AIDS reappraisal

The AIDS reappraisal movement (or AIDS dissident movement) is a
loosely-connected group of scientists, doctors, researchers, journalists,
activists and citizens from around the world who in some way challenge or
question the prevailing scientific consensus that the human immunodeficiency
virus (HIV) is the cause of acquired immune deficiency syndrome (AIDS).

Their challenges take several forms, which can be listed thusly:

   * HIV does not exist
   * HIV does exist, and may or may not cause AIDS, but it hasn't been
     proven to cause AIDS
   * HIV does exist, but does not cause AIDS: other infectious factors cause
     AIDS
   * HIV does exist, but does not cause AIDS: other non-infectious factors
     cause AIDS
   * HIV does exist, but does not cause AIDS: a combination of other
     infectious and non-infectious factors causes AIDS

The claims of dissidents are met with resistance, and even hostility, by
most of the scientific community, who accuse the dissidents of ignoring
evidence in favor of HIV's role in AIDS, and irresponsibly posing a
dangerous threat to public health by their continued activities. Dissidents
assert that the current approach to AIDS based on HIV causation has resulted
in inaccurate diagnoses, psychological terror, toxic treatments, and a
squandering of public funds. The debate and controversy regarding this issue
from the early 1980s to the present has provoked heated emotions and
passions from both sides.

Terminology

One component of the debate centers around semantic issues related to
labeling supporters of various perspectives, or in referring to various
theories and ideas. Ultimately, the disagreement over the cause of AIDS is a
conflict between scientific theories, and the terminology used in that
conflict has no bearing on the evaluation of those theories; nonetheless, a
mention of this semantic disagreement must be made.

For example, some HIV researchers and activists have used the term
"denialist" in referring to those who question HIV's role in AIDS, perhaps
in analogy to Holocaust denial. Some dissenters have reacted by referring to
themselves as "realists", implying that their perspective is more realistic
than the prevailing view. The terms "dissident" or "skeptic" will be used in
this article to refer to those who question HIV's role in AIDS. The
viewpoint of those who support the prevailing view in the scientific
community that HIV causes AIDS will be referred to as the "mainstream" or
"consensus" viewpoint.

Similarly, the two camps are often in conflict over terminology with regard
to the notion that HIV causes AIDS. This notion is variously called the "HIV
hypothesis" or "HIV theory." To dissidents, the notion that HIV causes AIDS
is, and remains, merely a hypothesis. To mainstream scientists, it is an
established fact. In this article, the phrase "HIV theory" will be used.

Arguments by dissidents

Although dissidents disagree amongst themeselves on many aspects concerning
HIV and AIDS, there are several claims that almost all dissidents support,
and these claims form the heart of their arguments. This section describes
some of the arguments that are frequently made by dissidents, along with the
counter-arguments that are made by respondents. The following are summarised
from some major papers of Peter Duesberg and others.

Claim: AIDS is not infectious

Dissidents of the prevailing HIV perspective claim that AIDS has not behaved
like a typical infectious disease. Typically, infectious diseases spread
rapidly, often in an exponential fashion. AIDS has progressed relatively
slowly in comparison with other known infectious diseases; this is taken by
dissidents to be evidence against AIDS being caused by an infectious agent.

Respondents say that the relatively slow spread of AIDS is due to HIV's long
latency period, and to new treatments and prevention campaigns which have
eroded the spread of AIDS. There are many infectious diseases which develop
slowly and spread slowly, such as Jacob-Creutzfeld disease; the consensus
view is that the slow rate of development of AIDS does not imply that it is
not infectious.

Another claim made by dissidents is that HIV does not fulfill Koch's
postulates for infectious disease. In order for HIV to satisfy Koch's
postulates as the cause of AIDS,

   * It must be found in all individuals with AIDS (and not in those without
     AIDS)
   * It must be possible to isolate HIV from someone with AIDS
   * The isolated HIV should cause AIDS when introduced into a healthy
     person
   * It should be possible to isolate HIV from the newly infected individual

Ideally, and within the constraints of ethical experimentation, proof of the
fulfillment of these postulates is considered a sufficient demonstration of
the causality of a disease. According to dissidents, failure to satisfy
these postulates may cast doubt on HIV as the cause of AIDS.

