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The Lancet has hailed the new approach evident in South Africa in which the government has decisively turned away from the AIDS denialism associated with former President Thabo Mbeki. 

The Lancet, Volume 374, Issue 9705, Page 1867, 5 December 2009

HIV/AIDS: a new South Africa takes responsibility

On Dec 1 the usual activities surrounding World AIDS Day will take on a special significance for South Africans. In a high-profile event in Pretoria, the South African National AIDS Council (SANAC) is bringing together people who work in HIV/AIDS, those who have been affected by HIV, and government officials, including President Jacob Zuma, Deputy President and SANAC Chair Kgalema Motlanthe, and the Minister of Health Aaron Motsoaledi. Zuma will give a televised address on HIV/AIDS to the nation. Under the motto “I am responsible, we are responsible, South Africa is taking responsibility”, a new era in the country's response to HIV/AIDS is being publicly heralded. In a key-messages booklet, SANAC calls on everyone to know their HIV status by frequent testing; on communities to stop stigma and discrimination against people living with HIV; and on itself to ensure that the government is taking responsibility for people to receive counselling, provide condoms, and give access to treatment for tuberculosis and HIV.

Already on Oct 29, in what has been widely praised as a landmark speech, Zuma left no doubt about the decisive departure from the previous government's stance of denialism and indifference: “South Africa must work harder to implement the national strategy to tackle HIV/AIDS…all South Africans need to know their HIV status and be informed of the treatment options available to them…there should be no shame, no discriminations, and no recriminations”. The non-governmental organisation Treatment Action Campaign called Zuma's speech, which came almost 10 years after Thabo Mbeki made his HIV/AIDS denial clear before the same National Council of Provinces, as “one of the most important speeches in the history of AIDS in South Africa”.

Rob Sharp reports in The Independent on the presistence of AIDS denialism

A middle-aged man walks into an East London café and apologises for being late. With his clipped hair and bus-driver's uniform of thick overcoat, shirt, and branded tie, he looks like any other public service employee. But soon he delivers a speech of startling ferocity against the medical establishment.

Mike explains that he runs a London-based health website on which he posts articles and links to information that questions whether HIV causes Aids, disputes the existence of HIV, and denies the fact that unprotected sex helps to spread it. He offers support for those who, he says, are "negotiating with medical authorities over taking a different approach to dealing with their circumstances." He claims to get thousands of hits on his site and has helped advise several people who have been diagnosed with HIV and are launching legal action against their local health authorities, in the belief that they have been unfairly treated by the doctors who are trying to help them.

Stephanie Law writes in the McGill Daily:

Christina Maggiore died of an AIDS-related illness on December 27, 2008. She was a successful businesswoman who started a multimillion-dollar import/export clothing company, and a freelance consultant for U.S. government export programs. Maggiore is most notorious for her role as an HIV-positive activist who promoted the idea that HIV is not the real cause of AIDS. She was an HIV-denialist.

Maggiore was diagnosed with HIV in 1992. In 1994, she met Peter Duesberg, a molecular biology professor at the University of California at Berkley. Duesberg convinced Maggiore that HIV does not lead to AIDS. A year later, Maggiore started one of the largest networks of HIV-denialists and skeptics, called Alive & Well AIDS Alternatives.

Maggiore refused antiretroviral treatment for HIV because she did not think HIV would lead to AIDS and AIDS-related illnesses. She did not take the recommended treatment for pregnant HIV-positive women to prevent mother-to-child transmission. Her child died at the age of three from Pneumocystis jirovecii pneumonia. The Los Angeles County coroner and various other independent pathology experts concluded that the death was a direct result of her untreated HIV that had progressed into AIDS.

Talha Burki writes in The Lancet Infectious Diseases:

Strange, perhaps, for The Lancet Infectious Diseases to review House of Numbers. It is a threadbare documentary that claims there is no connection between HIV and AIDS. It arrives at this conclusion through a toxic combination of misrepresentation and sophistry. At best, it is a misguided and misbegotten film; at worst, it is downright malevolent.

All of which makes a fine case for ignoring it. HIV/AIDS denialism is an ideology in disgrace; the ravings of what Stephen Lewis—former UN Special Envoy for AIDS in Africa—describes as a “lunatic fringe”. To debate House of Numbers is to attend the film with an honesty and dignity that is entirely alien to its nature. Far better to leave it mouldering in the clutches of cranks and conspiracy theorists.

The World Health Organization's report Women and health: today's evidence, tomorrow's agenda identifies HIV/AIDS as the leading cause of death among women of reproductive age: "Globally, the leading cause of death among women of reproductive age is HIV/ AIDS. Girls and women are particularly vulnerable to HIV infection due to a combination of biological factors and gender-based inequalities, particularly in cultures that limit women’s knowledge about HIV and their ability to protect themselves and negotiate safer sex."

