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Deadly Quackery


"Until recently, AIDS researchers and activists in the United States tended to regard the denialists with derision, assuming they would fade away. Unfortunately, this has not happened. Harper's Magazine recently published an article by Celia Farber promoting the denialist view. There is a real risk that a new generation of Americans could be persuaded that H.I.V. either doesn't exist or is harmless, that safe sex isn't important and that they don't need to protect their children from this deadly virus. A resurgence of denialism in the United States would have far reaching effects on the global AIDS pandemic, just as it already has in South Africa..." see full NYT Op-Ed


Contents:

New York Times
Op-Ed Contributor
Deadly Quackery
By JOHN MOORE and NICOLI NATTRASS
Published: June 4, 2006

H.I.V. causes AIDS. This is not a controversial claim but an established fact, based on more than 20 years of solid science. It is as certain as the descent of humans from apes and the falling of dropped objects to the ground.

So why reiterate the obvious? Because lately, a bizarre theory has gained ground - one that claims that H.I.V. is harmless, and that the antiretroviral drugs that curb the growth of the virus cause rather than treat AIDS. Such talk sounds to most of us like quackery, but the theory has emerged as a genuine menace to public health in the United States and, particularly, in South Africa.

The theory, which we call AIDS denialism, has gained such currency with President Thabo Mbeki of South Africa that his administration is reluctant to expand access to antiretroviral drugs. Despite generous allocations from the country's Treasury and substantial assistance from foreign donors, only a quarter of those needing antiretrovirals receive them. This response is poor by the standards of middle-income countries, but it is especially troublesome in South Africa, which has more H.I.V.-positive people than any other country.

American AIDS denialists are partly to blame for South Africa's backsliding AIDS policy. Manto Tshabalala-Msimang, the health minister, has described antiretrovirals as poisons. She is supported in these views by Roberto Giraldo, a New York hospital technologist who says AIDS is caused by deficiencies in the diet, and who served on President Mbeki's AIDS advisory panel in 2000. The minister promotes nutritional alternatives like lemons, garlic and olive oil to treat H.I.V. infection. Several prominent South Africans have died of AIDS after opting to change their diets instead of taking antiretrovirals.

Another American AIDS denialist, David Rasnick, a regular letter-writer to South African newspapers, absurdly claims that H.I.V. cannot be transmitted between heterosexuals. Mr. Rasnick now works in South Africa for a multinational vitamin company, the Rath Foundation, conducting clinical trials in which AIDS patients are encouraged to take multivitamins instead of antiretrovirals.

In the past, South Africa's Medicines Control Council acted swiftly to curb such abuses, and the Medical Research Council condemned AIDS denialism. But recent high-level political appointments of administration supporters to both bodies have neutered their influence. In South Africa, AIDS denialism now underpins a lucrative nutritional supplements industry that has the tacit, and sometimes active, support of the Mbeki administration.

By courting the AIDS denialists, President Mbeki has increased their stature in the United States. He lent credibility to Christine Maggiore, a Californian who campaigns against using antiretrovirals to prevent transmission of H.I.V. from mothers to children, when he was photographed meeting her. Two years later, Ms. Maggiore gave birth to an H.I.V.-infected daughter, Eliza Jane, who acquired an AIDS-related infection last year and died at age 3.

Mother-to-child H.I.V. transmission is now rare in the United States, thanks to the widespread use of preventive therapy and the activities of organizations like the National Institutes of Health and the Elizabeth Glaser Pediatric AIDS Foundation. Sadly, this is not so in South Africa, where many children are born infected and then face short, painful lives. The health and lives of American children are also still under threat: a small clique of AIDS denialists is trying to block the provision of antiretrovirals to H.I.V.-infected children in the New York City foster care system.

Until recently, AIDS researchers and activists in the United States tended to regard the denialists with derision, assuming they would fade away. Unfortunately, this has not happened. Harper's Magazine recently published an article by Celia Farber promoting the denialist view. There is a real risk that a new generation of Americans could be persuaded that H.I.V. either doesn't exist or is harmless, that safe sex isn't important and that they don't need to protect their children from this deadly virus. A resurgence of denialism in the United States would have far reaching effects on the global AIDS pandemic, just as it already has in South Africa.

The AIDS denialists use pseudoscience and non-peer-reviewed Internet postings to bolster their false claims about H.I.V. The real facts about this virus have been uncovered by scientists supported by the National Institutes of Health, the British and South African Medical Research Councils, the Pasteur Institute and many other national research organizations. The public should seek AIDS truth from the latter sources.

It is sad when selling magazines and vitamin supplements is considered more important than promoting public health and scientific truth. The truth is that H.I.V. does exist, that it causes AIDS and that antiretroviral drugs can prevent H.I.V. transmission and death from AIDS. To deny these facts is not just wrong - it's deadly.

John Moore is a professor of microbiology and immunology at Cornell University. Nicoli Nattrass is the director of the AIDS and Society Research Unit at the University of Cape Town.



South Africa and AIDS

To the Editor:

Re "Deadly Quackery," by John Moore and Nicoli Nattrass (Op-Ed, June 4):

The South African government's comprehensive H.I.V. and AIDS program has three principal objectives. One, prevent the transmission of H.I.V. Two, when transmission occurs, delay for as long as possible the onset of AIDS-defining illness. Three, care for patients whose infections have progressed to AIDS-defining illness.

Once an H.I.V.-positive person has a CD4 cell count of 200 per cubic millimeter of blood or exhibits Stage 4 AIDS-defining illness as defined by the World Health Organization, he or she is eligible for antiretroviral treatment at public expense. By the end of March, at least 134,473 people were receiving free treatment at 231 facilities around the country. Government has allocated more than $500 million to procure antiretroviral drugs through the end of 2007.

A recent report by Health Systems Trust, an independent group that monitors the health care delivery in South Africa, found that our progress in delivering antiretroviral treatment "has probably been swifter than in any comparable country."

How symptomatic is this of leadership in denial about AIDS, its causation or the efficacy of antiretroviral treatment?

Barbara Masekela
Ambassador of South Africa
Washington, June 6, 2006



In her reply to our New York Times article ‘Deadly Quackery’, the South African Ambassador presented South Africa’s conventional HIV/AIDS prevention and treatment interventions as evidence that South African AIDS policy was not based on denialism. We welcome this statement. But while the general design of South African AIDS policy is indeed based on conventional science, the actions of South Africa’s Health Minister undermine this. She has described antiretrovirals as poison and routinely proclaims the benefits of alternative and untested nutritional interventions. Indeed, she did just this, yet again, a few days after the ambassador's letter was published. This, we believe, is the main legacy of President Mbeki’s AIDS denialism. The South African ambassador also claimed that the recent rollout of highly active antiretroviral therapy HAART) was fast by international standards. Unfortunately, the truth is that South Africa’s HAART coverage remains comparatively poor, and while the numbers of people on treatment have indeed grown rapidly in recent years, this has been strongly underpinned by support from the Global Fund and PEPFAR. South Africa’s Health Minister remains a major obstacle to the rollout. If she had actually implemented the Cabinet’s 2003 Operational Plan (for which funding had been allocated by the Treasury), then at least a quarter of a million more people would be on HAART today. For more details, see: Rolling Out HAART in South Africa.

John Moore is a professor of microbiology and immunology at Cornell University. Nicoli Nattrass is the director of the AIDS and Society Research Unit at the University of Cape Town.


 
 
 

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