Not all individuals diagnosed with AIDS have detectable amounts of HIV in
their blood. Dissidents claim that Koch's postulates are not adequately
fulfilled, because there are cases in which virus cannot be found or
reisolated. Respondents claim that HIV does fulfill these postulates, and
that the exceptions are due to the imperfect sensitivity of HIV testing, or
because of imperfect isolation techniques, rather than the absence of the
virus.

Dissidents note that in North America and Western Europe, AIDS spreads
non-randomly, affecting specific groups of people, and moreover, that it is
fragmented into distinct subepidemics with exclusive AIDS-defining diseases.
According to dissidents, AIDS in Africa looks completely different than the
corresponding syndrome in North America and Western Europe; one example that
has been cited is that in Africa AIDS affects roughly equal numbers of men
and women, while in North America and Western Europe it affects more men
than women. Another statistic that is sometimes cited is that AIDS is highly
correlated with drug use in Western countries, while it is associated with
malnutrition and poor living conditions in Africa. According to dissidents,
these are indicators of a non-infectious cause of AIDS.

Respondents counter that AIDS spreads within groups because it is
infectious. HIV is said to cause the condition of immune suppresion, which
in turn causes specific diseases, and thus it should come as no surprise
that AIDS manifests itself differently among different groups of people.
They note that there could be many explanations for the discrepancy;
educational campaigns may have had a beneficial effect in Western countries,
while those in Africa have not received such educational benefits. They also
note that promiscuity among heterosexuals is more rampant in Africa, and
Africans are less likely to practice safe sex, thus contributing to the
spread of AIDS. According to the prevailing perspective, none of this
changes the fact that HIV is the underlying cause among all these groups.

Claim: HIV is harmless

In addition to the claims regarding the variations in AIDS definition
between North America, Western Europe, and Africa, another fact cited as
supporting evidence that HIV is harmless is the fact that there are many
people who are HIV-positive and remain healthy 15 or 20 years after testing
positive for HIV. Conversely, there are many HIV-seronegative people who
develop what would otherwise be AIDS-defining diseases.

The long period of HIV infection preceding AIDS manifestations was
discovered by mainstream scientists and is expected by them: according to
the mainstream perspective, HIV can take years to cause the
immunosuppression necessary to permit opportunistic disease to occur. This
long period before the development of severe consequences does not,
according to them, mean that the virus is harmless.

Regarding the individuals who have developed AIDS-defining diseases in the
absence of HIV, mainstream scientists state that such individuals have had
their immune system compromised in other ways, and that this fact has no
bearing on the ability of HIV to cause immunosuppression.

Another statistic cited by skeptics is the level of HIV infection over time.
HIV has remained prevalent at a relatively constant rate in the United
States population the past 20 years, suggesting to dissidents that it has
existed long before the outbreak of AIDS there in the early 1980s.
Mainstream scientists reply that this suggests only that the number of new
infections are approximately equal to the number of deaths; thus, the level
of infection remains consistent.

Claim: AIDS is inconsistently defined

Of substantial concern to AIDS dissidents is the use of HIV antibody or
viral testing as part of the definition of AIDS. Some of the approximately
30 AIDS-defining diseases, including Kaposi's Sarcoma and Pneumocystis
Carinii Pneumonia (PCP), are considered diagnostic of AIDS only when
serologic evidence of HIV is present. In the absence of such evidence, these
diseases are thought to be related to other immune problems, and are not
diagnosed as AIDS. In other words, according to dissidents, the definition
of AIDS is an example of circular logic; because diagnosis with AIDS
requires the presence of HIV antibodies, there can be no AIDS without HIV,
by definition. Moreover, say dissidents, many of the AIDS-defining diseases,
such as cervical cancer, have nothing to do with immune deficiency, and
should not be considered part of the definition of AIDS.

