sex, drugs, and a clinical case of denial

Despite decades of experiments and mountains of evidence, there are still activists who refuse to believe HIV causes AIDS. And they have blood on their hands.

Illustration from a Canadian sexual health PSA

The plagues of the Dark Ages are often considered to be one of the worst epidemics humans ever faced. With no sanitary practices, germ theory, or scientific medicine to speak of, the diseases were unstoppable and the patients’ survival depended solely on their luck and the strength of their immune systems. Today, we’re better off than our ancestors since we have modern medicine on our side, and two of the most fearsome plagues of our time, HIV and AIDS, can be managed with a complex cocktail of antiretroviral drugs. Unfortunately, just like our ancestors, we still have our fair share of cranks and denialists ready and willing to derail ongoing relief efforts in nations struggling with HIV/AIDS in their quest to validate their ideas, even if it means patients will die by refusing to take their prescribed antiviral drugs in favor of alt med woo, and help the disease spread.

While doctors, charities, and activists across the world have been working on new generations of treatments, promoting safe sex practices and encouraging people to get tested for HIV or AIDS, cancer researcher Peter Duesberg was busy starting a movement that fervently denies the link between the two disorders. As a result of his opposition to the medical consensus, a number of HIV-positive patients stopped taking their medicine, allowing the disease to progress into full blown AIDS. In South Africa, his pseudoscientific notions convinced a government to refuse aid shipments of retroviral drugs and promote vitamins and various folk cures as perfectly viable long term treatment options, netting German vitamin mogul and crank Matthias Rath a fortune in the process.

But hold on, you might ask, if an accomplished cancer researcher with an international reputation asks if HIV and AIDS are linked, he must surely have a reason for his doubts, right? Well, it’s true that science could only move forward when scientists challenge conventional wisdom, but the link between HIV and AIDS held up to quite a bit of scrutiny, and the evidence for it is as solid as it gets in medicine. As was noted in an official reply to South Africa’s Thabo Mbeki’s AIDS-denialist policies mentioned above, The Durban Declaration, there is an undeniable link between HIV and AIDS based on both experimental, and real world data. Patients treated with antiretroviral drugs which were rejected by Mbeki and his staff under the direction of Duesberg and Rath as a Big Pharma conspiracy to “scam South Africans,” could’ve been brought back from the brink of death. Without antiretroviral treatments, HIV patients develop AIDS in 5 to 10 years. And even more importantly, the same set of treatments that block HIV replication, also block the replication of AIDS virions.

According to Duesberg and his disciples however, that’s not proof enough. Instead, they charge that drug use is the culprit in AIDS infections, as well as the first antiretroviral drug approved for AIDS treatment, AZT. But the evidence for this notion is slim. Duesberg’s strongest arguments, which claim to show a uniform rise in AIDS cases in drug users and HIV-negative patients suddenly developing AIDS, have both been tested and shown to be false. A Dutch study of drug users from 1989 to 1994 found that only those who were HIV positive would develop AIDS, while HIV-negative users had a total of zero cases and their immune systems stayed normal. It doesn’t mean that drug use is harmless by any stretch of the imagination, but it does show that drug use with no other compounding factors does not lead to AIDS. It may make it more likely for drug users to engage in a number of risky behaviors through which they could contract HIV, but the drug themselves won’t summon an infestation of AIDS virions. As for the claim of HIV-negative patients developing AIDS, researchers who took a look at Duesberg’s diagnostic criteria found it to be pretty much arbitrary, and the patients in the study he tried to analyze did not meet the CDC’s criteria for an AIDS diagnosis.

Finally, as for the claim of AZT actually causing AIDS, the science also says no. As noted in the previous link, a study of some 1749 HIV patients taking the drug showed that while those taking AZT suffer fewer AIDS-related complications, they fare little better than the control group. This meant that AZT was a very inefficient treatment which had to be replaced as soon as possible, but it also showed the lack of causation between taking it and developing AIDS. In fact, the only relationship comes from patients with HIV taking the drug and then suffering from the virus’ escalation into AIDS because their treatment fails to do its job. But of course, none of this could be accepted by the AIDS denialist camp for the same reason as all cranks reject scientific evidence that fails to agree with their convictions. They see themselves as luminaries and geniuses who made a discovery that the close-minded establishment fails to acknowledge their momentous insights out of fear, greed, or politics. To the AIDS denialists, the force of scientists disagreeing with their efforts in South Africa is seen as a sign of the establishment’s desire to silence their wisdom and they dismiss all estimates of how much harm they’ve caused as a Big Pharma conspiracy to sell more antiretroviral drugs.

Maybe at one time, they started with very genuine skepticism, but today, they care much more about sticking it to the man than helping the people who live with the ravages of HIV and AIDS as per the lifecycle of virtually all persistent crank claims. And this is exactly why doctors, scientists, and concerned activists want to stop them. AIDS denialism is yet another example of how denying sound, thoroughly investigated science for the sake of personal self-aggrandizement can have dire consequences for hundreds of thousands of people…

For AZT study information, see: Concord Coordinating Committee (1994). Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection The Lancet, 343 (8902), 871–881 DOI: 10.1016/S0140–6736(94)90006-X