Misconceptions about HIV/AIDS

From Wikipedia, the free encyclopedia

People with HIV-AIDS up to 2016

 

The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. In 2016, UNAIDS estimated: 2.1 million children (less than 15 years) worldwide were living with HIV/ AIDS and 17.8 million women (15+ years) worldwide were living with HIV/ AIDS. In 2011, UNAIDS estimated: 1.8 million new HIV infections in sub-Saharan Africa compared to 2.4 million new infections in 2001 a 25% decline. Between 2005-2011, the number of deaths from AIDS-related causes in sub-Saharan Africa declined by 32%,1.8 million to 1.2 million. From 2009 and 2011, the number of children newly infected with HIV fell in sub-Saharan Africa fell by 24%.

Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.

The relationship between HIV and AIDS

HIV is the same as AIDS

HIV is an acronym for human immunodeficiency virus, which is the virus that causes AIDS (acquired immunodeficiency syndrome). Contracting HIV can lead to the development of AIDS or stage 3 HIV, which causes serious damage to the immune system. While this virus is the underlying cause of AIDS, not all HIV-positive individuals have AIDS, as HIV can remain in a latent state for many years. If undiagnosed or left untreated, HIV usually progresses to AIDS, defined as possessing a CD4+ lymphocyte count under 200 cells/μl or HIV infection plus co-infection with an AIDS-defining opportunistic infection. HIV cannot be cured, but it can be treated, and its transmission can be halted. Treating HIV can prevent new infections, which is the key to ultimately defeating AIDS.

Treatment

Cure

A bottle containing Stribild tablets (medication used to treat HIV). Stribild is a combination drug containing tenofovir disoproxil fumarate, emtricitabine, elvitegravir and cobicistat.

 

Highly Active Anti-Retroviral Therapy (HAART) in many cases allows the stabilization of the patient's symptoms, partial recovery of CD4+ T-cell levels, and reduction in viremia (the level of virus in the blood) to low or near-undetectable levels. Disease-specific drugs can also alleviate symptoms of AIDS and even cure specific AIDS-defining conditions in some cases. Medical treatment can reduce HIV infection in many cases to a survivable chronic condition. However, these advances do not constitute a cure, since current treatment regimens cannot eradicate latent HIV from the body. 

High levels of HIV-1 (often HAART-resistant) develop if treatment is stopped, if compliance with treatment is inconsistent, or if the virus spontaneously develops resistance to an individual's regimen. Antiretroviral treatment known as post-exposure prophylaxis reduces the chance of acquiring an HIV infection when administered within 72 hours of exposure to HIV. These problems mean that while HIV-positive people with low viremia are less likely to infect others, the chance of transmission always exists. In addition, people on HAART may still become sick.

Sexual intercourse with a virgin will cure AIDS

The myth that sex with a virgin will cure AIDS is prevalent in South Africa. Sex with an uninfected virgin does not cure an HIV-infected person, and such contact will expose the uninfected individual to HIV, potentially further spreading the disease. This myth has gained considerable notoriety as the perceived reason for certain sexual abuse and child molestation occurrences, including the rape of infants, in South Africa.

Sexual intercourse with an animal will avoid or cure AIDS

In 2002, the National Council of Societies for the Prevention of Cruelty to Animals (NSPCA) in Johannesburg, South Africa, recorded beliefs amongst youths that sex with animals is a means to avoid AIDS or cure it if infected. As with "virgin cure" beliefs, there is no scientific evidence suggesting a sexual act can actually cure AIDS, and no plausible mechanism by which it could do so has ever been proposed. While the risk of contracting HIV via sex with animals is likely much lower than with humans due to HIV's inability to infect animals, the practice of bestiality still has the ability to infect humans with other fatal zoonotic diseases.

HIV antibody testing is unreliable

Diagnosis of infection using antibody testing is a well-established technique in medicine. HIV antibody tests exceed the performance of most other infectious disease tests in both sensitivity (the ability of the screening test to give a positive finding when the person tested truly has the disease) and specificity (the ability of the test to give a negative finding when the subjects tested are free of the disease under study). Many current HIV antibody tests have sensitivity and specificity in excess of 96% and are therefore extremely reliable. While most patients with HIV show an antibody response after six weeks, window periods vary and may occasionally be as long as three months.

Progress in testing methodology has enabled detection of viral genetic material, antigens, and the virus itself in bodily fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests.

Positive HIV antibody tests are usually followed up by retests and tests for antigens, viral genetic material and the virus itself, providing confirmation of actual infection.

HIV infection

Symptoms of acute HIV infection

HIV can be spread through casual contact with an HIV infected individual

Symptoms of AIDS

 

One cannot become infected with HIV through normal contact in social settings, schools, or in the workplace. One cannot be infected by shaking someone's hand, by hugging or "dry" kissing someone, by using the same toilet or drinking from the same glass as an HIV-infected person, or by being exposed to coughing or sneezing by an infected person. Saliva carries a negligible viral load, so even open-mouthed kissing is considered a low risk. However, if the infected partner or both of the performers have blood in their mouth due to cuts, open sores, or gum disease, the risk is higher. The Centers for Disease Control and Prevention (CDC) has only recorded one case of possible HIV transmission through kissing (involving an HIV-infected man with significant gum disease and a sexual partner also with significant gum disease), and the Terence Higgins Trust says that this is essentially a no-risk situation.

Other interactions that could theoretically result in person-to-person transmission include caring for nose bleeds and home health care procedures, yet there are very few recorded incidents of transmission occurring in these ways. A handful of cases of transmission via biting have occurred, though this is extremely rare.

HIV-positive individuals can be detected by their appearance

Due to media images of the effects of AIDS, many people believe that individuals infected with HIV always appear a certain way, or at least appear different from an uninfected, healthy person. In fact, disease progression can occur over a long period of time before the onset of symptoms, and as such, HIV infections cannot be detected based on appearance.