One response to this claim is that there is, and always has been, a strong
correlation between HIV and AIDS, and thus it is perfectly natural for the
presence of HIV antibodies to be a defining characteristic of AIDS.

Dissidents claim there is no consistent definition of AIDS across political
or international boundaries. One example they give is that in Africa, a
laboratory test is not required for a diagnosis of AIDS. This leaves global
AIDS epidemiology without clear standards or norms.

Consensus scientists counter by saying that the inconsistencies among the
various definitions of AIDS do not detract from the fact that HIV causes
AIDS, and that while these inconsistencies represent difficulties in
comparing the prevalence and incidence of the disease—which dissidents
insist cause public money to be misspent—they are unrelated to the
causation of the disease.

Claim: HIV testing is unreliable

Skeptics of the HIV theory of AIDS claim that the process of testing
individuals for the presence of HIV is flawed. One commonly cited example is
the possibility of encountering a false positive, which would falsely
identify someone as HIV positive when in fact they were HIV negative.
Dissidents also claim that the presence of antibodies to HIV should be taken
as an indicator that the HIV within the body are being neutralized by the
body's immune system, rather than as an indicator of active HIV.

Mainstream scientists do not think these problems are prevalent enough to
make an appreciable difference in accurately detecting HIV. With technology
such as the polymerase chain reaction, HIV is detectable in nearly all
symptomatic AIDS patients. According to supporters of the HIV theory,
current HIV antibody tests have sensitivity (ability to give a positive
result when HIV is present) and specificity (ability to give a negative
result when no HIV is present) in excess of 98%. This is an adequate level
of accuracy, according to them. They also point out that testing for actual
viral RNA in the blood is far more sensitive and reliable than testing for
HIV antibodies.

Consensus arguments

Those who defend the HIV theory have many claims to counter the dissidents.
[The following are summarised from the official NIH/NIAID fact sheet and
other publications.]

1. HIV fulfills Koch's postulates in humans and in non-human (e.g.
chimpanzee) models of AIDS. See reference section ( "HIV causes AIDS: Koch's
postulates fulfilled", O'Brien SJ, Goedert JJ.)

     Dissidents assert: HIV has not fulfilled Koch's postulates.

2. HIV and AIDS have a strong correlation with each other. AIDS and HIV
infection are invariably linked in time, place and population group.

     Dissidents counter: Correlation is not the same as causation. There may
     very well be a biological or biochemical reason for the correlation
     between HIV positive test results and the progression of AIDS diseases,
     but this does not prove causation. Each may be the result of another,
     unrelated biochemical cause or factor. Yet for this basic scientific
     fact, recognized by all scientists, to support their position, HIV and
     AID would both have to correlate with their posited "causitive" factor.
     If they believe that poverty causes AIDS, or poppers cause AIDS, or
     drug-use causes AIDS, one would expect correlations between those
     factors and AIDS to be stronger than the correlation between HIV and
     AIDS. In fact, those correlations are weaker. Nor can dissident theory
     explain why treatment of a pregnant woman with antiretroviral
     medication reduces the incidence of AIDS in her children, or explain
     why post-exposure prophylaxis with antiretroviral medication reduced
     the number of people exposed to HIV through needlestick incident who
     develop AIDS. Nor can dissident theory explain why giving
     antiretroviral medication to lactating women who are HIV infected
     reduces the incidence of AIDS in their breast-fed children.

3. In cohort studies, severe immunosuppression and AIDS-defining illnesses
occur almost exclusively in individuals who are HIV-infected.

     Dissidents counter: AIDS-defining illnesses do occur in the absence of
     HIV infection. Consensus scientists reply: because more things than HIV
     cause immunsuppression.

