Policy Forum HIV Denial in the Internet Era Tara C. Smith*, Steven P. Novella

t may seem remarkable that, 23 to many other forms of popular denial, years after the identifi cation of including denial of evolution, mental Ithe human immunodefi ciency illness, and the Holocaust. virus (HIV), there is still denial that the virus is the cause of acquired Three Prominent Deniers and immune defi ciency syndrome (AIDS). Denial Groups This denial was highlighted on an One of the prominent HIV denial international level in 2000, when groups currently is Christine South African president Thabo Mbeki Maggiore’s “Alive and Well” (formerly convened a group of panelists to discuss “HEAL,” Health Education AIDS the cause of AIDS, acknowledging that Liaison) (http:⁄⁄www.aliveandwell. he remained unconvinced that HIV was org/). Maggiore’s life story is at the the cause [1]. His ideas were derived at center of this group. Diagnosed with least partly from material he found on doi:10.1371/journal.pmed.0040256.g001 HIV in 1992, Maggiore claims she has the Internet [2]. Though Mbeki agreed since been symptom-free for the past 14 later that year to step back from the Example of a typical slogan from an HIV years without the use of antiretroviral debate [3], he subsequently suggested denialist group drugs, including protease inhibitors a re-analysis of health spending with a [10]. She has risen to prominence, decreased emphasis on HIV/AIDS [4]. and been embroiled in controversy, HIV denial has taken root in the that HIV does not cause AIDS at in recent years after giving birth to general population and has shown its concerts [6], and it lists the HIV denial and openly breast-feeding her two potential to frustrate public education group “Alive and Well” as a worthy children, Charles and Eliza Jane. She efforts and adversely affect public cause on its Web site (http:⁄⁄www. had neither child tested for HIV, and funding for AIDS research and foofi ghters.com/community_cause. did not take antiretroviral medication prevention programs. For example, html). during her pregnancy or subsequent the AIDS Coalition to Unleash Power As these challenges to mainstream breast-feeding [11]. Eliza Jane died (ACT UP) was for many years on the theories have largely occurred outside in September 2005 of HIV-related front lines of AIDS education and of the scientifi c literature, many pneumonia [12], though Maggiore activism. But now a San Francisco physicians and researchers have had remains unconvinced that HIV had any chapter of the group has joined the the luxury of ignoring them as fringe role in her daughter’s death [13], and denialist movement, stating on its Web beliefs and therefore inconsequential. continues to preach her message to site that “HIV does not cause AIDS… Indeed, the Internet has served as a other HIV-positive mothers. HIV antibody tests are fl awed and fertile and un-refereed medium to Peter Duesberg initiated the HIV dangerous…AIDS drugs are poison” spread these denialist beliefs. The denial movement with a 1987 article (http:⁄⁄www.actupsf.com/aids/index. Group for the Scientifi c Reappraisal htm). In 2000 the chapter wrote letters of the HIV/AIDS Hypothesis Funding: TCS received research start-up funding to every member of Congress asking (“Reappraising AIDS”) noted, “Thanks from the University of Iowa, but received no specifi c them to stop funding research into HIV to the ascendance of the internet, funding for this article. [5]. ACT UP San Francisco’s position we are now able to reinvigorate Competing Interests: The authors have declared has been condemned by other ACT UP our informational campaign” [7]. that no competing interests exist. chapters, such as ACT UP Philadelphia The Internet is an effective tool for Citation: Smith TC, Novella SP (2007) HIV denial in and ACT UP East Bay (http:⁄⁄www. targeting young people, and for the Internet era. PLoS Med 4(8): e256. doi:10.1371/ actupny.org/indexfolder/actupgg. spreading misinformation within a journal.pmed.0040256 html). Rock stars have weighed in on group at high risk for HIV infection. Copyright: © 2007 Smith and Novella. This is an the topic. Members of the group “The Two excellent online fact sheets open-access article distributed under the terms of the Creative Commons Attribution License, Foo Fighters” provided music for a have been prepared to counter many which permits unrestricted use, distribution, soundtrack of the recent documentary, of the most commonly used arguments and reproduction in any medium, provided the “The Other Side of AIDS” (http:⁄⁄www. to deny HIV causation of AIDS [8,9]; original author and source are credited. theothersideofaids.com/), which as such, we will not discuss these in Tara C. Smith is with the Department of questions whether HIV is the cause of this article. Instead, we will review Epidemiology, University of Iowa College of Public AIDS. The band has spread its message Health, Iowa City, Iowa, United States of America. the current intellectual strategies Steven P. Novella is with the Department of used by the HIV denial movement. Neurology, Yale University School of Medicine, New The Policy Forum allows health policy makers around Although other forms of science denial Haven, Connecticut, United States of America. the world to discuss challenges and opportunities for improving health care in their societies. will not be specifi cally discussed, the * To whom correspondence should be addressed. characteristics described below apply E-mail: [email protected]

