Denying AIDS and the Rwandan Genocide?
An example of the dishonesty of Valendar Turner
and at least one of Christian Fiala, David Crowe, David Rasnick,
Etienne de Harven, Henry Bauer, Ken Anderlini, Kevin Corbett and
By Nathan Geffen and Jeanne Bergman, Ph.D.
4 June 2006
This article builds upon an issue raised by
Nathan Geffen, Nicoli Nattrass and Glenda Gray in a letter in Nature
(Nature 441, 406, 25 May 2006). In
places we copy directly from that letter without reference. It is
reprinted after this article.
There are so many instances of AIDS denialists
egregiously misrepresenting facts that one can only reach the
conclusion that they are dishonest or incompetent. Incompetence
probably underlies their persistent rejection of scientifically
proven facts and erroneous, obsolete, and thoroughly debunked claims.
But we recently came across an apparently deliberate
misrepresentation of legitimate research findings so deplorably wrong
that it deserves special mention.
We recognize the seriousness of charging with
dishonesty Valender Turner (who, as far as we can ascertain, first
made this misrepresentation) and, for reiterating and signing their
names to his error, at least one of Christian Fiala, David Crowe,
David Rasnick, Etienne de Harven, Henry Bauer, Ken Anderlini, Kevin
Corbett and Martin Maloney. We would comfortably defend our
accusation in a court of law, because it is with high probability a
true statement in the public interest. Some of the denialists, of
course, have already been shown to be dishonest in other respects.
For example, David Rasnick has repeatedly misrepresented a prior
temporary affiliation with the University of California, Berkeley,
despite requests from the University that he desist from doing so.
The deception at hand began with a letter by
Valendar Turner, an active member of “The Perth Group” of HIV
denialists, last year in Nature ("HIV drug remains unproven
without placebo trial" Nature 435, 137; 2005). Turner
wrote that without a placebo-controlled randomized trial,
statements that the efficacy of single-dose nevirapine in reducing
perinatal transmission has not been invalidated are unwarranted. He
contrasted the HIV transmission rate of 13.1% reported in the HIVNET
(which he notes “abandoned its placebo group... under pressure of
complaints that the use of placebo was unethical”) and stated that
the “HIVNET 012 outcome is higher than the 12% transmission rate
reported in a prospective study of 561 African women given no
antiretroviral treatment (J. Ladner, et al. J Acquir. Immun. Def.
Syndr. Hum. Retrovirol. 18, 293-298; 1998).” Turner’s inference
is clear: perinatal HIV transmission was no better, perhaps even
worse, with antiretroviral treatment than without it.
Turner's point was then amplified by a group
writing to defend denialist Celia Farber from searing criticisms by
Gallo et al. (2006)
of her infamous article
in Harper’s Magazine (March 2006). Farber had quoted Turner's
letter and written that he had “unpegged the core claim of NIAID
and its satellite organizations in the AIDS industry regarding
The group of individuals listed above—Fiala,
Crowe, Rasnick, de Harven, Bauer, Anderlini, Corbett and
Maloney–repeated the Turner claims in their effort to defend
Farber. Their document is sloppy and littered with errors and
admissions, but that's beyond the scope of this article. Our concern
here is that they wrote:
referencing an African study published in 1998 that stated that
“Presence of HIV-infection was assessed in 158 children [of
HIV-positive mothers]… Overall, 19 children were diagnosed as
HIV-infected [12%, even though there was no access to antiretroviral
therapy or other interventions]” (Ladner J et al. Chorioamnionitis
and pregnancy outcome in HIV-infected African women. J Acquir Immune
Defic Syndr. 1998 Jul 1; 18(3): 293-8).
(Fiala et al., 2006,
brackets in the original)
If it were true, a finding that only 12% of the
children born to a group of untreated HIV-positive Rwandan women were
themselves infected with HIV would be surprising. Of course, it
would not refute the findings of the HIVNET 012 study, which was a
randomized controlled study and has far greater empirical value than
a retrospective comparison of two cohorts from completely different
studies. Nevertheless, the argument raised by Turner and Fiala et
al. appeared on the face of it to have some, albeit small, merit.
A rebuttal to Turner's letter was published in a
subsequent issue of Nature,
but it did not mention our critical point: the claim made by Turner
and echoed by Fiala et al. that the Ladner et al. study
found a 12% prevalence rate for a cohort of HIV-positive women not
taking antiretrovirals is a gross misrepresentation of what the study
reported. It is true that Ladner et al. found a 12% prevalence rate
in 158 children born to untreated HIV-positive women. But those 158
children were only a fragment of the full cohort born to 275
HIV-positive women. The authors did not and could not examine the
full cohort for the simple reason that many women and children had
been lost to follow-up. Some of these had probably died of AIDS.
Ladner et al. had enrolled 275 HIV-positive women
(and 286 HIV-negative women) in the study between July 1992 and
The women were between 24 and 28 weeks gestation. The researchers
determined the HIV status of 158 of the children of HIV+ mothers
enrolled in the study by antibody testing them at 15 months or by
PCR tests at 3 and 6 months of age. Why only 158 of them?
What Turner and Fiala et al. neglect to point out
is Ladner et al.’s sentence immediately preceding the section
quoted by Fiala et al. above: "Follow-up of the cohort was
interrupted by the events of the Rwandan civil war." (Ladner
et al., op cit., emphasis ours.)