HIV cannot be transmitted through oral sex

Contracting HIV through oral sex is not impossible, but it is much lower than from anal sex and penile–vaginal intercourse.

HIV is transmitted by mosquitoes

When mosquitoes bite a person, they do not inject the blood of a previous victim into the person they bite next. Mosquitoes do, however, inject their saliva into their victims, which may carry diseases such as dengue fever, malaria, yellow fever, or West Nile virus and can infect a bitten person with these diseases. HIV is not transmitted in this manner. On the other hand, a mosquito may have HIV-infected blood in its gut, and if swatted on the skin of a human who then scratches it, transmission is hypothetically possible, though this risk is extremely small, and no cases have yet been identified through this route.

HIV survives for only a short time outside the body

HIV can survive at room temperature outside the body for hours if dry (provided that initial concentrations are high), and for weeks if wet (in used syringes/needles). However, the amounts typically present in bodily fluids do not survive nearly as long outside the body—generally no more than a few minutes if dry. Again, the amount of time is longer if wet, especially in syringes/needles and related equipment.

HIV can infect only homosexual men and drug users

Irrespective to sexual orientation, HIV can transmit from one person to another if an engaging partner is HIV positive. In the United States, the main route of infection is via homosexual anal sex, while for women transmission is primarily through heterosexual contact. Nevertheless, HIV can infect anybody, regardless of age, sex, ethnicity, or sexual orientation. It is true that anal sex (regardless of the gender of the receptive partner) carries a higher risk of infection than most sex acts, but most penetrative sex acts between any individuals carry some risk. Properly used condoms can reduce this risk.

An HIV-infected female cannot have children

HIV-infected women remain fertile, although in late stages of HIV disease a pregnant woman may have a higher risk of miscarriage. Normally, the risk of transmitting HIV to the unborn child is between 15 and 30%. However, this may be reduced to just 2–3% if patients carefully follow medical guidelines.

HIV cannot be the cause of AIDS because the body develops a vigorous antibody response to the virus

This reasoning ignores numerous examples of viruses other than HIV that can be pathogenic after evidence of immunity appears. Measles virus may persist for years in brain cells, eventually causing a chronic neurologic disease despite the presence of antibodies. Viruses such as Cytomegalovirus, Herpes simplex virus, and Varicella zoster may be activated after years of latency even in the presence of abundant antibodies. In other animals, viral relatives of HIV with long and variable latency periods, such as visna virus in sheep, cause central nervous system damage even after the production of antibodies.

HIV has a well-recognized capacity to mutate to evade the ongoing immune response of the host.

Only a small number of CD4+ T-cells are infected by HIV, not enough to damage the immune system

Although the fraction of CD4+ T-cells that is infected with HIV at any given time is never high (only a small subset of activated cells serve as ideal targets of infection), several groups have shown that rapid cycles of death of infected cells and infection of new target cells occur throughout the course of the disease. Macrophages and other cell types are also infected with HIV and serve as reservoirs for the virus.

Furthermore, like other viruses, HIV is able to suppress the immune system by secreting proteins that interfere with it. For example, HIV's coat protein, gp120, sheds from viral particles and binds to the CD4 receptors of otherwise healthy T-cells; this interferes with the normal function of these signalling receptors. Another HIV protein, Tat, has been demonstrated to suppress T cell activity.

Infected lymphocytes express the Fas ligand, a cell-surface protein that triggers the death of neighboring uninfected T-cells expressing the Fas receptor. This "bystander killing" effect shows that great harm can be caused to the immune system even with a limited number of infected cells.

History of HIV/AIDS

The cover page of MMWR in July 3, 1981. The first major public info regarding (what later became known as) AIDS/HIV.

 

The current consensus is that HIV was introduced to North America by a Haitian immigrant who contracted it while working in the Democratic Republic of the Congo in the early 1960s, or from another person who worked there during that time. In 1981 on June 5, the U.S. Centers for Disease Control and Prevention(CDC) publish a Morbidity and Mortality Weekly Report (MMWR), describing cases of a rare lung infection, Pneumocystis carinii pneumonia (PCP), from five healthy, gay men in Los Angeles. This edition would later become MMWR's first official reporting of the AIDS epidemic in North America. By year-end, a cumulative total of 270 reported cases of severe immune deficiency was founded amid gay men, 121 out of the 270 reported cases had died. On September 24 in 1982, CDC started to use the term “AIDS” (acquired immune deficiency syndrome) for the first time, and released the first case definition of AIDS: “a disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known case for diminished resistance to that disease.” Than an edition in March 4,1983 of the Morbidity and Mortality Weekly Report (MMWR), notes that CDC founded most cases of AIDS have been reported among homosexual men with multiple sexual partners, injection drug users, Haitians, and hemophiliacs. The report suggests that AIDS may be caused by an infectious agent that is transmitted sexually or through exposure to blood or blood products and issues recommendations for preventing transmission. Although most cases founded of HIV/AIDS were founded in gay men on January 7, 1983 CDC reported cases of AIDS in female sexual partners of males with AIDS. In 1984 Scientists identified the virus that causes AIDS, which was first named after the T-cells affected by the strain and is now called HIV or human immunodeficiency virus. Afterwards, A Canadian flight attendant, dubbed "Patient Zero," dies of AIDS-related complications. His sexual connection to several of the first victims of HIV is erroneously reported that he is responsible for introducing the virus into North America. By this time there were 8,000 confirmed cases in the U.S., resulting in an alarming 3,500 deaths.