PLoS Medicine | www.plosmedicine.org 1312 August 2007 | Volume 4 | Issue 8 | e256 suggesting that HIV does not cause AIDS, adverse reactions to vaccines and They argue that when mainstream AIDS [14]. While he is no longer on medications, exposure to chemicals in scientists speak out against the scientifi c the front lines of this movement, the the home, environment or workplace” “orthodoxy,” they are persecuted and arguments put forth by others trace (http:⁄⁄www.toxi-health.com/). dismissed. For example, HIV deniers back to his publications. Similarly, German vitamin supplier make much of the demise of Peter Celia Farber is a journalist who has and HIV denier Matthias Rath not only Duesberg’s career, claiming that when spent much of her career covering HIV. pushed his vitamins as a treatment for he began speaking out against HIV as Farber is the author of a recent Harper’s AIDS [19], but his spokesman refused the cause of AIDS, he was “ignored and article repeating Duesberg’s claims that to be interviewed by Nature Medicine discredited” because of his dissidence HIV does not cause AIDS [15], and about the case because he claimed the [23]. South African President Mbeki has recently authored a book on “the journal is “funded to the hilt with drug went even further, stating: “In an shadowy story of AIDS science” [16]. money” [20]. earlier period in human history, these There are serious inconsistencies Deniers argue that because scientists [dissidents] would be heretics that within the broad HIV denial receive grant money, fame, and would be burnt at the stake!” [1]. movement, and the individuals prestige as a result of their research, it HIV deniers accuse scientists of mentioned above are only the tip of is in their best interest to maintain the quashing dissent regarding the cause the iceberg. HIV denial groups diverge status quo [15]. This type of thinking is of AIDS, and not allowing so-called even on the most basic tenet: does HIV convenient for deniers as it allows them “alternative” theories to be heard. exist at all? Nevertheless, disagreements to choose which authorities to believe However, this claim could be applied within the movement are overlooked and which ones to dismiss as part of a to any well-established scientifi c for the sake of presenting a unifi ed grand conspiracy. In addition to being theory that is being challenged by front. selective, their logic is also internally politically motivated pseudoscientifi c inconsistent. For example, they dismiss notions—for example, creationist Conspiracy Theories and Selective studies that support the HIV hypothesis challenges to evolution. Further, Distrust of Scientifi c Authority as being biased by “drug money,” while as HIV denial can plausibly reduce That HIV is the primary cause of they accept uncritically the testimony of compliance with safe sex practices and AIDS is the strongly held consensus HIV deniers who have a heavy fi nancial anti-HIV drugs, potentially costing opinion of the scientifi c community, stake in their alternative treatment lives, this motivates the scientifi c and based upon over two decades of robust modalities. health care communities to exclude research. Deniers must therefore HIV denial from any public forum. (As reject this consensus, either by Portraying Science as Faith and one editorial has bluntly phrased it, denigrating the notion of scientifi c Consensus as Dogma HIV denial is “deadly quackery”) [24]. authority in general, or by arguing Since the ideas proposed by deniers do Because HIV denial is not scientifi cally that the mainstream HIV community not meet rigorous scientifi c standards, legitimate, such exclusion is justifi ed, is intellectually compromised. It is they cannot hope to compete against but it further fuels the deniers’ claims therefore not surprising that much of the mainstream theories. They of oppression. the newer denial literature refl ects a cannot raise the level of their beliefs basic distrust of authority and of the up to the standards of mainstream Expert Opinion and the Promise of institutions of science and medicine. science; therefore they attempt to Forthcoming Scientifi c Acceptance In her book, Christine Maggiore lower the status of the denied science Although the HIV deniers condemn thanks her father Robert, “who taught down to the level of religious faith, scientifi c authority and consensus, they me to question authority and stand characterizing scientifi c consensus have nevertheless worked to assemble up for what’s right” [10]. Similarly, as scientifi c dogma [21]. As one HIV their own lists of scientists and other mathematical modeler Dr. Rebecca denier quoted in Maggiore’s book [10] professionals who support their ideas. Culshaw, another HIV denier, states: remarked, As a result, the