Here is an extract from the report:

This section is copied without footnotes or graphs. To download the full report, see below.

Women and HIV/AIDS

Globally, HIV is the leading cause of death and disease in women of reproductive age. Of the 30.8 million adults living with HIV in 2007,a 15.5 million were women. The prevalence of HIV infection in women has increased since the early 1990s and is most marked in sub-Saharan Africa.

Total number of people living with HIV/AIDS in 2007 was 33 million, including two million children younger than 15 years.

Southern Africa is most affected; in 2005–2006, median HIV prevalence among pregnant women attending antenatal care was above 15% in eight Southern African countries. Infection was acquired primarily through heterosexual transmission.

South Africa's Mail & Guardian newspaper reports:

"In 11 years -- from 1997 to 2008 -- the rate of death has doubled in South Africa. That is obviously something that cannot but worry a person," Health Minister Aaron Motsoaledi told reporters at Parliament in Cape Town.

He said that in 1997 the total number of deaths stood about 300 000. Last year the figure was 756 000.

Motsoaledi said the figures called for a "massive change in behaviour and attitude" toward Aids among South Africans.

"On the figures, it's shocking. As to whether it has been affected by what we did in the past 10 years, to me that's obvious," he said, according to the South African Press Association.

Read the full article.

The Treatment Action Campaign's statement on the South African president's unequivocal repudiation of AIDS denialism in a speech to the upper house of the country's parliament:

Yesterday, President Jacob Zuma made one of the most important speeches in the history of AIDS in South Africa. In front of the National Council of Provinces (NCOP), he unequivocally acknowledged the devastation of AIDS on our country. With this speech state-supported AIDS denialism has been banished. The Treatment Action Campaign welcomes the ushering in of this new era, almost exactly ten years since former President Mbeki made a speech that began the era of state-supported denial in front of the NCOP.

Joe Sonnabend writes in his POZ blog:

House of Numbers is the title of a documentary film which according to its promotional material will "rock the foundations on which all conventional wisdom on HIV/AIDS is based"

I have seen the film. It is completely unable to achieve this grandiose objective. It is in fact an AIDS denialist film, despite the contention to the contrary by Brent Leung who made it.

The denialists are a disparate group who remarkably continue to believe that HIV cannot be the causative agent of AIDS either because it is harmless or because it does not exist. There are even those who believe that AIDS itself does not exist as a distinct disease entity. Of course there is no shortage of people with strange views that fly in the face of solid evidence. We can mostly just ignore them. But sometimes these views can be dangerous, and then we really do have to confront and challenge fallacious assertions that can lead to harm.

AIDSTruth contributor Nicoli Nattrass and Seth Kalichmann, author of Denying AIDS were among the scientists and activists who participated in Harvard University's symposium on AIDS Denial. The Harvard Gazette reports:

People who deny that the HIV virus causes AIDS continue to persist in their beliefs despite overwhelming scientific evidence to the contrary, nurtured by the broad reach of the Internet and cherry-picked scientific claims, AIDS authorities said Monday (Oct. 19).

Researchers from Harvard, elsewhere in the United States, and South Africa convened at the Carpenter Center for the Visual Arts to decry HIV “denialism,” saying that the continued questioning of HIV’s role in AIDS harms those infected with the virus by discouraging both testing and treatment.

According to the speakers, denialism takes two major forms. Some skeptics deny that HIV plays a role in AIDS, or that it even exists, while others believe in AIDS conspiracies, acknowledging that HIV causes AIDS but questioning HIV’s origins, saying it results from a government conspiracy, is intended as a genocide campaign against blacks, that it was created in CIA labs, or is of other sinister origin or purpose.

The Spectator's editor, who has in the past questioned climate change, has now started "Questioning the AIDS consensus", inspired by the denialist film House of Numbers.

Update: Now Neville Hodgkinson writes in The Spectator "on a new film that challenges the tenets of the Aids religion and exposes the dangerous confusion at the heart of the industry".

New Statesman's Mehdi Hassan writes:

I have blogged before on the new Spectator editor Fraser Nelson's crude denialism of climate change and his failure to engage with the peer-reviewed scientific literature. I see he has now turned his attention to questioning the link between HIV and Aids, in his Coffee House blog post "Questioning the Aids consensus". Here is how he puts it:

Ben Goldacre writes in The Guardian:

A lot of strange stuff can fly in under the claim that you are "simply starting a debate". You may remember the Aids denialist documentary House of Numbers from three weeks ago. Since then, it has received many glowing outings. The London Raindance film festival explained that they were proud to show it, and a senior programmer appeared on YouTube saying they had gone through the film at 15-second intervals, finding no inaccuracies at all.