On September 17,1985 President Ronald Reagan for the first time mentioned AIDS and vowed in a letter to Congress to make AIDS a priority. In 1987 the FDA approved AZT which is the first antiretroviral drug for treating AIDS. The Ad Council partners with AMFAR and the National AIDS Network in 1989 launched a national AIDS education campaign. This was the first ad campaign in the U.S. to use the word "condom." One of the campaign's slogans were "Using it won't kill you. Not using it might." Singer Paul Jabara starts the Red Ribbon Foundation in 1991, which begins distributing ribbons as a symbol of tolerance for those living with HIV/AIDS. At the 11th International AIDS Conference in Vancouver, combination antiretroviral treatment is presented for the first time. These drugs are shown to be effective against HIV. Media outlets in 1997 started to report that for the first time since the epidemic of AIDS/HIV began, the AIDS death rate had declined in the U.S. thanks to the success of drug therapies. Researchers from the University of Alabama at Birmingham reported a discovery in 1999 of HIV-1 in a subspecies of chimpanzee. They believed this to be the source of the virus and theorize that human hunters contracted it when exposed to infected blood. Later in 2003, The FDA approved the first of a new type of anti-HIV drug called Fuzeon (also known as enfuvirtide or T-20). This drug is designed to prevent the entry of HIV into human cells. George W. Bush launched PEPFAR in 2004, the U.S. President's Emergency Plan to combat AIDS worldwide. "This historic commitment is the largest by any nation to combat a single disease internationally," according to the PEPFAR website. President Obama removed a travel ban in 2009 that prevented HIV-positive people from entering the U.S. This leads to the announcement that the International AIDS Conference will be held in the U.S. for the first time in more than 20 years. During 2012 UNAIDS announced that new HIV infections had dropped more than 50% in 25 low- and middle-income countries, and the number of people getting antiretroviral treatment had increased 63% in the past two years. More than 34 million people are still living with HIV, according to global estimates.

Origin of AIDS through human–monkey sexual intercourse

While HIV is most likely a mutated form of simian immunodeficiency virus (SIV), a disease present only in chimpanzees and African monkeys, highly plausible explanations for the transfer of the disease between species (zoonosis) exist not involving sexual intercourse. In particular, the African chimpanzees and monkeys which carry SIV are often hunted for food, and epidemiologists theorize that the disease may have appeared in humans after hunters came into blood-contact with monkeys infected with SIV that they had killed. The first known instance of HIV in a human was found in a person who died in the Democratic Republic of the Congo in 1959, and a recent study dates the last common ancestor of HIV and SIV to between 1884 and 1914 by using a molecular clock approach.

Tennessee State Senator Stacey Campfield was the subject of controversy in 2012 after stating that AIDS was the result of a human having sexual intercourse with a monkey.

AIDS denialism

There is no AIDS in Africa, as AIDS is nothing more than a new name for old diseases

The diseases that have come to be associated with AIDS in Africa, such as cachexia, diarrheal diseases and tuberculosis have long been severe burdens there. However, high rates of mortality from these diseases, formerly confined to the elderly and malnourished, are now common among HIV-infected young and middle-aged people, including well-educated members of the middle class.

For example, in a study in Côte d'Ivoire, HIV-seropositive individuals with pulmonary tuberculosis were 17 times more likely to die within six months than HIV-seronegative individuals with pulmonary tuberculosis. In Malawi, mortality over three years among children who had received recommended childhood immunizations and who survived the first year of life was 9.5 times higher among HIV-seropositive children than among HIV-seronegative children. The leading causes of death were wasting and respiratory conditions. Elsewhere in Africa, findings are similar.

HIV is not the cause of AIDS

There is broad scientific consensus that HIV is the cause of AIDS, but some individuals reject this consensus, including biologist Peter Duesberg, biochemist David Rasnick, journalist/activist Celia Farber, conservative writer Tom Bethell, and intelligent design advocate Phillip E. Johnson. (Some one-time skeptics have since rejected AIDS denialism, including physiologist Robert Root-Bernstein, and physician and AIDS researcher Joseph Sonnabend.)

A great deal is known about the pathogenesis of HIV disease, even though important details remain to be elucidated. However, a complete understanding of the pathogenesis of a disease is not a prerequisite to knowing its cause. Most infectious agents have been associated with the disease they cause long before their pathogenic mechanisms have been discovered. Because research in pathogenesis is difficult when precise animal models are unavailable, the disease-causing mechanisms in many diseases, including tuberculosis and hepatitis B, are poorly understood, but the pathogens responsible are very well established.

AZT and other antiretroviral drugs, not HIV, cause AIDS

The vast majority of people with AIDS never received antiretroviral drugs, including those in developed countries prior to the licensure of AZT in 1987. Even today, very few individuals in developing countries have access to these medications.

In the 1980s, clinical trials enrolling patients with AIDS found that AZT given as single-drug therapy conferred a modest (and short-lived) survival advantage compared to placebo. Among HIV-infected patients who had not yet developed AIDS, placebo-controlled trials found that AZT given as a single-drug therapy delayed, for a year or two, the onset of AIDS-related illnesses. The lack of excess AIDS cases and death in the AZT arms of these placebo-controlled trials effectively counters the argument that AZT causes AIDS.

Subsequent clinical trials found that patients receiving two-drug combinations had up to 50% increases in time to progression to AIDS and in survival when compared to people receiving single-drug therapy. In more recent years, three-drug combination therapies have produced another 50–80% improvements in progression to AIDS and in survival when compared to two-drug regimens in clinical trials. Use of potent anti-HIV combination therapies has contributed to dramatic reductions in the incidence of AIDS and AIDS-related deaths in populations where these drugs are widely available, an effect which would be unlikely if antiretroviral drugs caused AIDS.

Behavioral factors such as recreational drug use and multiple sexual partners—not HIV—account for AIDS

The proposed behavioral causes of AIDS, such as multiple sexual partners and long-term recreational drug use, have existed for many years. The epidemic of AIDS, characterized by the occurrence of formerly rare opportunistic infections such as Pneumocystis carinii pneumonia (PCP), did not occur in the United States until a previously unknown human retrovirus—HIV—spread through certain communities.