4. Numerous studies of HIV-infected people have shown that high levels of
infectious HIV, viral antigens, and HIV nucleic acids (DNA and RNA) in the
body predict immune system deterioration and an increased risk for
developing AIDS. Conversely, patients with low levels of virus have a much
lower risk of developing AIDS.

     Dissidents counter: Even if this is true, this does not prove
     causation. High levels of infectious HIV and nucleic acids may be
     correlated with increased risk of developing AIDS, but this does not
     establish a causative relationship in the absence of plausible
     biological mechanisms. Yet Consensus theory explains this correllation:
     Dissident theory is unable to explain it.

5. HIV causes the death and dysfunction of CD4+ T lymphocytes in vitro and
in vivo.

     Dissidents counter: This death of cells by HIV in vitro or in vivo has
     never been demonstrated.

6. There is significant correlation between the level of viral production
and viral load and disease prognosis. The onset of AIDS is greatly delayed
in individuals who have low levels of viral replication, while patients with
high amounts of the virus in the blood and lymph nodes have a much worse
prognosis.

     Dissidents counter: Viral load does not have a high correlation with
     onset of AIDS illnesses.
          This is to be expected, as viral load varies markedly during the
          day. Viral load correlates imperfectly with t-cell level, but
          t-cell level correlates well with AIDS illnesses.

7. The availability of potent combinations of drugs that specifically block
HIV replication has dramatically improved the prognosis for HIV-infected
individuals. Such an effect would not be seen if HIV did not have a central
role in causing AIDS.

     Dissidents counter: AIDS drugs are not specific to HIV. Even if AIDS
     drugs were effective against HIV, this is not proof that HIV causes
     AIDS.

8. The HIV theory has been verified repeatedly in thousands of studies.

     Dissidents counter: Although there have been hundreds of thousands of
     studies on HIV and AIDS, no individual paper or group of papers has
     ever established that HIV causes AIDS - to their satisfaction.

9. Although immune deficiency has long existed in humans, the current
epidemic of immune deficiency is a new phenomenon that has only existed
since the onset of the AIDS epidemic.

     Dissidents counter: The current epidemic of immune deficiency IS a new
     phenomenon, but HIV is not a plausible cause. There are many other
     possible causes (e.g. drug use) which temporally fit the onset of the
     AIDS epidemic and have a more plausible biological mechanism.
          Drug use existed long before AIDS, and didn't cause the diseases
          found in AIDS. Dissidents, however, point to a particular class of
          nitrate drugs that became popular just before the initial
          outbreak. They also point out that xenotransplants from monkeys
          were around long before AIDS, so if HIV jumped from monkeys as
          orthodoxy claims, SIV must be a new phenomenon as well.
          Furthermore, dissident theory predicts a cousin of those drugs,
          Viagra, will cause a rash of immunological problems; this will
          make an interesting test of the position.

10. Although many questions remain about the role of HIV in AIDS causation,
there is a virtual unanimous consensus among researchers that HIV is the
primary cause of AIDS.

     Dissidents counter: Consensus is not proof. Science and medicine have
     been completely wrong in the past over specific issues (SMON, malaria,
     etc.) There is no reason to believe such a situation could not repeat itself.

Much of the debate between dissident and establishment concerns the very
conceptualisation of the syndrome itself. Many dissidents contend that the
concept of "AIDS" is itself artificial and a false construct. Mainstream
researchers contend that the AIDS construct is a conceptual response to a
natural phenomenon: the diseases included in the syndrome were selected by
observation, not arbitrarily. The definition of AIDS was a description of a
new syndrome and needed to be refined once the causative organism had been
found. This resulted in the so-called "circular" definition that certain
diseases marked progression to AIDS only in the presence of HIV infection:
it had always been known that these diseases occurred outside the context of
the syndrome. There are clearly great epistemological divides between the
two camps, as has been pointed out by several sociologists of science and
other observers (e.g. Steven Epstein).

