The Pride-week issue of the GLT is the widest read and distributed of the year. For this reason, many advertisers invest in this issue. One such advertiser is Rethinking AIDS: The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis, who purchased a 2-page ad in the July 15th issue. Rethinking AIDS is a group of AIDS denialists, individuals who believe that HIV is not the cause of AIDS.

The dogma of AIDS denialism varies, with some refuting the very existence of HIV while others claim that HIV is a harmless “passenger virus”. Most denialists believe that AIDS is caused by oxidative stress secondary to recreational drug use, poor nutrition, poor sanitation and/or the use of antiretroviral medications used to treat HIV. Denialists discourage HIV testing and treatment, warning that a meaningless HIV positive test result could change your life forever. Mothers would be pressured to take toxic drugs that could harm their babies. Uninformed sex partners could have you incarcerated for having sex with them. The list of reasons why you shouldn’t take an HIV test or HIV meds is lengthy and provocative.

The AIDS denialism movement is largely attributed to Dr. Peter Duesberg, a cancer researcher who published a paper questioning the link between HIV and AIDS in 19871. In 1988 Duesberg went further, publishing and article in Science entitled HIV is not the cause of AIDS2. In 1989, he used his membership with the National Academy of Sciences to publish his views without peer review in their scientific journal. Though his membership in the organization conferred the right to publish, his submission was met with some resistance. It was finally accepted by the editor with the commentary, “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.”3 As it turns out, the editor was mistaken. Duesberg’s theory was largely rejected, but he did find a small group of like minded scientists with whom he formed The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis in 1991. Duesberg’s group would continue to recruit scientists and lay-people alike to sanction its cause, and would use the scientific credentials of its supporters to lend credence to its claims.

All of this is very disturbing, in retrospect, but those of us who remember the AIDS crisis of the 80’s and 90’s might be able to find some forgiveness in our hearts. This was a time when AZT was prescribed at toxic, oppressive doses and our “medical breakthroughs” were other nucleoside drugs that caused neuropathy, pancreatitis, and other health issues while failing to keep HIV at bay for more than a few months. Acute drug toxicity and minimal effectiveness at extending life created understandable dissent. In an era of inadequate science and little hope, the notion that we were barking up the wrong scientific tree was a welcome one. However, all of this changed in 1995 and 1996, which saw the licensing of the first protease inhibitors and the advent of combination therapy (aka “the cocktail”). Protease inhibitors were a new class of drug that interrupted a key step in the life cycle of HIV and resulted in a profound reduction of AIDS related deaths. In 1996, US AIDS deaths dropped 50%, and 1997 they dropped another 20%. The chart below illustrates the profound changes in epidemiology following the advent of protease inhibitors:

Source: CDC Annual HIV/AIDS Surveillance Reports

This medical breakthrough changed the face of HIV/AIDS from death sentence to chronic manageable disease. The first protease inhibitors, while life-saving, were also very toxic. Pharmaceutical research in the last decade has yielded more treatment options and lower drug toxicity. While we still lack the science to cure HIV and most other chronic viral infections, we have gotten very good at halting HIV disease progression. An enormous body of evidence supports the HIV/AIDS connection, and many former AIDS denialists have rescinded their convictions in the post-protease era. Those AIDS denialists who still cling to their beliefs have been relegated to the lunatic fringe.

So here we are in 2010, where rational people who remember the plague of the 80’s and 90’s know how far we’ve come medically. How can the AIDS denialists still find someone to listen to them? Could it be a whole new generation of youth who never experienced the ravages of AIDS? A whole generation who didn’t sit by death-beds, attended funerals, cross names out of their address books or bury lovers? I think back on all of the work the SILENCE=DEATH Project and Act Up did to drag AIDS into the open and to change the cultural norms around testing, disclosure and safer sex. Now that silence no longer equals death, are we returning to a culture of silence? Certainly silence is more comfortable. Denial is more comfortable. I cringe when I think about the impact “The AIDS Trap” ad in the GLT may have on our youth. The AIDS Trap ad actively warns against HIV testing and treatment, undoing the crux of recent public health efforts aimed at getting people tested and into care. These public health efforts exist because:

HIV positive individuals who know their status are much less likely to transmit the virus than those who don’t.

People who find out their HIV status because they develop AIDS and present with an opportunistic infection already have extensive damage to their immune systems that impacts prognosis and response to antiretrovirals.

HIV positive individuals who are on effective antiretroviral therapy with undetectable viral loads are much less infectious than those who aren’t.

Antiretroviral therapy slows or halts disease progression and drastically increases longevity and quality of life for the majority of people with HIV.

Antiretroviral therapy allows HIV positive mothers to give birth to HIV negative children.

We’ve already seen the harm that AIDS denialist beliefs can cause in South Africa under Thabo Mbeki’s presidency from 1999 to 2008. Dr. Peter Duesberg served on president Mbeki’s AIDS advisory panel, and Mbeki’s adoption of AIDS denialist dogma influenced his health policy during this time. Tragically, effective combination therapy was available during these years, but the president’s health minister instead promoted garlic, olive oil, lemons and beetroot as cures for AIDS and referred to antiretroviral drugs as “poison”. Recent studies of South African health policy between 2000 and 2005 estimate Mbeki’s denialist policies are responsible for 330,000 deaths and 35,000 infant infections.4, 5

GLT Publisher Michael Portantino defends his sale of advertising space to the AIDS denialists by citing freedom of speech and expressing concern about censorship. These are certainly difficult issues to negotiate, and I don’t envy him the job of deciding where to draw the line. I’m relatively certain there is a line, however. The GLT must use some discretion in who it sells ad space to, or we’d be seeing ads promoting ex-gay support groups, Westboro Baptist Church, and Yes on 8 campaigns. To his credit, Michael did invite me to write this commentary in response to the AIDS denialist ad in the Pride issue. I’m all for freedom of speech. Let the AIDS denialists rant from the highest rooftops. However, I urge the publisher to add disinformation to the list of content he refuses to print.

Duesberg P (1987). “Retroviruses as carcinogens and pathogens: expectations and reality”. Cancer Research47 (5): 1199–220

Duesberg P (July 1988). “HIV is not the cause of AIDS”. Science241 (4865): 514, 517

Booth W (1989). “AIDS paper raises red flag at PNAS”. Science243 (4892): 733

Chigwedere P, Seage GR, Gruskin S, Lee TH, Essex M (October 2008). “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa”. Journal of acquired immune deficiency syndromes (1999)49: 410

Nattrass N (February 2008). “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa”. African Affairs107 (427): 157–76