Compelling evidence against the hypothesis that behavioral factors cause AIDS comes from recent studies that have followed cohorts of homosexual men for long periods of time and found that only HIV-seropositive men develop AIDS. For example, in a prospectively studied cohort in Vancouver, British Columbia, 715 homosexual men were followed for a median of 8.6 years. Among 365 HIV-positive individuals, 136 developed AIDS. No AIDS-defining illnesses occurred among 350 seronegative men, despite the fact that these men reported appreciable use of nitrite inhalants ("poppers") and other recreational drugs, and frequent receptive anal intercourse (Schechter et al., 1993).

Other studies show that among homosexual men and injection-drug users, the specific immune deficit that leads to AIDS—a progressive and sustained loss of CD4+ T-cells—is extremely rare in the absence of other immunosuppressive conditions. For example, in the Multicenter AIDS Cohort Study, more than 22,000 T-cell determinations in 2,713 HIV-seronegative homosexual men revealed only one individual with a CD4+ T-cell count persistently lower than 300 cells/µl of blood, and this individual was receiving immunosuppressive therapy.

In a survey of 229 HIV-seronegative injection-drug users in New York City, mean CD4+ T-cell counts of the group were consistently more than 1000 cells/µl of blood. Only two individuals had two CD4+ T-cell measurements of less than 300/µl of blood, one of whom died with cardiac disease and non-Hodgkin's lymphoma listed as the cause of death.

AIDS among transfusion recipients is due to underlying diseases that necessitated the transfusion, rather than to HIV

This notion is contradicted by a report by the Transfusion Safety Study Group (TSSG), which compared HIV-negative and HIV-positive blood recipients who had been given blood transfusions for similar diseases. Approximately 3 years following blood transfusion, the mean CD4+ T-cell count in 64 HIV-negative recipients was 850/µl of blood, while 111 HIV-seropositive individuals had average CD4+ T-cell counts of 375/µl of blood. By 1993, there were 37 cases of AIDS in the HIV-infected group, but not a single AIDS-defining illness in the HIV-seronegative transfusion recipients.

High usage of clotting factor concentrate, not HIV, leads to CD4+ T-cell depletion and AIDS in hemophiliacs

This view is contradicted by many studies. For example, among HIV-seronegative patients with hemophilia A enrolled in the Transfusion Safety Study, no significant differences in CD4+ T-cell counts were noted between 79 patients with no or minimal factor treatment and 52 with the largest amount of lifetime treatments. Patients in both groups had CD4+ T-cell-counts within the normal range. In another report from the Transfusion Safety Study, no instances of AIDS-defining illnesses were seen among 402 HIV-seronegative hemophiliacs who had received factortherapy.

In a cohort in the United Kingdom, researchers matched 17 HIV-seropositive hemophiliacs with 17 HIV-seronegative hemophiliacs with regard to clotting factor concentrate usage over a ten-year period. During this time, 16 AIDS-defining clinical events occurred in 9 patients, all of whom were HIV-seropositive. No AIDS-defining illnesses occurred among the HIV-negative patients. In each pair, the mean CD4+ T-cell count during follow-up was, on average, 500 cells/µl lower in the HIV-seropositive patient.

Among HIV-infected hemophiliacs, Transfusion Safety Study investigators found that neither the purity nor the amount of factor VIII therapy had a deleterious effect on CD4+ T-cell counts. Similarly, the Multicenter Hemophilia Cohort Study found no association between the cumulative dose of plasma concentrate and incidence of AIDS among HIV-infected hemophiliacs.

The distribution of AIDS cases casts doubt on HIV as the cause. Viruses are not gender-specific, yet only a small proportion of AIDS cases are among women

The distribution of AIDS cases, whether in the United States or elsewhere in the world, invariably mirrors the prevalence of HIV in a population. In the United States, HIV first appeared in populations of injection-drug users (a majority of whom are male) and gay men. HIV is spread primarily through unprotected sex, the exchange of HIV-contaminated needles, or cross-contamination of the drug solution and infected blood during intravenous drug use. Because these behaviors show a gender skew—Western men are more likely to take illegal drugs intravenously than Western women, and men are more likely to report higher levels of the riskiest sexual behaviors, such as unprotected anal intercourse—it is not surprising that a majority of U.S. AIDS cases have occurred in men.

Women in the United States, however, are increasingly becoming HIV-infected, usually through the exchange of HIV-contaminated needles or sex with an HIV-infected male. The CDC estimates that 30 percent of new HIV infections in the United States in 1998 were in women. As the number of HIV-infected women has risen, so too has the number of female AIDS patients in the United States. Approximately 23% of U.S. adult/adolescent AIDS cases reported to the CDC in 1998 were among women. In 1998, AIDS was the fifth leading cause of death among women aged 25 to 44 in the United States, and the third leading cause of death among African-American women in that age group.

In Africa, HIV was first recognized in sexually active heterosexuals, and AIDS cases in Africa have occurred at least as frequently in women as in men. Overall, the worldwide distribution of HIV infection and AIDS between men and women is approximately 1 to 1. In sub-Saharan Africa, 57% of adults with HIV are women, and young women aged 15 to 24 are more than three times as likely to be infected as young men.

HIV is not the cause of AIDS because many individuals with HIV have not developed AIDS

HIV infections have a prolonged and variable course. The median period of time between infection with HIV and the onset of clinically apparent disease is approximately 10 years in industrialized countries, according to prospective studies of homosexual men in which dates of seroconversion are known. Similar estimates of asymptomatic periods have been made for HIV-infected blood-transfusion recipients, injection-drug users and adult hemophiliacs.