deniers claim that “As someone who has been raised by they are just on the cusp of broader “There is classical science, the way parents who taught me from a young acceptance in the scientifi c community it’s supposed to work, and then there’s age never to believe anything just and that they remain an underdog religion. I regained my sanity when because ‘everyone else accepts it to be due to the “established orthodoxy” I realized that AIDS science was a true,’ I can no longer just sit by and do represented by scientists who believe religious discourse. The one thing I nothing, thereby contributing to this that HIV causes AIDS. will go to my grave not understanding craziness” [17]. In an effort to support its claim that is why everyone was so quick to accept Distrusting mainstream medical an increasing number of scientists everything the government said as practitioners, many HIV deniers turn do not believe that HIV causes AIDS, truth. Especially the central myth: the to “alternative” medicine in search Reappraising AIDS has published a list cause of AIDS is known.” of treatment. One such practitioner, of signatories agreeing to the following Dr. Mohammed Al-Bayati, suggests Others suggest that the entire statement: that “toxins” and drug use, rather spectrum of modern medicine is a “It is widely believed by the general than HIV, cause AIDS [18]. Dr Al- religion [22]. public that a retrovirus called HIV Bayati personally profi ts from his HIV Deniers also paint themselves as causes the group [of] diseases called denialism: for $100 per hour, Al-Bayati skeptics working to break down a AIDS. Many biochemical scientists now will consult “on health issues related to misguided and deeply rooted belief. question this hypothesis. We propose

PLoS Medicine | www.plosmedicine.org 1313 August 2007 | Volume 4 | Issue 8 | e256 that a thorough reappraisal of the currently be provided. If the evidence Interestingly, alternative hypotheses existing evidence for and against this is then provided at a later date, simply for AIDS causation depend on where hypothesis be conducted by a suitable change the demand to require even the patient lives. In Africa, HIV deniers independent group. We further propose more evidence, or refuse to accept the attribute AIDS to a combination of that critical epidemiological studies be kind of evidence that is being offered. malnutrition and poor sanitation, i.e., devised and undertaken” [25]. In the 1980s, HIV deniers argued they believe that AIDS is simply a re- These signatories do not, however, that drug therapy for AIDS was labeling of old diseases. In America suggest who the “suitable independent” ineffective, did not signifi cantly and other wealthy countries, they group should be, since, presumably, prolong survival, and in fact was toxic claim AIDS is caused by drug use many scientists have already been and damaged the immune system [28]. and promiscuity. Duesberg has long “indoctrinated” into believing that HIV However, after the introduction of a been an advocate of the idea that the causes AIDS. (Indeed, many of the cocktail of newer and more effective use of “poppers,” or amyl nitrate, is a signatories to this statement lack any agents in the 1990s, survival rates did cause of AIDS in the gay community qualifi cations in virology, epidemiology, impressively increase [29]. HIV deniers [31]. With the identifi cation of AIDS or even basic biology.) They also ignore no longer accept this criterion as in individuals who have never used thousands of epidemiological studies evidence for drug effectiveness, and poppers, this hypothesis has been that have already been published in the therefore the HIV theory of AIDS. Even widened by HIV deniers to implicate a scientifi c literature. And the signatories stacks of papers and books published number of recreational drugs (cocaine, fail to provide a convincing case that on the subject are not enough. crack, heroin, methamphetamines) there is widespread acceptance in the Christine Maggiore writes in her book, as well as prescription drugs such as scientifi c community for their marginal “Since 1984, more than 100,000 papers antibiotics and steroids in the etiology position. have been published on HIV. None of of AIDS. HIV deniers have criticized Nevertheless, Farber wrote in a these papers, singly or collectively, has the idea that immunosuppression 1992 article that “more and more been able to reasonably demonstrate due to infection with HIV could scientists are beginning to question or effectively prove that HIV can cause result in all of the different infections the hypothesis that HIV single- AIDS” [10]. that characterize AIDS, and yet they handedly creates the chaos in the HIV deniers also arbitrarily reject support the idea that poppers or other immune system that leads to AIDS” categories of evidence, even though drugs—including many that have not [26]. Similarly, a March 2006 article they are generally accepted across been shown to cause severe immune appearing on the AIDS denial Web scientifi c disciplines. For example, defi ciencies—could cause AIDS. In site “New AIDS Review” claims that, in they