This is pretty good for a film which suggests that HIV doesn't cause Aids, but antiretroviral drugs, or poverty, or drug use do, or HIV probably doesn't exist, diagnostic tools don't work, and Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems, and the treatments don't work either.

Jennifer Steinhauer writes in the New York Times:

People who do not believe in vaccinating children have never had much sway over Leslie Wygant Arndt. She has studied the vaccine debate, she said, and came out in favor of having her 10-month-old daughter inoculated against childhood diseases. But there is something different about the vaccine for the H1N1 flu, she said.

“I have looked at the people who are against it, and I find myself taking their side,” said Ms. Wygant Arndt, who lives in Portland, Ore. “But then again I go back and forth on this every day. It’s an emotional topic.”

Anti-vaccinators, as they are often referred to by scientists and doctors, have toiled for years on the margins of medicine. But an assemblage of factors around the swine flu vaccine — including confusion over how it was made, widespread speculation about whether it might be more dangerous than the virus itself, and complaints among some health care workers in New York about a requirement that they be vaccinated — is giving the anti-vaccine movement a fresh airing, according to health experts.

Seth Kalichman's Denying AIDS is reviewed by Talha Burki in the latest issue of The Lancet Infectious Diseases.

Denying AIDS

Talha Burki

The Lancet Infectious Diseases. Volume 9, Issue 10, October 2009, Page 600

Seth Kalichman, Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy, Copernicus Books (2009) ISBN 978-0-387-79475-4 Pp 205. £13.99..

Ben Goldacre writes in his Bad Science column for The Guardian:

This week, listening to the Guardian science podcast, I had a treat. Caspar Melville, editor of New Humanist magazine, leader of something called the Rationalist Association, had been to see two films at the Cambridge film festival. One was a dreary creationist movie that famously misrepresented the biologists interviewed for it. This was obvious bad science, he explained. But the other was different: House of Numbers, a new film about Aids, really had something in it.

I have now seen this film. It presents itself as a naive journey by one young film-maker to discover the science behind HIV. In reality, it's a dreary and pernicious piece of Aids denialist propaganda.

All the usual ideas are there. It's antiretroviral drugs themselves that are the cause of symptoms called Aids. Or it's poverty. Or it's drug use. HIV doesn't cause Aids. Diagnostic tools don't work, Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems – and the drugs don't work either.

It would take two months of columns to address all the bogus claims of this film, and that blizzard, perhaps, is the point of making it, with all the classic rhetorical devices that have been honed by Aids denialists and creationists over decades. It engages, for example, in repeated overstatement of marginal internal disagreements about the details of HIV research, to the extent that 18 doctors and scientists interviewed for the film have issued a statement saying that the director was "deceptive" in his interactions with them, that it perpetuates pseudoscience and myths, and that they were selectively quoted to make it seem as if they are in disagreement and disarray, when in fact they agree on all the important facts.

Read the full article at The Guardian.

The last holdover of the Mbeki/Tshabalala-Msimang era of state-supported AIDS denialism in South Africa, Director-General of Health Thami Mseleku, has been dismissed.

Health-e reports:

Mseleku axed

18.09.2009 Anso Thom

text Health department Director General Thami Mseleku, a destructive leftover from former health minister Dr Manto Tshabalala-Msimang’s reign, will leave the end of the month, with the Western Cape’s Director-General for Health Professor Craig Househam set to step in.

Unconfirmed reports of Mseleku’s departure and Househam’s appointment have been doing the rounds for several days and have been confirmed by several sources, some within the national health department.

Fidel Hadebe, spokesperson for health minister Dr Aaron Motsoaledi, has declined to comment while Househam denied, via his spokesperson Faiza Steyn, that he had been approached.

Dr Francois Venter, president of the Southern African HIV Clincians Society said he had also heard the rumours that Mseleku was on his way out.

Failure to disclose conflicts of interest, substandard peer review and the involvement of some scientists in pharma profiteering weakens the public's trust in legitimate science and creates an environment in which denialism and pseudoscience flourish. We welcome the policy changes that some journals are implementing.

The New York Times reports:

The scientific integrity of medical research has been clouded in recent years by articles that were drafted by drug company-sponsored ghostwriters and then passed off as the work of independent academic authors.

Yet the leading medical journals have continued to rely largely on an honor system of disclosure to detect such potential bias, asking authors to voluntarily report any industry ties or contributors to their manuscripts.

But now, in light of recently released evidence that some drug makers have gone to great lengths to turn scientific articles into marketing vehicles for their products, some influential medical editors are cracking down on industry-financed ghostwriting. And they are getting help from some members of Congress.

There can be few greater embarrassments for scientists than for a publisher to retract their papers forcibly. This is exactly what has happened to two AIDS denialist articles, one of them co-authored by Peter Duesberg and David Rasnick. Here is what happened.