As with many diseases, a number of factors can influence the course of HIV disease. Factors such as age or genetic differences between individuals, the level of virulence of the individual strain of virus, as well as exogenous influences such as co-infection with other microbes may determine the rate and severity of HIV disease expression. Similarly, some people infected with hepatitis B, for example, show no symptoms or only jaundice and clear their infection, while others suffer disease ranging from chronic liver inflammation to cirrhosis and hepatocellular carcinoma. Co-factors probably also determine why some smokers develop lung cancer while others do not.

HIV is not the cause of AIDS because some people have symptoms associated with AIDS but are not infected with HIV

Most AIDS symptoms result from the development of opportunistic infections and cancers associated with severe immunosuppression secondary to HIV. 

However, immunosuppression has many other potential causes. Individuals who take glucocorticoids or immunosuppressive drugs to prevent transplant rejection or to treat autoimmune diseases can have increased susceptibility to unusual infections, as do individuals with certain genetic conditions, severe malnutrition and certain kinds of cancers. There is no evidence suggesting that the numbers of such cases have risen, while abundant epidemiologic evidence shows a very large rise in cases of immunosuppression among individuals who share one characteristic: HIV infection.

The spectrum of AIDS-related infections seen in different populations proves that AIDS is actually many diseases not caused by HIV

Pneumocystis jiroveci pneumonia

 

Mycobacterium avium complex

 

The diseases associated with AIDS, such as Pneumocystis jiroveci pneumonia (PCP) and Mycobacterium avium complex (MAC), are not caused by HIV, but rather result from the immunosuppression caused by HIV disease. As the immune system of an HIV-infected individual weakens, he or she becomes susceptible to the particular viral, fungal, and bacterial infections common in the community. For example, HIV-infected people in the Midwestern United States are much more likely than people in New York City to develop histoplasmosis, which is caused by a fungus. A person in Africa is exposed to pathogens different from individuals in an American city. Children may be exposed to infectious agents different from adults.

HIV is the underlying cause of the condition named AIDS, but the additional conditions that may affect an AIDS patient are dependent upon the endemic pathogens to which the patient may be exposed.

AIDS can be prevented with complementary or alternative medicine

Many HIV-infected people turn to complementary and alternative medicine, such as traditional medicine, especially in areas where conventional therapies are less widespread. However, the overwhelming majority of scientifically rigorous research indicates little or negative effect on patient outcomes such as HIV-symptom severity and disease duration, and mixed outcomes on psychological well-being. It is important that patients notify their healthcare provider prior to beginning any treatment, as certain alternative therapies may interfere with conventional treatment.

HIV/AIDS denialism

From Wikipedia, the free encyclopedia

Electron micrograph of the human immunodeficiency virus. HIV/AIDS denialists dispute the existence of HIV or its role in causing AIDS.

 

HIV/AIDS denialism is the belief, contradicted by conclusive evidence, that human immunodeficiency virus (HIV) does not cause acquired immune deficiency syndrome (AIDS). Some of its proponents 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. Insofar as they acknowledge AIDS as a real disease, they attribute it to some combination of sexual behavior, recreational drugs, malnutrition, poor sanitation, haemophilia, or the effects of the drugs used to treat HIV infection (antiretrovirals).

The scientific consensus is that the evidence showing HIV to be the cause of AIDS is conclusive and that HIV/AIDS denialist claims are pseudoscience based on conspiracy theories, faulty reasoning, cherry picking, and misrepresentation of mainly outdated scientific data. With the rejection of these arguments by the scientific community, HIV/AIDS denialist material is now targeted at less scientifically sophisticated audiences and spread mainly through the Internet.

Despite its lack of scientific acceptance, HIV/AIDS denialism has had a significant political impact, especially in South Africa under the presidency of Thabo Mbeki. Scientists and physicians have raised alarm at the human cost of HIV/AIDS denialism, which discourages HIV-positive people from using proven treatments. Public health researchers have attributed 330,000 to 340,000 AIDS-related deaths, along with 171,000 other HIV infections and 35,000 infant HIV infections, to the South African government's former embrace of HIV/AIDS denialism. The interrupted use of antiretroviral treatments is also a major global concern as it potentially increases the likelihood of the emergence of antiretroviral-resistant strains of the virus.

History

A constellation of symptoms named "Gay-related immune deficiency" was noted in 1982. In 1983, a group of scientists and doctors at the Pasteur Institute in France, led by Luc Montagnier, discovered a new virus in a patient with signs and symptoms that often preceded AIDS. They named the virus lymphadenopathy-associated virus, or LAV, and sent samples to Robert Gallo's team in the United States. Their findings were peer reviewed and slated for publication in Science. 

At a 23 April 1984 press conference in Washington, D.C., Margaret Heckler, Secretary of Health and Human Services, announced that Gallo and his co-workers had discovered a virus that is the "probable" cause of AIDS. This virus was initially named HTLV-III. That same year, Casper Schmidt responded to Gallo's papers with "The Group-Fantasy Origins of AIDS", Journal of Psychohistory. Schmidt posited that AIDS was not an actual disease, but rather an example of "epidemic hysteria" in which groups of people are subconsciously acting out social conflicts. Schmidt compared AIDS to documented cases of epidemic hysteria in the past which were mistakenly thought to be infectious. (Schmidt himself would later die of AIDS in 1994.)

In 1986, the viruses discovered by Montagnier and Gallo, found to be genetically indistinguishable, were renamed HIV.

In 1987, the molecular biologist Peter Duesberg questioned the link between HIV and AIDS in the journal Cancer Research. Duesberg's publication coincided with the start of major public health campaigns and the development of zidovudine (AZT) as a treatment for HIV/AIDS.

