It's back: the old, discredited argument that HIV is not the cause of AIDS has begun to capture headlines again.
In earlier years, the challenge posed by so-called "AIDS dissidents" who did not believe that HIV was the cause of AIDS occasionally served a useful purpose. For instance, in the 1980s, the field of human retrovirology was relatively new and could not explain why HIV appeared to be "latent" for about ten years between the time of infection and the onset of AIDS-related symptoms. Dissidents pointed out this shortcoming of the medical model of AIDS and prompted researchers to make the important discovery that HIV is not latent after infection but rather in a long, slow battle with the immune system.
Such advances in scientific knowledge, combined with the clinical success of combination antiretroviral therapies since the mid-1990s, convinced many lingering skeptics that HIV was indeed the cause of AIDS. However, small but highly vocal groups of dissidents have persisted. In the United States, some groups of dissidents hail from the political right, where they find it useful to perpetuate the notion that people with HIV/AIDS are the victims of their own behavioral excesses and not of the actions of a virus. Other dissident, including several break-away factions of the protest group ACT UP, hail from the political left and view the continued emphasis on HIV/AIDS as a way to stigmatize the sexuality of gay men and the substance use of injecting drug users. The media, with their emphasis on journalistic objectivity and on "telling both sides of the story," as well as a tendency toward sensationalism, have drastically amplified the size and importance of the dissident factions by giving them an unwarranted amount of attention.
Most recently, AIDS dissidents have received a boost from statements made by South African President Thabo Mbeki, who has questioned the link between HIV and AIDS and who went so far as to create a commission with equal representation from dissidents and proponents of the mainstream consensus. In some ways, Mbeki's inquiry into the nature of HIV/AIDS drew from a skepticism about the applicability of Western solutions to African realities. In particular, Mbeki noted major differences in epidemiology between AIDS in the developed and the developing world, and also noted that the use of costly antiretroviral therapies might never be an affordable or viable approach to combating AIDS in deeply impoverished countries. A veteran of the African National Congress's battle against apartheid in South Africa, Mbeki was also skeptical of the wholesale importing of "Western models" and urged a top-to-bottom rethinking of the nature of AIDS in Africa.
At best, Mbeki's skepticism may provoke a useful re-thinking and re-conceptualization of the battle against African AIDS. At worst, however, his extremely influential position on the continent may start to roll back two decades of progress in education about the causes of AIDS, the nature of HIV, the urgent need for safer sex practices, and the development of an effective vaccine against HIV. Concerned that the presence of the International AIDS Conference in Durban, South Africa last July might appear to be an implicit endorsement of Mbeki's skepticism, a group of scientists and medical practitioners drafted "The Durban Declaration" and gathered the signatures of 5,018 prominent figures to reiterate the fundamental reality that HIV is the cause of AIDS. On the following pages, the Durban Declaration is reprinted in its entirety.
-- Raymond A. Smith, Ph.D.
|The Durban Declaration|
Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of people from around the world are gathered in Durban, South Africa to attend the XIII International AIDS Conference. At the turn of the millennium, an estimated 34 million people worldwide are living with HIV or AIDS, 24 million of them in sub-Saharan Africa.(1) Last year alone, 2.6 million people died of AIDS, the highest rate since the start of the epidemic. If current trends continue, Southern and South-East Asia, South America and regions of the former Soviet Union will also bear a heavy burden in the next two decades.
Like many other diseases, such as tuberculosis and malaria that cause illness and death in underprivileged and impoverished communities, AIDS spreads by infection. HIV-1, the retrovirus that is responsible for the AIDS pandemic, is closely related to a simian immunodeficiency virus (SIV) which infects chimpanzees. HIV-2, which is prevalent in West Africa and has spread to Europe and India, is almost indistinguishable from an SIV that infects sooty mangabey monkeys. Although HIV-1 and HIV-2 first arose as infections transmitted from animals to humans, or zoonoses,(2) both are now spread among humans through sexual contact, from mother to infant and via contaminated blood.
An animal source for a new infection is not unique to HIV. The plague came from rodents. Influenza and the new Nipah virus in South-East Asia reached humans via pigs. Variant Creutzfeldt-Jakob disease in the United Kingdom came from 'mad cows.' Once HIV became established in humans, it soon followed human habits and movements. Like other viruses, HIV recognizes no social, political or geographic boundaries.
The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous. This evidence meets the highest standards of science.(3-7) The data fulfill exactly the same criteria as for other viral diseases, such as poliomyelitis, measles and smallpox:
In different regions of the world HIV/AIDS shows altered patterns of spread and symptoms. In Africa, for example, HIV-infected persons are 11 times more likely to die within 5 years,(7) and over 100 times more likely than uninfected persons to develop Kaposi's sarcoma, a cancer linked to yet another virus.(11)
As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS.
In this global emergency, prevention of HIV infection must be our greatest worldwide public health priority. The knowledge and tools to prevent infection exist. The sexual spread of HIV can be prevented by monogamy, abstinence or by using condoms. Blood transmission can be stopped by screening blood products and by not re-using needles. Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs.(12, 13)
Limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of HIV infection. People already infected can be helped by treatment with life-saving drugs, but high cost puts these treatments out of reach for most. It is crucial to develop new antiviral drugs that are easier to take, have fewer side effects and are much less expensive, so that millions more can benefit from them.
There are many ways to communicate the vital information about HIV/AIDS. What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and hopefully a vaccine. But for now, emphasis must be placed on preventing sexual transmission.
There is no end in sight to the AIDS pandemic. By working together, we have the power to reverse the tide of this epidemic. Science will one day triumph over AIDS, just as it did over smallpox. Curbing the spread of HIV will be the first step. Until then, reason, solidarity, political will and courage must be our partners.
Signed by 5,018 physicians and scientists from 82 countries who are dedicated to the control of HIV/AIDS