In 2008, the Journal of AIDS (JAIDS) published an article by Pride Chigwedere [1] and colleagues of Harvard University, who estimated that delays in providing antiretroviral drugs in South Africa due to state-supported AIDS denialism had caused over 300,000 deaths. This publication confirmed the results of a previous study by South African professor and aidstruth.org member Nicoli Nattrass. [2] AIDS denialist Peter Duesberg, whose influence on the disastrous South African government policies was mentioned in Chigwedere’s article, submitted a response to JAIDS that was co-authored by four others including Rasnick. After this article was rejected because of its poor academic quality, Duesberg et al. submitted it to a different journal, Medical Hypotheses. Two days later, the editor accepted the paper. Medical Hypotheses does not practice peer review, a process in which several scientists check a submitted academic paper for quality and suggest needed improvements over a period of weeks or months. The Duesberg et al. paper was accepted without such a review process, after inspection only by the editor of Medical Hypotheses.

That Duesberg’s paper was not properly reviewed by experts is painfully obvious, as neither facts nor logic are allowed to temper the authors’ denialist speculations and opinions. For example, they argue that AIDS is not a problem in Africa because the total population of Africa has increased during the AIDS era. One could as easily conclude that cancers are never fatal, since the population of California has increased despite the presence of these diseases. Duesberg et al. also say antiretroviral medicines have not reduced AIDS mortality, an obvious lie since these drugs have drastically lowered mortality. Worse, Duesberg et al. say they derived this idea from a scientific article. [3] In fact, the article they cite states nothing of the sort; it actually shows that a newer combination of antiretroviral drugs is not substantially better than an older combination. Of course, both these combinations are better than Duesberg’s favored treatment option – nothing. Doing nothing in the face of HIV infection is, however, very often a death sentence, as it was to over 300,000 South Africans. [1,2]

From the New York Times:

Couched as a “personal journey” through the history of H.I.V. and AIDS, “House of Numbers” is actually a weaselly support pamphlet for AIDS denialists. Trafficking in irresponsible inferences and unsupported conclusions, the filmmaker Brent Leung offers himself as suave docent through a globe-trotting pseudo-investigation that should raise the hackles of anyone with even a glancing knowledge of the basic rules of reasoning.

Assembled from interview fragments with doctors, scientists, journalists and others, the film cobbles together an insinuating argument against the existence of H.I.V. as a virus and AIDS as the resulting disease. Among the many inflammatory claims is that diagnosis is a pharmaceutical-industry ruse to sell complex drug therapies (which the film then presents as the real cause of the syndrome we identify as AIDS). Evidence to support this and other highly dangerous contentions is found not in verifiable statistics (house of numbers, my foot) but in the impassioned anecdotes of individuals who have outlived the expectations of an H.I.V.-positive diagnosis.

Read the full review.

The New York Times writes in an editorial titled Hope in South Africa:

For years, South Africa was an international laughing stock for its tragically absurd approach to the deadly AIDS epidemic. Now, that nationalnightmare may be ending.

The new government of President Jacob Zuma seems to have a clearer-eyed view of the problem, its remedies and the need to improve the overall health care system than its predecessor did. Fixing what’s broken will not be easy, but we are encouraged by signs of a commitment to do so.

To see how far South African leaders have come, one needs to recall where the country was.

The former president, Thabo Mbeki, compiled a record that is still hard to fathom: he embraced crackpot theories that disputed the demonstrable fact that AIDS was transmitted by a treatable virus. He insisted that antiretroviral drugs were toxic and encouraged useless herbal folk remedies instead. He even claimed he knew nobody with the disease, although nearly 20 percent of the adult population is said to be living with H.I.V.

Jonny Steinberg writes in New Scientist:

ON 27 December 2008, a well-heeled 52-year-old woman died in a Los Angeles hospital. Her death certificate describes a body riddled with opportunistic infections typical of the late stages of AIDS. Christine Maggiore had tested HIV positive 16 years earlier, but she had shunned ART, the antiretroviral therapy that stops HIV replicating and prevents AIDS.

This was not the first time a death in Maggiore's family had made headlines: five years earlier her 3-year-old daughter Eliza Jane had died. The autopsy described a chronically ill little girl who was underweight, under-height, and had encephalitis and pneumonia - all AIDS-related. When pregnant, Maggiore had again rejected ART and she had breastfed Eliza Jane, another way of transmitting the virus.

Why, in 21st-century California, would a middle-class woman and her young daughter die like this when there is tried-and-tested treatment for their illness? The answer lies in a bizarre medical conspiracy theory that says AIDS is not caused by HIV infection (see Five myths about HIV and AIDS).