In 1988, a panel of the Institute of Medicine of the U.S. National Academy of Sciences found that "the evidence that HIV causes AIDS is scientifically conclusive." That same year, Science published Blattner, Gallo, and Temin's "HIV causes AIDS", and Duesberg's "HIV is not the cause of AIDS". Also that same year, the Perth Group, a group of denialists based in Perth, Western Australia led by Eleni Papadopulos-Eleopulos, published in the non-peer-reviewed journal Medical Hypotheses their first article questioning aspects of HIV/AIDS research, arguing that there was "no compelling reason for preferring the viral hypothesis of AIDS to one based on the activity of oxidising agents."

In 1989, Duesberg exercised his right, as a member of the National Academy of Sciences, to bypass the peer review process and publish his arguments in Proceedings of the National Academy of Sciences of the United States of America (PNAS) unreviewed. The editor of PNAS initially resisted, but ultimately allowed 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."

In 1990, Robert Root-Bernstein published his first peer-reviewed article detailing his objections to the mainstream view of AIDS and HIV. In it, he questioned both the mainstream view and the "dissident" view as potentially inaccurate. 

In 1991, The Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis, comprising twelve scientists, doctors, and activists, submitted a short letter to various journals, but the letter was rejected.

In 1993, Nature published an editorial arguing that Duesberg had forfeited his right of reply by engaging in disingenuous rhetorical techniques and ignoring any evidence that conflicted with his claims. That same year, Papadopulos-Eleopulos and coautors from the Perth Group alleged in the journal Nature Biotechnology (then edited by fellow denialist Harvey Bialy) that the Western blot test for HIV was not standardized, non-reproducible, and of unknown specificity due to a claimed lack of a "gold standard".

On 28 October 1994, Robert Willner, a physician whose medical license had been revoked for, among other things, treating an AIDS patient with ozone therapy, publicly jabbed his finger with blood he said was from an HIV-infected patient. Willner died in 1995 of a heart attack.

In 1995, The Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis in 1991 published a letter in Science similar to the one they had attempted to publish in 1991. That same year, Continuum, a denialist group, placed 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. The challenge was later dismissed by various scientists, including Duesberg, asserting that HIV undoubtedly exists. Stefan Lanka argued in the same year that HIV does not exist. Also that year, the National Institute of Allergy and Infectious Diseases released a report concluding that "abundant epidemiologic, virologic and immunologic data support the conclusion that infection with the human immunodeficiency virus (HIV) is the underlying cause of AIDS."

In 1996, the British Medical Journal published "Response: arguments contradict the "foreign protein-zidovudine" hypothesis" as a response to a petition by 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 questioned the existence of HIV, and speculated that the production of antibodies recognizing HIV proteins can be caused by allogenic stimuli and autoimmune disorders. They continued to repeat this speculation through at least 2006.

In 1998, Joan Shenton published the book Positively False – Exposing the Myths Around HIV and AIDS, which promotes AIDS denialism. In the book, Shenton claims that AIDS is a conspiracy created by pharmaceutical companies to make money from selling antiretroviral drugs.

In 2006, Celia Farber, a journalist and prominent HIV/AIDS denialist, published an essay in the March issue of Harper's Magazine entitled "Out of Control: AIDS and the Corruption of Medical Science", in which she summarized a number of arguments for HIV/AIDS denialism and alleged incompetence, conspiracy, and fraud on the part of the medical community. Scientists and AIDS activists extensively criticized the article as inaccurate, misleading, and poorly fact-checked.

In 2007, members of the Perth Group testified at an appeals hearing for Andre Chad Parenzee, asserting that HIV could not 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."

In 2009, a paper was published in the then non-peer-reviewed journal Medical Hypotheses by Duesberg and four other researchers which criticized a 2008 study by Chigwedere et al., which found that HIV/AIDS denialism in South Africa resulted in hundreds of thousands of preventable deaths from HIV/AIDS, because the government delayed the provision of antiretroviral drugs. The paper concluded that "the claims that HIV has caused huge losses of African lives are unconfirmed and that HIV is not sufficient or even necessary to cause the previously known diseases, now called AIDS in the presence of antibody against HIV." Later that year, the paper was withdrawn from the journal on the grounds of it having methodological flaws, and that it contained assertions "that could potentially be damaging to global public health”. A revised version was later published in Italian Journal of Anatomy and Embryology.

U.S. courts

In 1998, HIV/AIDS denialism and parental rights clashed with the medical establishment in court when Maine resident Valerie Emerson fought for the right to refuse to give AZT to her four-year-old son, Nikolas Emerson, after she witnessed the death of her daughter Tia, who died at the age of three in 1996. Her right to stop treatment was upheld by the court in light of "her unique experience." Nikolas Emerson died eight years later. The family refused to reveal whether the death was AIDS related.

South Africa

In 2000, South Africa's President Thabo Mbeki invited several HIV/AIDS denialists to join his Presidential AIDS Advisory Panel. A response named the Durban Declaration was issued affirming the scientific consensus that HIV causes AIDS:

"The declaration has been signed by over 5,000 people, including Nobel Prize winners, directors of leading research institutions, scientific academies and medical societies, notably the US National Academy of Sciences, the US Institute of Medicine, Max Planck institutes, the European Molecular Biology Organization, the Pasteur Institute in Paris, the Royal Society of London, the AIDS Society of India and the National Institute of Virology in South Africa. In addition, thousands of individual scientists and doctors have signed, including many from the countries bearing the greatest burden of the epidemic. Signatories are of MD, PhD level or equivalent, although scientists working for commercial companies were asked not to sign."

In 2008, University of Cape Town researcher Nicoli Nattrass, and later that year a group of Harvard scientists led by Zimbabwean physician Pride Chigwedere each independently estimated 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, voiced shame over the studies' findings and stated: "The era of denialism is over completely in South Africa."