A brief history of the dissident movement

The dissident movement is often associated with one individual, Peter
Duesberg, a professor of molecular and cell biology at the University of
California at Berkeley. Duesberg has contributed more than any other
dissident scientist to the debate. However, there were those who questioned
the HIV theory before Duesberg. These include researchers in the NIH itself.
Before 1984, many hypotheses were put forward to explain the new epidemic.
Recreational and pharmaceutical drug abuse, multifactorial environmental
models, infection with multiple STDs, behavioral models, and others were all
posited by government researchers. However, after the announcement of HIV as
the cause of AIDS at a government press conference on 23 April 1984,
publicly funded research became almost exclusively focused on HIV.

One of the first people to publicly question this aim was John Lauritsen, a
former survey researcher and freelance journalist. He began publishing
articles in the New York Native critical of the HIV theory and direction of
research. He also began to develop his own ideas about recreational drug use
as a cause of AIDS. His articles attracted some attention in the gay
community, but remained little known among the general public.

In 1987, Peter Duesberg wrote his first major scientific paper questioning
HIV in the journal Cancer Research; its title was "Retroviruses as
Carcinogens and Pathogens: Expectations and Reality" (
http://duesberg.com/papers/ch1.html ). It attacked not only the virus-AIDS
research program, but also the virus-cancer program. Duesberg's paper caused
an immediate furor. The paper was published at just about the same time that
major public health campaigns were being launched and AZT was being promoted
as a treatment. A major publication, "Confronting AIDS", had been published
in 1986, and this book set out an agenda for the public health sector in
dealing with new epidemic. Many accused Duesberg of jeopardising public
health by raising questions. During the same year, Lauritsen interviewed
Duesberg, and his interview was published in the New York Native.

Over the next several years, Duesberg continued to publish papers
questioning HIV, and other scientists began to publicly voice their doubts.
In 1991, several dozen scientists, researchers, and doctors submitted a
short letter to the editor of several scientific journals. It read:

"It is widely believed by the general public that a retrovirus called HIV
causes the group diseases called AIDS. Many biochemical scientists now
question this hypothesis. We propose that a thorough reappraisal of the
existing evidence for and against this hypothesis be conducted by a suitable
independent group. We further propose that critical epidemiological studies
be devised and undertaken. 6 June 1991"

All the journals refused to publish it. Out of this event, however, the
group of signatories formed "The Group for the Scientific Reappraisal of the
HIV-AIDS Hypothesis". The number of signatories and members of the group has
since grown into the thousands since 1991. They currently maintain a
periodical publication, "Rethinking AIDS". A partial list of the current
signatories can be found at http://www.virusmyth.net/aids/group.htm

In 1990, Lauritsen published "Poison By Prescription: The AZT Story", a book
that was highly critical of the studies demonstrating the efficacy and
safety of AZT in the treatment of AIDS. In 1992, Duesberg published a
lengthy paper promoting his own alternative causation theory of AIDS -- the
"drug-AIDS hypothesis". He claimed that the majority of AIDS cases in North
America and Western Europe were the result of recreational and
pharmaceutical drug abuse. His arguments mirrored many that had been put
forward by Lauritsen earlier. In 1993, Lauritsen published his own
manifesto, "The AIDS War", a collection of his writings on AIDS from 1985 to
1992. Robert Root-Bernstein, an associate professor of physiology at
Michigan State University and former MacArthur prize recipient, professed
his own doubts about the HIV theory in his 1993 book "Rethinking AIDS: The
Tragic Cost of Premature Consensus". In 1994, Neville Hodgikson and the
London Sunday Times published a headline story on the dissidents, which
attracted much media attention itself. A medical doctor, Robert Wilner,
publicly injected himself with HIV on television the same year.