deny inferential evidence that the past decade, the very drugs used to reference to the theory that HIV causes HIV causes AIDS, including data treat HIV/AIDS have come under fi re AIDS: “…the fabric of this theoretical examining the closely related simian by HIV deniers, who have suggested mantle is threadbare to the point immunodefi ciency virus (SIV) in that the medicines themselves of disintegration” [27]. Mainstream genomic and animal studies [30]. are a cause of AIDS (http:⁄⁄www. scientists, of course, do not believe in Likewise they reject correlation as aliveandwell.org/) . the imminent demise of the HIV theory; insuffi cient to establish causation instead they continue to produce novel [28]. However, multiple independent Conclusion research on preventing and treating correlations pointing to the same Because these denialist assertions are HIV and publish thousands of papers causation—in this case that HIV causes made in books and on the Internet every year on the topic. AIDS—is a legitimate and generally rather than in the scientifi c literature, Further, deniers exploit the sense of accepted form of epidemiological many scientists are either unaware fair play present in most scientists, and evidence used to establish causation. of the existence of organized denial also in the general public, especially in The same type of evidence, for groups, or believe they can safely open and democratic societies. Calling example, has been used to establish ignore them as the discredited fringe. for a fair discussion of dissenting views, that smoking causes certain types of And indeed, most of the HIV deniers’ independent analysis of evidence, lung cancer. arguments were answered long ago by and openness to alternatives is likely scientists. However, many members to garner support, regardless of the What Are Their Alternatives? of the general public do not have the context. But it is misleading for the After so much criticism levied upon scientifi c background to critique the HIV denial movement to suggest that the prevailing theories by deniers, one assertions put forth by these groups, there is any real doubt about the cause might think they would have something and not only accept them but continue of AIDS. to offer to replace HIV as the cause to propagate them. A recent editorial of AIDS. However, the alternatives in Nature Medicine [32] stresses the need Pushing Back the Goalpost they offer are much more speculative to counteract AIDS misinformation Of all the characteristics of deniers, than the mainstream theories they spread by the deniers. repeatedly nudging back the decry as lacking evidence. Further, While the descriptions of HIV goalpost—or the threshold of evidence their arguments amount to little denialism above refer to relatively required for acceptance of a theory—is more than another logical fallacy, organized campaigns, there are other often the most telling. The strategy the false dichotomy: they assume that less orchestrated examples of such behind goalpost-moving is simple: overturning the prevailing theory will denialism. A recent study, for example, always demand more evidence than can prove their theory correct, by default. showed that a large percentage of

PLoS Medicine | www.plosmedicine.org 1314 August 2007 | Volume 4 | Issue 8 | e256 African Americans are suspicious Further, countering the virusmyth.net/aids/reappraising. Accessed 14 November 2006. of mainstream AIDS theories due misinformation of HIV deniers needs 8. National Institute of Allergy and Infectious to a general distrust of government to be conducted in the broader societal Diseases (2003) The evidence that HIV causes authorities [33]. Arguments by denial context of countering anti-science AIDS. Available: http:⁄⁄www.niaid.nih.gov/ factsheets/evidhiv.htm. Accessed 17 July 2007. groups may have played a role in the and pseudoscience. The strategies of 9. AIDS Truth (2007) Debunking AIDS denialist formation of their opinion. Indeed, HIV deniers, like many other denialist myths. Available: http:⁄⁄www.aidstruth.org/ the effect of denial groups on public movements, seek to undermine the debunking-denialist-myths.php. 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PLoS Medicine | www.plosmedicine.org 1315 August 2007 | Volume 4 | Issue 8 | e256 29. Holtgrave D (2005) Causes of the decline 31. Duesberg P (1992) AIDS acquired by drug among African Americans? J Acquir Immune in AIDS deaths, United States, 1995–2002: consumption and other noncontagious risk Defi c Syndr 38: 213–218. prevention, treatment or both? Int J STD AIDS factors. Pharmacol Ther 55: 201–277. 34. National Science Board (2004) Science 16: 777–781. 32. [No authors listed] (2006) Denying science. and technology: Public attitudes and 30. Harrison-Chirimuuta R (1997) Is AIDS Nat Med 12: 369. understanding. Available: http:⁄⁄www.nsf. African? Available: http:⁄⁄www.virusmyth.net/ 33. Bogart L, Thorburn S (2005) Are HIV/AIDS gov/statistics/seind04/c7/c7s2.htm. Accessed aids/data/rcdisson.htm. Accessed 17 July 2007. conspiracy beliefs a barrier to HIV prevention 17 July 2007.

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