In 2009, Fraser McNeill wrote an article arguing that South Africa's reluctance to openly address HIV/AIDS resulted from social conventions that prevent people from talking about causes of death in certain situations, rather than from Mbeki's denialist views. Similarly, political scientist Anthony Butler has argued that "South African HIV/AIDS policy can be explained without appeals to leadership irrationality or wider cultural denialism."

In July 2016 Aaron Motsoaledi, the Health Minister of South Africa, wrote an article for the Centre for Health Journalism in which he criticised past South African leaders for their denialism, describing it as an "unlucky moment" in a country which has since become a leader in treatment and prevention.

Denialists' claims and scientific evidence

Although members of the HIV/AIDS denialist community are united by their disagreement with the scientific finding that HIV is the cause of AIDS, the specific positions taken by various groups differ. Denialists claim many incompatible things: HIV does not exist; HIV has not been adequately isolated, HIV does not fulfill Koch's postulates, HIV testing is inaccurate, and 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. Regarding Koch's postulates, New Scientist reported: "It is debatable how appropriate it is to focus on a set of principles devised for bacterial infections in a century when viruses had not yet been discovered. HIV does, however, meet Koch's postulates as long as they are not applied in a ridiculously stringent way". The author then demonstrated how each postulate has been met – the suspected cause is strongly associated with the disease, the suspected pathogen can be both isolated and spread outside the host, and when the suspected pathogen is transmitted to a new and uninfected host, that host develops the disease. The latter was proven in a number of tragic accidents, including an instance when multiple scientific technicians with no other known risk factors were exposed to concentrated HIV in a laboratory accident, and transmission by a dentist to patients, the majority of whom had no other known risk factor or source of exposure except the same dentist in common. In 2010, Chigwedere and Max Essex demonstrated in the medical journal AIDS and Behavior that HIV as the cause of AIDS fulfills both Koch's postulates and the Bradford Hill criteria for causality.

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 anti-viral activity and the HIV/AIDS paradigm. The development of effective anti-AIDS therapies based on targeting of HIV has been a major factor in convincing some denialist scientists to accept the causative role of HIV in AIDS.

In a 2010 article on conspiracy theories in science, Ted Goertzel lists HIV/AIDS denialism as an example where scientific findings are being disputed on irrational grounds. He describes proponents as relying on rhetoric, appeal to fairness, and the right to a dissenting opinion rather than on evidence. They frequently invoke the meme of a "courageous independent scientist resisting orthodoxy", invoking the name of persecuted physicist and astronomer Galileo Galilei. Regarding this comparison, Goertzel states:

...being a dissenter from orthodoxy is not difficult; the hard part is actually having a better theory. Publishing dissenting theories is important when they are backed by plausible evidence, but this does not mean giving critics 'equal time' to dissent from every finding by a mainstream scientist.

— Goertzel, 2010

Denialist community

Denialists often use their critique of the link between HIV and AIDS to promote alternative medicine as a cure, and attempt to convince HIV-positive individuals to avoid ARV therapy in favour of vitamins, massage, yoga and other unproven treatments. Despite this promotion, denialists will often downplay any association with alternative therapies, and attempt to portray themselves as "dissidents". An article in the Skeptical Inquirer stated:

AIDS denialists [prefer] to characterize themselves as brave "dissidents" attempting to engage a hostile medical/industrial establishment in genuine scientific "debate." They complain that their attempts to raise questions and pose alternative hypotheses have been unjustly rejected or ignored at the cost of scientific progress itself...Given their resistance to all evidence to the contrary, today's AIDS dissidents are more aptly referred to as AIDS denialists.

Several scientists have been associated with HIV/AIDS denialism, although they have not themselves studied AIDS or HIV. One of the most famous and influential is 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 HIV/AIDS denialism include biochemists David Rasnick and Harvey Bialy. Kary Mullis, who was awarded a Nobel Prize for his role in the development of the polymerase chain reaction, has expressed sympathy for denialist theories. Biologist Lynn Margulis argued that "there's no evidence that HIV is an infectious virus" and that AIDS symptoms "overlap...completely" with those of syphilis. Pathologist Étienne de Harven also expressed sympathy for HIV/AIDS denial.

Additional notable HIV/AIDS denialists include Australian academic ethicist Hiram Caton, the late mathematician Serge Lang, former college administrator Henry Bauer, journalist Celia Farber, American talk radio host and author on alternative and complementary medicine and nutrition Gary Null, and the late activist Christine Maggiore, who encouraged HIV-positive mothers to forgo anti-HIV treatment and whose 3-year-old daughter died of complications of untreated AIDS. Nate Mendel, bassist with the rock band Foo Fighters, expressed support for HIV/AIDS denialist ideas and organized a benefit concert in January 2000 for Maggiore's organization Alive & Well AIDS Alternatives. Organizations of HIV/AIDS denialists include the Perth Group, composed of several Australian hospital workers, and the Immunity Resource Foundation.

HIV/AIDS denialism has received some support from political conservatives in the United States. Duesberg's work has been published in Policy Review, a journal once published by The Heritage Foundation but later acquired by the Hoover Institution, and by Regnery Publishing. Regnery published Duesberg's Inventing the AIDS Virus in 1996, and journalist Tom Bethell's The Politically Incorrect Guide to Science, in which he endorses HIV/AIDS denialism, in 2005. Law professor Phillip E. Johnson has accused the Centers for Disease Control of "fraud" in relation to HIV/AIDS. Describing the political aspects of the HIV/AIDS denialism movement, Sociology professor 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 blog LewRockwell.com has also published articles supportive of HIV/AIDS denialism.

