in the developing world where the consequences of AIDS were much more horrific than in Western Europe or North America)
He wrote the book “Inventing the AIDS Virus” which came out in 1996 asserting that HIV is harmless, and that it is recreational drugs and Anti-retro-viral drugs (specifically AZT, an early developed Anti-Retroviral drug) which caused AIDS. It gained him quite a lot of notoriety as this rather (stomach churning-ly) deferential interview demonstrates. It even got a foreward from Nobel laureate (in Chemistry) Kary Mullis, who among things (like being into Astrology apparently) is also a climate-change denialist – shows that sometimes the brightest of the bright can be taken in by the conspiracy theory quack mindset. Soon enough, other people like David Rasnick also started appearing on the scene; peddling the same ideas, that HIV does not cause AIDS and the Scientific consensus is a conspiracy to allow big Pharma to profit. Remember all of this was happening as the evidence was for HIV causing AIDS was becoming even more watertight. Both Rasnick and Duesberg were to take their ideas to South Africa over the turn of the Millennium, where President Thabo Mbeki tragically gave them credence and enacted actively AIDS-denialist policies throughout his reign from 2000-2008 – a period which was to prove deadly for many South Africans. Perhaps Mbeki’s attitude was a legacy of the brutal Apartheid regime in South Africa, notorious for committing various bio-ethical atrocities on the population – but this paranoia is a feeble excuse (at best) not an exoneration. I’m actually preparing a post specifically on that aspect of this wretched idea, so I won’t go into in much detail now. Suffice is to say that Duesberg and Rasnick play a significant and deplorable role in facilitating the South African catastrophe.
For anyone, who thinks this is a cautionary tale of how bad ideas influence things in the past but are now discredited and we don’t have to deal with them, think again. As recently as 2009, a film called House of Numbers was released, which posited itself as ‘an objective, naive investigation’ into AIDS. Here is the trailer if you can stomach it. That is how it was marketed to people but as Ben Goldacre of Bad Science explains, It contained
All the usual ideas are there. It’s antiretroviral drugs themselves that are the cause of symptoms called Aids. Or it’s poverty. Or it’s drug use. HIV doesn’t cause Aids. Diagnostic tools don’t work, Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems, and the drugs don’t work either.
We have to beware of things like ‘Oh we’r just starting a debate, we’r just asking questions’ line on this. Firstly because its so trite and meaningless, but more importantly it is then an invitation for you to put the most comprehensively assembled evidence on AIDS that is out there, on equal (or even less of a) footing with fringe crackpot conspiracy theories. It also highlights how ‘On the one hand, and the other hand’ model of journalism breaks down in explaining these things – though I don’t think the film even amounts to that.
The Specific Claims of AIDS-Denialists
Because this has the potential to get really long-winded, I will for brevity and clarity, address them in point form. (Also I’m not going to link directly to each claim because a) they are so many and b) I don’t want to direct too much traffic their way. Suffice to say, you can easily find them yourself, and if I have misrepresented their basic contentions, do let me know. I will definitely review it.)
- HIV does NOT Cause AIDs: This claim – as I have mentioned above – is the cornerstone of the AIDS denialist movement. The work of Gallo and Montagnier initially showed that HIV causes AIDs. Since then with very few exceptions, HIV itself or antibodies to HIV are detected in people with AIDS. Studies of people who are HIV-positive show they are more likely to develop AIDS symptoms and more likely to die at younger ages than people without HIV. Scientists can now describe in great detail how HIV infection occurs and how it causes AIDS. In fact there are very good peer reviewed studies showing where the virus originated.
- AIDS in the West is high because of Recreational Drug Use among Minorities/Immigrants: This is a curious claim. Because I think it has its roots in all the moralistic sentiments that are often banded about in AIDS discourse (usually dinner time discussions in aloof suburban idylls) And part of the AIDS-Denialist brief, is to tap into that (right wing) sentiment, hence Duesberg contentions (see links/references above) that it is THIS (rater than HIV), that causes AIDS got alot of play in some circles because it flattered their preconceived ideologies about race, drugs and immigration. But what is the evidence for these claims? For starters, the fact is that no published peer-reviewed study supports this theory should immediately raise a red-flag about the veracity of this claim. There are interesting tidbits about how alcohol use may increase risk of AIDS but that too is indirect i.e. from it being undisciplined about taking medication/using protection(condoms) – no direct biochemical link to AIDS as the denialists want to imply. AIDS can be spread using needles, ofcourse but that’s a transmission claim – not a causal one. M.S. Ascher examined this by looking at the data of several research cohorts and found no correlation between drug use and AIDS. The graph below is from that study, Does drug use cause AIDS? published in Nature in 1993 shows that there is no correlation between recreational drug use and AIDS. It is important to note that drug use may indeed facilitate transmission AIDS through the use of needles, but that is not AIDS-Denialist are saying; which is that drug-use itself causes AIDS
- HIV cannot be transmitted hetrosexually In fact studies investigating this claim have shown the EXACT OPPOSITE opposite as this article demonstrates. I don’t think, this claim even fools people who are remotely interested in this topic, as the sheer numbers of victims and deaths are so visible to everybody. You really have to have tunnel vision to believe this one. Though this idea is very popular with people who believe that homesexuality is a sin (often with religious undertones) and AIDS is a risk of that sinful behaivour. As with needles other forms of sexual intercourse, there is no evidence for homosexual lifestyle causing AIDS, only that it can spread if contraception is not used – the same with heterosexuals. As this study showed, that none of these things ’cause’ AIDS. Its conclusively the HIV Virus.
