While the global HIV/AIDS pandemic continues to rage, a small number of fringe groups have been aggressively promoting misinformation about AIDS. Some claim that "AIDS is over" or that "AIDS is a myth," and that HIV is a harmless virus. Peter Duesberg, a retrovirologist at UC Berkeley, has challenged the "AIDS establishment" for thirteen years, asserting that factors such as promiscuous homosexual activity, sexually transmitted diseases (STDs), recreational drugs, and AZT (Retrovir) are responsible for the AIDS pandemic. More recently, malnutrition, poverty, and illicit drug use have been cited as causes of AIDS. The individuals and groups who hold these views are often referred to as "AIDS dissidents" or "AIDS denialists."
The AIDS denialists deliberately ignore the overwhelming scientific evidence gathered over the past nineteen years concerning the relationship between HIV and AIDS. Unprotected sex, malnutrition, and a host of factors contribute to the spread of HIV and the development of AIDS.
They do not cause AIDS, however. And while scientists do not completely understand the precise mechanism by which HIV causes AIDS, one thing cannot be disputed: HIV is found in all people with AIDS -- and AIDS is not found in people who do not have HIV.
The HIV antibody test became widely available in 1985. Even in the earliest studies, 79 percent to 100 percent of people with symptoms of AIDS tested positive for HIV antibody. A 1995 study of 230,000 people with AIDS found only 168 HIV-seronegative people. Scientists now know that advanced AIDS -- and immune system depletion -- can result in the immune system's inability to continue to manufacture antibody, which likely explains why HIV antibody could not be found in everyone tested. However, newer, more sophisticated tests like the polymerase chain reaction (PCR) and branched DNA (bDNA) viral load tests have detected HIV (i.e., the virus itself) in everyone with AIDS who has undergone one of these assays.
HIV, AIDS, and CD4 T-Cell Counts
The higher the amount of HIV in the body, the lower the CD4 cell count will be. When the CD4 cell level drops below 200 cells/mm3, an AIDS diagnosis is given. People with low CD4 cell counts, and therefore weakened immune systems, are susceptible to certain diseases because their immune systems are compromised. For instance, many people carry the virus that causes cytomegalovirus (CMV -- an AIDS-defining illness -- but they do not develop CMV because their immune systems function normally. Other common opportunistic illnesses include Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), toxo plasmosis, and Kaposi's sarcoma (KS).
In the nineteenth century, the German scientist Robert Koch established four requirements (postulates) that must be demonstrated to establish that a specific microorganism, or "bug," causes a particular disease. Recent developments in HIV/AIDS research have shown that HIV fulfills all four criteria as the cause of AIDS. This proof has been ignored by AIDS deniers for reasons that are unclear.
Reports over the past four years show that the numbers of new cases of AIDS, AIDS deaths, and new opportunistic diseases have been dramatically reduced in the U.S. The only factor that has changed during this period of time is the introduction of highly active antiretroviral therapy (HAART) which, despite its many problems, greatly inhibits HIV reproduction. HIV and AIDS have been repeatedly linked in time, place, and population groups.
Among people without HIV, AIDS-like symptoms are extraordinarily rare except among people receiving organ transplants or cancer chemotherapy whose immune systems are being intentionally suppressed. Only one common denominator exists for gay men, elderly transfusion recipients, heterosexual women, heterosexual men who inject drugs, and infants who have developed AIDS: infection with HIV.
What Are the Public Health Consequences?
The public health consequences of this misinformation remain largely speculative, at least in North America and Europe. In Africa, AIDS deniers have gained the ear of a few politicians, with potentially horrific consequences. There is evidence that AIDS deniers have already caused some damage, even in North America.
For example, about a year ago, an article in a respected Cleveland weekly paper touted the bravery of a few local men who, citing "AIDS is a myth" groups, decided to deal with the difficulties of HIV treatment by throwing out their medication, without consulting their doctors, because they concluded that the adverse effects were not worth the benefits.
At the time, and until fairly recently, many people in the treatment arena -- especially researchers and clinicians -- felt that a public response to what they hoped were isolated cases of media-reported misinformation would backfire by dignifying the deniers' point of view. Since then, similar reports have appeared. Many of these stories have concerned the refusal of parents to give their HIV-positive children medication, based on the parents' ill-informed beliefs that HIV does not cause AIDS and that anti-HIV medicines would kill their children. It appears that several such cases are still being litigated.
Over the past few months, reports about the latest deceptions involving AIDS denialists have surfaced daily on the Internet or in the press. Nicholas Regush, the science editor for ABC News, has been particularly caustic toward those who have been working to control the spread and effects of HIV. Because ABC is a mainstream news source, the potential for unsuspecting people to trust Regush seems high.
Without a doubt, this is a confusing time in terms of HIV treatment. Since the XI International Conference on AIDS in Vancouver four years ago, when optimism about HAART was at its peak, new and serious side effects of anti-HIV drugs have emerged, including body fat abnormalities (lipodystrophy). While there is plenty of press on how HAART has decreased the death rate and emptied hospital wards, there is also news about how toxic these treatments can be, and activists continue to lobby for new and improved drugs. People with HIV are told that it is crucial to adhere faithfully to their medications -- to take every dose -- and yet reports about the new concept of treatment interruption have been increasing. What is a person to think when it comes to making treatment decisions?
Confusion about treatment could work in the denialists' favor, as they try to manipulate vulnerable HIV-positive people and claim that everyone has been misled -- and that HIV does not cause AIDS. While not everyone is susceptible to half-truths and outright lies, others might quit taking their medication, stop consulting their healthcare providers, and refuse treatment for themselves or for their HIV-positive children. And if people start believing that HIV is harmless, it won't be long before they start throwing away their condoms and forgoing the use of clean needles. This is an extreme scenario, but clearly the public health consequences of willful disregard of scientific and epidemiological evidence could be devastating.
The preceding article first appeared in the San Francisco AIDS Foundation publication OUTreach_. © 2000 San Francisco AIDS Foundation. Reprinted by permission._