In a follow-up article in Skeptical Inquirer, Nattrass overviewed the prominent members of the HIV/AIDS denialist community and discussed the reasons of the intractable staying power of HIV/AIDS denialism in spite of scientific and medical consensus supported by over two decades of evidence. She observed that despite being a disparate group of people with very different background and professions, the HIV/AIDS denialists self-organize to fill four important roles:

• "Hero scientists" to provide scientific legitimacy: Most notably Duesberg who plays the central role of HIV/AIDS denialism from the beginning. Others include David Rasnick, Étienne de Harven, and Kary Mullis whose Nobel Prize makes him symbolically important.
• "Cultropreneurs" to offer fake cures in place of antiretroviral therapy: Matthias Rath, Gary Null, Michael Ellner, and Roberto Giraldo all promote alternative medicine and remedies with a dose of conspiracy theories in the form of books, healing products, radio shows and counseling services.
• HIV-positive "living icons" to provide proof of concept by appearing to live healthily without antiretroviral therapy: Christine Maggiore was and still is the most important icon in the HIV/AIDS denialist movement despite the fact that she died of AIDS related complications in 2008.
• "Praise singers": sympathetic journalists and filmmakers who publicize the movement with uncritical and favorable opinion. They include journalists Celia Farber, Liam Scheff and Neville Hodgkinson; filmmakers Brent Leung and Robert Leppo.

Some of them had overlapping roles as board members of Rethinking AIDS and Alive and Well AIDS Alternatives, were involved in the film House of Numbers, The Other Side of AIDS or on Thabo Mbeki's AIDS Advisory Panel. Nattrass argued that HIV/AIDS denialism gains social traction through powerful community-building effects where these four organized characters form "a symbiotic connection between AIDS denialism and alternative healing modalities" and they are "facilitated by a shared conspiratorial stance toward HIV science".

Former denialists

Several of the few prominent scientists who once voiced doubts about HIV/AIDS have since changed their views and accepted the fact that HIV plays a role in causing AIDS, in response to an accumulation of newer studies and data. 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 HIV/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 HIV/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.

A former denialist wrote in the Journal of Medical Ethics in 2004:

The group [of denialists] 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 HIV/AIDS denialists who had died of AIDS-related causes. For example, the editors of the magazine Continuum consistently denied the existence of HIV/AIDS. The magazine shut down after both editors died of AIDS-related causes. In each case, the HIV/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 Scovill 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 2009, with no admission of wrongdoing. The L.A. coroner's ruling that Eliza Jane Scovill died of AIDS remains standing as the official verdict.

Local community group denialism

Australia: In 2009 representing the Australian Vaccination-Skeptics Network, President Meryl Dorey signed a petition claiming that "the AIDS industry and the media" had tricked the public and the media into believing that HIV causes AIDS.

Canada: The Alberta Reappraising AIDS Society created the petition in March 2000 and has reportedly since attracted "2,951 doubters" representing groups and individuals through the globe. Signatories reportedly deny the theory "that Aids is heterosexually transmitted".

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.

North America and Europe

Skepticism about HIV being 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 caused by amyl nitrite poppers, and that the government had conspired to hide the truth. Lauritsen's The AIDS War was published in 1993.

Scientific literature

The publication of 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 diminished 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 of the United States of America (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."

HIV/AIDS denialists often resort to special pleading to support their assertion, arguing for different causes of AIDS in different locations and subpopulations. In North America, AIDS is blamed on the health effects of unprotected anal sex and poppers on homosexual men, an argument which does not account for AIDS in drug-free heterosexual women who deny participating in anal sex. In this case, HIV/AIDS denialists claim the women are having anal sex but refuse to disclose it. In haemophiliac North American children who contracted AIDS from blood transfusions, the haemophilia itself or its treatment is claimed to cause AIDS. In Africa, AIDS is blamed on poor nutrition and sanitation due to poverty. For wealthy populations in South Africa with adequate nutrition and sanitation, it is claimed that the antiretroviral drugs used to treat AIDS cause the condition. In each case, the most parsimonious explanation and uniting factor – HIV positive status – is ignored, as are the thousands of studies that converge on the common conclusion that AIDS is caused by HIV infection.

Haemophilia is considered the best test of the HIV-AIDS hypothesis by both denialists and AIDS researchers. While Duesberg claims AIDS in haemophiliacs is caused by contaminated clotting factors and HIV is a harmless passenger virus, this result is contradicted by large studies on haemophiliac patients who received contaminated blood. A comparison of groups receiving high, medium and low levels of contaminated clotting factors found the death rates differed significantly depending on HIV status. Of 396 HIV positive haemophiliacs followed between 1985 and 1993, 153 died. The comparative figure for the HIV negative group was one out of 66, despite comparable doses of contaminated clotting factors. A comparison of individuals receiving blood donations also supports the results; in 1994 there were 6888 individuals with AIDS who had their HIV infection traced to blood transfusions. Since the introduction of HIV testing, the number of individuals whose AIDS status can be traced to blood transfusions was only 29 (as of 1994).

Lay press and on 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 HIV/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.

Lay opinion and AIDS-related behaviors

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. Similarly, a 2010 survey of 343 people living with HIV/AIDS found that one in five of them thought that there was no proof that HIV caused AIDS, and that HIV treatments did more harm than good. 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." African Americans are exceptionally likely to believe that HIV does not cause AIDS, partly because they sometimes perceive the role of HIV in the disease as part of a racist agenda. A 2012 survey of young adults in Cape Town, South Africa found that belief in AIDS denialism was strongly related to an increased probability of engaging in unsafe sex.

South Africa

HIV/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 HIV/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 HIV/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-related 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 HIV/AIDS denialists, including 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.

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, UN special envoy for AIDS in Africa, attacked Mbeki's government for its slow response to the AIDS epidemic and reliance on denialist claims:

It [South Africa] 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 HIV/AIDS denialists no longer use his name in their literature and 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 William Makgoba, one of South Africa's leading scientists, as a racist defender of "Western science" for opposing HIV/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."

Post-Mbeki government in South Africa

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 HIV/AIDS denialism and vowed a new course, stating: "The era of denialism is over completely in South Africa."