- AIDS in heomophilliacs is caused by clotting agents in donated blood not HIV Heomophillia is genetic disorder which affects the clotting of blood which is used to stop bleeding when the vessel is broken. So another conspiracy theory was based on the fact that a high proportion of haemophiliacs were exposed to Factor VIII (a clotting agent) and it was THAT (not HIV) that caused AIDS in the US. But retrospective tests of US blood supply showed that “in 1978, at least one batch of Factor VIII was contaminated with HIV”. Talk to a denialist, and they will purposely omit that finding from the discussion. And onwards they will move to their next claim
- There is no serious HIV epidemic in Africa, it is merely another name for diseases from poverty Of all their claims, this is perhaps the most hideous and dispicable. Effectively this is a denial of death on a biblical scale in Africa. And true to form, it is totally demolished by empirical evidence. Various studies in Africa have shown that the HIV infection is a predictor of higher disease and death rates. While poor people have greater exposure to HIV and are more likely to progress to AIDS faster, once infected with HIV, there is no evidence that poverty itself is the cause of AIDS. This study in Rakai, Uganda looked at nearly 20,000 people and found a much higher death rate among HIV than other impoverished people. Moreover, the HIV-related death-rate was higher among better-educated and well-off people as well, which completely torpedos this notion that there is no HIV epidemic in Africa. A Statistcs South Africa study looked at a count of death certificates in South Africa from 1997 to 2002 showed a 57% rise in deaths that cannot be explained by population growth or an improved death registration. The HIV-related mortality trends have become even clearer. This cannot be explained by poverty, because (i) economic conditions in South Africa have not changed drastically enough to explain this sudden rise in adult mortality (on the contrary, the social wage in South Africa has increased during this time) and (ii) if it had, we would expect to see a much higher rise in deaths among the elderly which we didnt. The only plausible explanation of the increase in adult mortality in South Africa is HIV.
- AZT causes AIDS (AZT is a type an Anti-retroviral drug – one of the earliest developed) One thing that deniers never focus is extremely diversity and adaptability of HIV. This is perhaps why its so deadly, because it can adapt newer strains which are very difficult to identify let alone fight off. So by definition, any Antiretro-viral treatment will have some people for whom they won’t work. That is just how HIV operates. That reality instead is fudged and mangled to the point (by the Denialists) where they start to make the absurd claim that it is AZT itself that causes AIDS – using ‘sciency-sounding’ language while doing so. And ofcourse it is book-ended with the phrase ‘it all fits’ hinting at the Big Pharma Conspiracy. Whenever you hear the phrase ‘It all fits’, be suspicious, because in life, nature, societies – nothing fits in neat little boxes and preconceptions. There are always caveats, hedges and outliers which confound explanation. The way to deal with them is through employing empirically testable methods like Randomized Controlled Trials. In the first AZT trial on people with AIDS symptoms, known as BW 002, 19 patients out of 137 on placebo died and 1 patient out of 145 on AZT died. The AZT patients did better on a range of scores including quality of life. In another randomized placebo-controlled study known as ACTG 016, the efficacy of AZT in reducing disease progression in symptomatic people with CD4 counts of 200 to 500 was again demonstrated. No benefit was found for people with CD4 counts above 500.
- Anti-retroviral drugs are untested and are harmful to feotus in Pregnant women Every Anti-retroviral registered in South Africa and the USA (of July 2006) had demonstrated its safety and efficacy in clinical trials. As with the pregnant women claim, the short term evidence is quite categorically against it, that pregnant women who take Anti-retrovirals reduce infecting their infants. The results of long-term data are awaited, but every bit of incremental evidence that has been gathered shows that Anti-retrovirals have been efficacious.
- HIV Tests are unrealiable because they produce False Positives As with any epidemiological study there are two vital measures that allow us to discriminate; Sensitivity Tests (likelihood that the research/trial/study will return positive results) and SpecificityTests (the likelihood that the researcg/trial/study will return negative results) and on both counts the tests for HIV (or its anti-bodies) have been demonstrated to be reliable.
- Tests that measure HIV are flawed because they find only dead virus particles This is simply a bogus assertion as there are viral load tests which give us an indication of a live viruses in a person with HIV
- AZT does not triophosphorylate and therefore cannot work AZT has to go through process known as triophosphorylation which allows AZT to work. Since this requires a nuanced understanding of Biochemistry, it is often trotted up by Denialist to bamboozle folks without prior knowledge of this issue. The fact is that there is both evidence that AZT works (above) and that it triophosphorylates
- HIV cannot be detected post-mortem Another bizarre claim which disintegrates at the first instance of scientific or any kind of examination. In fact it can be detected with high degree of accuracy and is vital information in screening for tissue donors.
- The fact that many people live in good health for many years is proof that HIV is harmless This is the classic small sample size fallacy. Sure some people will be able to live in good health with HIV for many years. But all big studies involving large sample size have demonstrated that most HIV people will develop AIDS. The plural of anecdotes is anecdotes, NOT Data