This statement about the disruption of the Rwandan
civil war, one of the greatest human tragedies in recent history, not
only immediately precedes the Ladner et al. quotation used by Fiala
et al.; it is the first sentence of that paragraph! And, lest the
point be missed, Ladner et al. return to the problem later, noting
again that “We do not know the HIV status of the entire sample of
children born to HIV-infected mothers as a result of interrupted
It is immediately clear to anyone with a
rudimentary background in statistics (or just some common sense) that
they’re not comparing apples to apples here. The low 12% figure,
seized upon by Turner, Farber and Fiala et al. to understate the rate
of perinatal HIV transmission by mothers without access to
nevirapine, is an artifact of war, of genocide, and of AIDS itself.
The Ladner et al. study enrolled 275 HIV-positive
pregnant women. 13.1% of these pregnancies ended in still births and
7.5 % of the newborns died, for a total reduction to the cohort of
20.6%--that’s 57 children, leaving 218 available for follow up. Only
158 of these children were tested for HIV, and of these 19 (12%)
were found to be HIV-positive 3, 6 or 15 months later.
What happened to the other 60 missing children?
Fifteen months is long enough for many
HIV-positive children and their mothers to have died of AIDS. In a
study conducted in Uganda between 1994 and 1998, Brahmbhatt et al.
found that 30.9% of the children perinatally infected with HIV died
before their first birthday, and 54% by their second (Brahmbhatt, H.
et al. Mortality in HIV-infected and uninfected children of
HIV-infected and uninfected mothers in rural Uganda. J Acquir Immune
Defic Syndr 2006; 41:504-508).
In Ladner et al.'s study, some of the children
were possibly killed in the war --women and children sick with AIDS
would have been less able to escape to safety. The surviving sample
of the initial cohort was not representative, but rather skewed in
favor of HIV-negative children. The actual figure for perinatal HIV
transmission was almost certainly much higher. (Brahmbhatt et al.
found perinatal HIV transmission rates in Uganda of 20.9%.)
We are by no means criticizing Ladner et al. Their
paper is well worth reading. It is competent and interesting science
conducted in staggeringly difficult circumstances. It was not their
intention to determine vertical HIV transmission rates in the absence
of antiretroviral intervention. Rather, the primary purpose of their
paper was to compare Chorioamnionitis and pregnancy outcomes in
HIV-positive and HIV-negative African women. The 12% statistic was a
detail they included while carefully repudiating its statistical
The failure of Turner and of at least one of Fiala
et al. to acknowledge the interruption of the follow-up of the cohort
is either dishonest or grossly incompetent. On balance of
probabilities it is dishonest. Researchers with the skill and
tenacity to find an incidental HIV transmission rate figure buried in
a not very well known article are unlikely to have missed the
sentence "Follow-up of the cohort was interrupted by the
events of the Rwandan civil war." More than likely, Turner
and at least one of Fiala et al. realised this fact would negate the
point they were making and deliberately left it out. This is
Or perhaps the AIDS denialists also deny the
Rwandan genocide took place?
We accuse Turner and at least one of Fiala et al.
of dishonesty for this misrepresentation. We are prepared to accept
that not all of them intentionally omitted the relevant fact. When
co-authoring an article, one depends on one's co-authors' integrity;
it is seldom possible to check everything the others contribute. So
if Fiala et al. indicate who among them was responsible for this
dishonesty, we will relieve the remaining authors from the accusation
of dishonesty on this particular point. Valendar Turner, however,
has no excuse. He was the sole author of the letter to Nature that
first misrepresented the research. He looked for and found an article
with a figure—12%—that, if he dishonestly concealed the
intervening genocide that prevented follow-up, would allow him to
make his case.
441, 406 (25 May 2006) | doi:10.1038/441406c; Published online
24 May 2006
ignore large gap in the study they cite
and Glenda Gray3
Campaign, 34 Main Road, Muizenberg 7945, South Africa
AIDS and Society Research
Unit, University of Cape Town, Private Bag, Rondebosch 7701, Cape Town,
Perinatal HIV Research
Unit, University of Witwatersrand, PO Box 114, Diepkloof 1864, South
Turner, in Correspondence ("HIV drug remains unproven without
placebo trial" Nature 435,
argues that there is no evidence for antiretrovirals reducing the
transmission of HIV from mother to child. He points out that HIV
transmission in people taking the antiretroviral drug nevirapine was
13.1% in the HIVNET 012 study in Uganda, whereas only 12% of women in
a Rwandan study were found to have transmitted HIV to their babies in
the absence of antiretroviral treatment.
a rebuttal in Correspondence by the authors of the Ugandan study,
Brooks Jackson and Thomas Fleming ("A drug is effective if
better than a harmless control" Nature 434,
Turner's letter continues to be cited by AIDS denialists (for
example, C. Farber Harper's Magazine 37–52; March 2006).
Rwandan study referred to by Turner enrolled 561 pregnant women, of
whom 286 were HIV-positive. Of the children born to HIV-positive
mothers, 158 were tested for HIV and 19 (12%, as Turner states) were
found to be HIV-positive. Why were only 158 children assessed? The
answer, conveniently ignored by the denialists, is that follow-up was
interrupted by the events of the Rwandan civil war (J. Ladner et
al. J. Acquir. Immun. Def. Syndr. Hum. Retrovirol. 18,
293–298; 1998). Given that this interruption was sufficiently
lengthy for many HIV-positive children and their mothers to die of
AIDS in the interim, the surviving sample of the initial cohort
cannot be regarded as representative. The actual figure for HIV
transmission was almost certainly much higher. Failing to acknowledge
this important caveat to the study appears to us to be inconsistent
with accepted academic standards.