In 1996, a flurry of publications came forward from many dissidents.
Duesberg published his manifesto, "Inventing the AIDS Virus", in which he
put forward his arguments and positions to the general reader. A collection
of scientific papers by dissidents was published by the journal Genetica the
same year ("AIDS: Virus or Drug Induced?"), including articles and papers by
Duesberg, mathematician Mark Craddock, NIDA researcher Harry Haverkos,
Lauritsen, Nobel prize winner Kary Mullis, Yale math professor Serge Lang,
public health professor Gordon Stewart, and journalist Celia Farber. Neville
Hodgkinson wrote his own book detailing his journalistic efforts, entitled
"AIDS: The Failure of Contemporary Science". A major internet website was
launched during this time (currently http://www.virusmyth.net ), and it
immediately became a destination for dissidents around the world to exchange
communication and views. In 1996, the dissident campaign truly gained
international attention.

As dissident scientists continued their questioning, a patient/activist
branch of the movement had also begun to develop. Heal Education AIDS
Liaison (HEAL) was founded in New York in 1982 and it eventually became the
most prominent activist organization in the dissident movement. Other groups
have come into being since then, including Alive and Well. These groups have
openly challenged the HIV theory.

In 1997, Lauritsen and Ian Young co-published a collection of articles on
the psychological aspects of AIDS, entitled "The AIDS Cult: Essays on the
Gay Health Crisis". In this book, they posit a sociopsychological aspect of
the epidemic based on hysteria, fear, and forced conformity. One article
which appears was written by the doctor Casper Schmidt in 1984 in the
Journal of Psychohistory, entitled "The Group-Fantasy Origins of AIDS". In this
essay, Schmidt posits that AIDS is an example of "epidemic hysteria" in which groups
of people are subconsciously acting out social conflicts, and he compares it to
documented cases of epidemic hysteria in the past, which were mistakenly
thought to be infectious. Other essays in the collection condemn the
psychological aspects of AIDS education which equate sex and an HIV
diagnosis with death.

Dissidents continue to campaign and publish. They have protested at recent
World AIDS Conferences and other international meetings. Quite recently,
dissidents attracted their first real endorsement from a major political
figure, Thabo Mbeki, president of South Africa. Mbeki has openly questioned
the HIV theory, and he has invited dissident scientists such as Duesberg and
David Rasnick to South Africa to debate the nature of AIDS with mainstream
scientists. Mbeki has suffered considerable political fallout over these actions.

Quotations

"If there is evidence that HIV causes AIDS, there should be scientific
documents which either singly or collectively demonstrate that fact, at
least with a high probability. There is no such document." -- Kary Mullis,
inventor of PCR, 1993 Nobel Prize in Chemistry (Sunday Times (London) 28 Nov 1993)

"Epidemiology is like a bikini: what is revealed is interesting; what is
concealed is crucial." -- Peter Duesberg (Proceedings of the National
Academy of Sciences, Feb 1991)

"If ever there was a rush to judgment with its predictable disastrous
results, it has been the HIV-AIDS hypothesis and its aftermath." -- Dr.
Richard Strohman, emeritus professor of molecular and cell biology, UC
Berkeley (preface to Inventing the AIDS Virus, 1995)

"It is the rare person who gets up and strips himself of his personal agenda
and articulates what we really do not know, because by saying that, they
would diminish the impact of their own work, which is their agenda." -- Dr.
Anthony Fauci, director of the National Institute of Allergy and Infectious
Diseases (NY Times, 30 Jan 2001)

"If I saw a man get hit by a truck and run over, and you asked, "Did you get
the proof? Did the truck do it?" OK, it comes to something like that.
Silly." -- Robert Gallo (Spin, Feb 1988)

"Last century there was a sharp difference of opinion between those, such as
Koch and Pasteur, who proposed that disease could be caused by invisible
microbes, and others who held that epidemics are the result of evil vapours
(malaria). Arguments that AIDS does not have an infectious basis are as
quaint as those of the miasmalists." -- Weiss and Jaffe (Nature, June 1990)