An insidious phenomenon that reared its destructive head early in the AIDS saga was what came to be known as HIV denialism: the belief, contradicted by overwhelming and conclusive medical evidence, that HIV does not cause AIDS.
I first became aware of this terrible issue in 1987 when Dr. Peter Duesberg began openly questioning whether HIV was the cause of the disease AIDS. Conspiracy theories regarding HIV had abounded ever since French investigators discovered HIV in 1983 and Bob Gallo proved that it was the cause of AIDS in 1984. Among the far-fetched and inflammatory theories put forth was that the CIA had created the virus to eliminate the gay population of the country and the world. But the fact that Peter Duesberg was a staunch denialist was most problematic. A German American molecular biologist, he was at the time a professor of molecular and cell biology at the University of California at Berkeley and a member of the prestigious National Academy of Sciences. This high honor, bestowed upon a scientist by one’s peers, by definition means that he was considered a highly respected and accomplished scientist.
Peter Duesberg shocked the scientific community with his new claims. Denying that HIV caused AIDS became his passion, and he soon devoted much of his time to promoting the idea. At the time, members of the academy could publish their papers in the academy’s journal, the Proceedings of the National Academy of Sciences, without going through peer review, and it was much to the chagrin of the editors of the journal and despite the outrage of most of the scientific community that Duesberg used this privilege as an academy member to publish his “theory.” In this 1991 paper the abstract states, “It is concluded that American AIDS is not infectious, and suggested that unidentified, mostly noninfectious pathogens cause AIDS.”
Soon others with scientific credentials joined the denialism bandwagon, and even Dr. Kary Mullis, who won the Nobel Prize in Chemistry in 1993 for development of the polymerase chain reaction, a transforming tool in molecular biology, showed solidarity with the denialists. It was inconceivable to me and all of my colleagues who worked daily in the arena of HIV and AIDS that people such as these, many with substantial scientific backgrounds, could deny the overwhelming evidence proving that HIV was the cause of AIDS. At first, I just ignored them since their ideas were so preposterous and fell apart on close scrutiny; however, denialism started to gain the attention of the media, and soon I and some of my scientific colleagues were left with no choice but to debate this topic with these deniers, usually Peter Duesberg. My comment in one such debate quoted in a Washington Post article on April 10, 1988, summarized the baselessness of the denialist argument that lifestyle alone and not HIV leads to AIDS. “ ‘What kind of risk behavior does the infant born of an infected mother have?’ asked Anthony S. Fauci, the coordinator of AIDS research for the National Institutes of Health. ‘And what about the 50-year-old woman who received a blood transfusion from an infected donor? The data overwhelmingly suggest that HIV is the cause of AIDS.’ ”
But no matter how many times we refuted it, the denialism movement would not go away. On several occasions, most concentrated in 1993 through 1995, I was drawn into discussions and debates with denialists, some on national television and often to the confusion of TV viewers. On the one hand, Peter Duesberg, who was a member of the prestigious National Academy of Sciences, was saying that HIV did not cause AIDS and was a harmless virus. On the other hand, Dr. Tony Fauci, also a member of the National Academy of Sciences, was saying that HIV was the unequivocal cause of AIDS. Inadvertently, the press, by attempting to report on this in an unbiased manner, was giving these senseless claims false equivalency with the established scientific facts. But the claims of each side were not equivalent. One side was overwhelmingly incorrect and the argument never should have taken place. And every time we debated the denialists, we gave them public exposure, which only compounded the problem.
Finally, I became fed up and asked a member of my staff, Greg Folkers, who was well versed in the medical literature related to HIV and AIDS, to put together a scientifically based point-by-point proof of HIV causality of AIDS and thus provide a formal refutation of the denialists’ spurious claims. We published the resulting “Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome” in hard copy and online in 1995. After that, whenever I was asked to engage in this debate, I referred the party in question to our publication. I thought that we were finally finished with this nonsense; sadly, I was wrong.
Although the furor over HIV denialism died down in the United States, a more insidious situation soon arose across the Atlantic Ocean. For reasons that are difficult to explain, Thabo Mbeki, the president of South Africa, became enamored of Duesberg’s denialist claims. In addition, his minister of health, Dr. Manto Tshabalala-Msimang, was even more of a denialist. She rejected the idea of treating people with AIDS with antiretroviral drugs, believing instead that AIDS should be treated with natural products such as garlic, beetroot, lemon juice, and olive oil. She even went on to say that the antiretroviral drugs exacerbated the disease. This led to a public health disaster. Mbeki and Tshabalala-Msimang refused to provide universal access to AIDS drugs for the people of South Africa, a country that had more people with HIV than any other country in the world. There were more than four million people with HIV in South Africa in the year 2000.
At the Thirteenth International AIDS Conference held in Durban, South Africa, that year, President Mbeki addressed the conference and expressed his view to the thousands of scientists and activists in the audience that HIV was not the cause of AIDS. Hundreds of delegates walked out during his speech. It was clear to virtually everyone outside the small denialist group that Mbeki’s behavior was aberrant, prompting a group of scientists and activists to develop the Durban Declaration, signed by more than five thousand individuals, declaring that HIV was unquestionably the cause of AIDS. Nonetheless, Mbeki and Tshabalala-Msimang were unrelenting.
The activist community of South Africa was enraged at the South African government’s dereliction of responsibility and mounted massive demonstrations under the leadership of the South African film director and activist Abdurrazack “Zackie” Achmat and the Treatment Action Campaign that he cofounded. They demanded universal access to antiretroviral drugs. In fact, Zackie, who publicly announced his HIV status in 1998, became world famous because of his refusal to take antiretroviral drugs until they were made available to everyone who needed them in South Africa. It was the drug equivalent of a hunger strike for a noble cause. He kept his pledge for five years until 2003, when the South African cabinet overruled Mbeki’s objections to provide such access. Zackie came to visit me in my office at the NIH on November 7, 2003, shortly after he began taking antiretroviral drugs, to thank me for leading NIAID’s efforts in the development and testing of the drugs that were now saving his life and the lives of so many of his countrymen.
The tragedy is that a number of studies have estimated that between the years 2000 and 2005 more than 330,000 deaths and an estimated 35,000 infant HIV infections occurred in South Africa due to the government’s failure to make the drugs available. And so what started out in 1987 as a completely unfounded movement instigated by a small group of misguided scientists turned out to be responsible for the avoidable deaths of hundreds of thousands of people.